Journal of Community Nursing

JCN

Supplement 2016

DEBRIDEMENT

some wounds, others may need

intervention. Establishing a

good dermal bed is crucial to

wound healing.

Identifying and removing any

factors that will prevent or slow the

healing process such as damaged

and dead tissue, debris, and bacteria

is an important goal and will help

to minimise infection risk and

encourage healthy granulation

tissue to form, thereby aiding

healing.

The acronym TIME is a useful

tool that can be used to determine

objectives and plan appropriate

care. A summary of the four main

components is (Dowsett and

Newton, 2005):

issue management

Control of

nfection

and inflammation

oisture balance

Advancement of the epithelial

dge of the wound.

There are a number of

debridement techniques available

from surgical to physical/

mechanical methods (Foot in

Diabetes UK [FDUK] expert

working group, 2014), and

clinicians should be aware of

the options available.

It is not necessary for all

community nurses to be able to

perform all types of debridement,

however, they should have

sufficient understanding to

recognise which treatment is the

most appropriate for the individual

person and their wound (Vowden

and Vowden, 2011).

WOUND ASSESSMENT

The decision whether to debride a

patient’s wound must be based on a

comprehensive wound assessment

performed by a competent and

trained practitioner (Ousey and

Cook, 2012). The assessment must

be fully documented. Effective

debridement of the wound allows

the clinician to make a detailed

assessment of the wound bed and

surrounding area.

Traditional practice

The treatment of leg ulcers has

traditionally involved debridement

and cleansing with a bucket wash

or similar, often incorporating a

bath oil or emollient. This allows

the gentle removal of hyperkeratosis

and can be soothing for many

patients. However, some patients

such as those with diabetes-

associated neuropathy for example

may experience increased pain and

thus refuse this cleansing regimen.

This practice is also physically

demanding for the clinician or

healthcare assistant as each

bucket of water is likely to contain

approximately four litres of water

(weighing 4kg) and is therefore

heavy to carry from the tap to the

patient and back again. The whole

process of filling and moving

buckets of water is time-consuming

and physically demanding, in some

cases leading to musculoskeletal

issues for clinicians who have to

repeat the task regularly.

CLEANSING AND DEBRIDING

WITH A PRE-MOISTENED

CLOTH

UCS

™

(medi UK) is a premoistened

debridement device — the fluid

used to premoisten the cloth

helps to soften unwanted tissue in

preparation for gentle and effective

removal by the UCS cloth.

UCS is a class IIb medical device

and is therefore safe for use in

deep wounds where there may be

exposed tissue and bone etc. UCS

was approved for registration on

the Drug Tariff in England, Scotland

and Wales in May 2014.

Figure 1.

UCS softness and durability.

Excellent

Good

Excellent

Good

Figure 2.

UCS ease of use.

KEY POINTS

In the community setting, leg

ulcer management involves both

care of the wound itself and the

skin of the lower limb.

Cleansing is vital to enure that

infection does not develop in

the wound itself and that the

integrity of the periwound skin

is maintained.

Maintaining the skin’s

barrier function is also vital,

as, without this, fluid loss,

inflammation, dryness and

infection can develop.

Wound exudate can also act

as an irritant to healthy skin,

particularly when permitted

to accumulate under

wound dressings.

Keeping the skin clean and

free of debris, alongside more

frequent dressing changes

can help in the treatment of

irritated skin.

This article highlights the use

of an innovative cleansing

product (UCS; medi UK), which

is designed as a pre-moistened

cloth that safely and efficiently

cleanses the wound of slough

and debris, while rehydrating

periwound skin.