Page 18 - Wound Care at End of Life Content: A Guide for Hospice Professionals - DEMO

Best practice for wound care includes implementing the following:
1. Identify the cause and factors that may interfere with healing and address patient‐centered concerns.
2. Differentiate the wound’s ability to heal: classify as healable, maintenance, or non‐healable wound.
3. Focus on use of topical antiseptics for non‐healable or maintenance wounds. Active debridement is
generally not appropriate.
4. Determine level of bacterial burden (superficially and/or infection in the deep wound bed).
5. Use topical treatment for superficial increased bacterial burden (NERDS). Monitor response to
treatment.
6. Use systemic agents for deep infection (STONES). Monitor response to treatment.
7. Reassess the wound at 1 week, 2 weeks, and 4 weeks for signs of improvement. Wound healing is not
always the primary goal in hospice. Consider the patient’s need for reduced pain, odor, dressing change
frequency, and management of exudate.
8. Do not use topical or systemic antibacterial agents longer than 14 days without weighing the benefits
and risks of their use.
9. Empower patients through education about wound bed preparation, treatment plans, and
prevention. Develop the plan of care in collaboration with the patient. Clinician awareness of individual
socioeconomic, cultural, and psychosocial factors for each patient is essential.

Antimicrobial Classifications: Comparison of Antibiotic, Antifungal, and Antiseptic Activity

•Pharmacologic agents that
destroy or inhibit bacteria. May be
broad or narrow in spectrum of
activity. Used systemically and
Antibiotics topically.
®
•Ex: Mupirocin (Bactroban ),
®
cephalexin (Keflex ),
®
metronidazole (Flagyl )

•Pharmacologic agents that inhibit
the growth of fungal infections.
May be broad or narrow in
Antimicrobials Antifungals spectrum of activity. Used
systemically and topically.
®
•Ex: Nystatin (Nystop ),
®
clotrimazole (Lotrimin ),
®
miconazole (Micatin )

•Chemical agents that prevent,
inhibit, or destroy microorganisms
including bacteria, viruses, fungi,
and protozoa. Topical use only.
Antiseptics
•Ex: Sodium hypochlorite
®
(Dakin’s ), chlorhexidine
®
gluconate (Hibiclens ), povidone‐
®
iodine (Betadine )

14