Complex Wound Care

Skin is the body's largest organ and its first barrier against infection. This lesson explains the layers of the skin and how a wound heals in general terms. Key points: skin has an outer layer called the epidermis, a deeper layer called the dermis and a fatty layer beneath; healing moves through stages of stopping bleeding, inflammation, rebuilding tissue and strengthening; healing needs good blood flow, nutrition, a clean moist wound environment and relief from pressure; and anything that interrupts these can slow or stop healing.

Most small cuts and grazes heal quickly with simple care. A complex wound is one that is slow to heal, is large or deep, has a high risk of infection, or needs specialised assessment and treatment. This lesson describes common types of complex wounds and the factors that slow healing. Key points: common complex wounds include pressure injuries, leg ulcers, diabetic foot ulcers, surgical wounds that break down, burns and serious skin tears; healing is slowed by poor circulation, diabetes, poor nutrition, smoking, infection, immobility, incontinence and some medicines; and many of these factors are common among the people we support.

Complex wound management is one of the high intensity daily personal activities in the NDIS Practice Standards, and the NDIS Commission's High Intensity Support Skills Descriptors describe, in general terms, the knowledge and skills workers need. This lesson explains how this applies to you. Key points: this course builds knowledge only; wounds are assessed and a wound care plan is written by a registered nurse, doctor or other qualified health practitioner; you must be trained and assessed as competent for each participant; you follow the plan exactly, including the dressing products and frequency; and you never change a dressing type yourself.

A pressure injury is damage to the skin and the tissue beneath it, usually over a bony area, caused by pressure or pressure combined with shear. This lesson explains how pressure injuries develop and who is most at risk. Key points: sustained pressure squeezes blood vessels and starves tissue of oxygen; shear happens when skin stays still while the body slides; friction and moisture make skin more fragile; common sites include the sacrum and tailbone, heels, hips, elbows, shoulder blades, back of the head and ears; and medical devices can also cause pressure injuries.

Pressure injuries are classified by how deep the damage goes, using an international staging system. Staging is done by a qualified health practitioner, but knowing the stages helps you recognise and describe what you see. Key points: stage 1 is intact skin with redness that does not fade when pressed; stage 2 is partial thickness skin loss, which may look like a shallow wound or blister; stage 3 is full thickness skin loss with fat visible; stage 4 exposes muscle, tendon or bone; an unstageable injury is covered by dead tissue; and a deep tissue injury is a deep red, maroon or purple area.

Regular skin checks catch pressure injuries early, when they are easiest to treat. This lesson explains how and when to check skin, and how to check darker skin tones. Key points: check skin as often as the plan directs, often during personal care and every repositioning; look closely at bony areas and under devices; press gently on red areas to see whether the colour fades; in darker skin, look for colour change and feel for warmth, coolness, firmness or swelling; ask the person about pain or tingling; always protect privacy and dignity; and record and report what you find.

Relieving pressure is the most important way to prevent pressure injuries. This lesson covers repositioning and moving people safely. Key points: reposition the person as often as the plan directs, whether in bed or in a chair; encourage and support people who can move themselves to do so; use slide sheets and other equipment to move people without dragging; avoid positioning directly on bony areas or on an existing injury; keep heels free of pressure where the plan says; and record each repositioning.

Skin that is kept clean and dry, and a body that is well nourished and hydrated, are much less likely to break down. This lesson covers moisture management, nutrition and hydration. Key points: check and change continence aids promptly; clean skin gently with pH balanced products and pat dry; use barrier products only as the plan directs; manage sweat and moisture in skin folds; support meals and drinks that provide enough protein, energy and fluid as the plan and dietitian advise; and report weight loss, poor appetite or reduced drinking.

Pressure care equipment redistributes pressure, but only works when it is used and maintained correctly. Medical devices can also cause pressure injuries. This lesson covers both. Key points: use pressure redistributing mattresses, cushions and heel protectors exactly as the plan directs; check equipment is working, correctly set up and not bottoming out; respond to air mattress alarms; avoid extra layers under the person that reduce the effect of the equipment; check skin under devices such as splints, tubes, masks and catheters; and report faulty equipment straight away.

When a participant has a complex wound, the wound care plan sets out exactly how it is cleaned and dressed. This lesson covers the principles of supporting dressings in general terms. Key points: only do dressings you are trained and signed off for; follow the plan for the products, method and frequency; clean your hands and use the technique you were trained in to avoid contaminating the wound; check the dressing is intact and not leaking between changes; do not lift a dressing to look unless the plan says; and record each dressing and what you observed.

Wound infection is a serious complication that can spread to the blood and become life threatening. This lesson covers the signs of infection and deterioration and when to seek urgent help. Key points: report increasing pain, spreading redness, heat, swelling, pus, a bad smell or a wound getting larger; report fever or the person feeling generally unwell; people with diabetes or low immunity may show fewer signs; signs of sepsis such as confusion, fast breathing, very high or low temperature, mottled skin or feeling extremely unwell need a triple zero call; and when in doubt, seek medical advice.

Accurate records show whether a wound is healing and help the health team act early. This lesson covers what to record, how to report, and how pressure injuries fit into incident management. Key points: record skin checks, repositioning, dressings and observations as the plan requires; describe wounds factually, including location, size compared with a known object, colour, fluid and odour; only take photographs if our policy and the person's consent allow; report every new pressure injury or deterioration through our incident management system; and some pressure injuries may need to be notified to the NDIS Commission.