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What are the best practices for treating a patient with multiple wounds?

I commonly get questions about the order of caring for multiple wounds. In general, you want to start with the “cleanest” wound.

You should wash hands, prepare the patient’s positioning, assure comfort and appropriate draping, create a “clean” field for the first dressing change and have an infection control (“red”) bag for discarded items. 

New dressings should be opened onto an impervious clean surface; many buildings use a sheet of waxed paper or aluminum foil to hold the dressings and other materials needed for the dressing change. You should try to have all necessary materials on hand before starting so that the wound can be cared for and covered to preserve the warmth of the wound bed. If you discover that the wound has an unexpected change, you can add products to the clean field as needed. 

You should wash hands and don clean gloves in order to remove and discard the old dressing. Then you should remove those gloves, wash hands and don a fresh pair of gloves to clean and inspect the wound and take measurements. Some wound nurses wash hands and don another pair of gloves at this point in order to place the new treatments and dressing. 

The date and initials of the nurse should be added to a piece of adhesive and placed on the dressing. Never write on a dressing that is already placed on a patient, as this is a dignity issue.

After changing the first dressing, move on to the next “cleanest” wound and finish with the “dirtiest” wound, meaning the one closest to the perirectal or sacral area. After finishing dressing changes for each of the wounds, remove any discarded materials and place them in an infection control bag and dispose in the designated area in your building.

Mary P. Evans, M.D., CMD, CWSP, Certified Medical Director and Certified Wound Specialist Physician