Wound care at home: clean hands, the dressing, and the signs to call about

Many people come home with a wound that still needs care: an incision that hasn’t closed, a pressure injury from time in bed, a sore on a foot. Most heal with clean hands, the right dressing and someone watching for trouble. Medicare counts wound care for a pressure sore or a surgical wound as skilled nursing it covers at home for people who qualify for home health.¹ This note covers the routine, the signs of infection, how to prevent pressure injuries and what the nurse does.

The short answer

• Clean your hands before and after touching the wound or the dressing, every time.²
• Call the same day for more redness, pain, swelling or bleeding, drainage that’s thick, discolored or bad-smelling, a wound that looks bigger, deeper, dry or dark, or a temperature of 100.5°F or higher.²
• Most surgical wound infections show up within the first 30 days after surgery.³
• To prevent pressure injuries, change position in bed every 1 to 2 hours and check the skin from head to toe every day.⁴
• With diabetes, check the feet every evening, and call about a sore that isn’t starting to heal after a few days.⁵

The routine at home

The surgeon or the nurse sets the plan for each wound: how often to change the dressing, what to clean it with and what goes on it. Follow that plan. It’s written for that wound. For the dressing change itself, MedlinePlus describes these basics:²

• Take off jewelry and wash your hands with soap for 15 to 30 seconds, under the nails too, then rinse and dry with a clean towel. An alcohol-based hand cleanser works too.
• Put on clean gloves.
• Loosen the tape gently. If the dressing sticks, wet it first, unless the provider said to pull it off dry.
• Clean the skin with saline or mild soapy water. Don’t use alcohol, peroxide, iodine or antibacterial soap.
• Seal the old dressing in a bag, double-bag it before it goes in the trash, and never reuse a dressing.
• Clean your hands again when you’re done.

Keep the supplies and the written instructions together in one clean, dry place, and write down each change: the date, what the wound looked like and anything new.

The signs of infection

Most surgical wound infections show up within the first 30 days after surgery.³ Call the surgeon or the home health nurse the same day if:^2,3

• There’s more redness, pain, swelling or bleeding at the wound
• The wound looks bigger, deeper, dry or dark
• Drainage turns thick, discolored or bad-smelling, which can mean pus
• The skin around the wound feels hot
• The temperature is 100.5°F (38°C) or higher, or there are chills

For a fever with new confusion or trouble breathing, call 911.

Preventing pressure injuries

A pressure injury, also called a bedsore or pressure ulcer, forms when weight presses on the same spot of skin for too long. People who spend most of the day in bed or in a chair are most at risk. MedlinePlus advises:⁴

• In bed, change position every 1 to 2 hours, to keep the pressure off any one spot.
• In a wheelchair, shift weight every 15 to 20 minutes: lean forward, then left, then right.
• Check the skin every day from head to toe, especially the heels, hips, tailbone and elbows.
• Clean and dry the skin right after the person urinates or has a bowel movement. Skip strong soaps and talc powder, and don’t bathe every day, which dries the skin.
• Eat enough calories and protein, and drink plenty of water.
• Use a foam or gel cushion in the wheelchair and a foam, gel or air mattress in bed. Avoid donut-shaped cushions.

Diabetes and the feet

Diabetes can damage the nerves in the feet, so a person may not feel a pebble in a sock or a blister, and poor blood flow can make a sore or an infection hard to heal.⁵ The National Institute of Diabetes and Digestive and Kidney Diseases suggests checking the feet each evening, when the shoes come off, for cuts, sores, red spots, swelling, blisters, ingrown toenails and warm spots.⁵

Get care right away for a cut, blister or bruise on the foot that doesn’t start to heal after a few days, or skin on the foot that turns red, warm or painful.⁵ Diabetes at home covers the rest of the daily routine.

What home health adds

For people who qualify for home health, Medicare covers wound care for a pressure sore or a surgical wound as skilled nursing, along with the medical supplies for use at home that the plan calls for.^1,6 The nurse looks at the wound at each visit, changes the dressing or teaches the family to, watches for infection, and calls the doctor when the wound isn’t healing the way it should.

If the person spends most of the day in bed or a chair, ask the nurse or a therapist to look at the mattress, the cushion and how the person is turned or moved, so the next injury doesn’t start.