Chapter 5: Wound Care and Infection Control

Wound management and infection prevention are foundational nursing competencies. Ineffective practice leads to delayed healing, hospital-acquired infections (HAIs), and increased patient morbidity. Every nurse must master aseptic technique and evidence-based wound care principles.

Phases of Wound Healing

Wound healing occurs in four overlapping phases:

Phase	Timing	Key Events
Hemostasis	Minutes–hours	Vasoconstriction, platelet aggregation, clot formation
Inflammation	Days 1–4	Increased blood flow, WBC migration, phagocytosis of debris
Proliferation	Days 5–21	Fibroblast activity, collagen synthesis, granulation tissue, epithelialization
Remodeling (Maturation)	Weeks–2 years	Collagen reorganization, scar formation, tensile strength increases to ~80%

Factors that impair healing: poor nutrition (especially protein, vitamin C, zinc), diabetes, peripheral vascular disease, infection, steroids, advanced age, obesity.

Wound Assessment

Assess wounds using the TIME framework:

• Tissue (viable vs. necrotic — slough or eschar)
• Infection/Inflammation (erythema, warmth, purulent exudate, odor)
• Moisture balance (too dry slows epithelialization; too wet causes maceration)
• Edge of wound (advancing vs. undermining/tunneling)

Dressing Selection

Wound Type	Appropriate Dressing
Clean, granulating	Transparent film, foam, hydrocolloid
Dry/necrotic (eschar)	Hydrogel (moisture donation)
Highly exudative	Alginate or foam
Infected	Antimicrobial (silver-impregnated, iodine)
Deep/tunneling	Packing: alginate rope, NPWT (vacuum-assisted closure)

Infection Control: Standard Precautions

Standard Precautions apply to all patients at all times and include:

• Hand hygiene: soap/water for visible contamination or C. difficile; alcohol-based hand rub for routine care
• PPE: gloves for contact with blood/body fluids; gown, mask, eye protection as indicated
• Safe sharps handling: never recap needles by hand; use safety devices; dispose in sharps containers

Transmission-Based Precautions

Type	Pathogen Examples	PPE Required	Room
Contact	MRSA, C. diff, VRE	Gloves + gown	Private or cohorting
Droplet	Influenza, meningitis	Surgical mask	Private preferred
Airborne	TB, measles, varicella	N95 respirator	Negative pressure room

Surgical vs. Medical Asepsis

Medical asepsis (clean technique): reduces the number and transfer of microorganisms. Used for routine care — hand hygiene, changing bed linens, urinary catheter care.

Surgical asepsis (sterile technique): eliminates ALL microorganisms from an area. Required for invasive procedures — IV insertion, urinary catheterization, wound irrigation with sterile saline, surgical procedures.

Key Checklist

• Describe the four phases of wound healing and identify two factors that can delay each phase
• Select the appropriate dressing for a heavily exudative wound and a dry necrotic wound, with rationale
• Distinguish between contact, droplet, and airborne precautions, including PPE requirements and room specifications