Introduction

Disruption of biofilm in the wound bed has been a concept that medical professionals have considered for centuries. Even before we understood the underlying concepts of microbiology, cleaning and wound debridement have been included in wound care.¹

However, wound hygiene as a concept has only recently become more widespread. In March 2020, the term wound hygiene was coined in the consensus document published by the Journal of Wound Care.² This document provided detailed guidance on wound hygiene techniques, such as cleansing, debridement, and wound dressing. Most importantly, though, this consensus document established the concept of wound hygiene as a practice, which has since become an accepted part of wound care.²

Although wound hygiene is a relatively new concept in wound care, it is quickly gaining traction. However, there are still challenges associated with wound hygiene that need to be addressed, including clinician confidence, the desire for additional research, and competency.² To address these barriers, one must consider the methods for guiding a wound hygiene protocol, the successes of wound hygiene, and the current and future related challenges.

From TIME To TIMERS: Developing A Practice Framework

There are many different factors that can impact a wound’s ability to heal, such as patient engagement, delivery of care, and cost, for instance. One such framework, initially called TIME, can help address these principles and provide guidance in the wound healing process.³ This protocol is now referred to as TIMERS, which stands for³:

• T: tissue viability
• I: infection/inflammation
• M: moisture balance
• E: wound edge
• R: repair/regeneration
• S: social and patient-related factors

When assessing a hard-to-heal wound, TIMERS can help health care professionals evaluate wound hygiene needs, develop wound management plans, and focus wound cleaning and wound dressing techniques on areas that patients may specifically need for wound hygiene interventions.³

Wound hygiene protocols have historically focused on wound cleansing and wound debridement with antiseptics and wound dressings, but this framework has been updated to consider the repair and regeneration of tissue as well as the social factors that may affect healing.³ Using a protocol, such as TIMERS, will allow wound care professionals better ability to develop wound management plans to ensure wound hygiene is applied effectively and efficiently.

Current Successes & Challenges of Wound Hygiene

Since its introduction, several studies have investigated wound hygiene for its effectiveness at wound healing and infection prevention.^4,5 The evidence so far has been largely positive, as wound hygiene has been found to reduce wound colonization, influence wound pathology, and promote faster healing.⁴ Despite these successes to wound hygiene, challenges remain in implementing wound hygiene protocols into facility standards of care. Some of these challenges include the following ^4,5:

• Ease of access to wound hygiene products (eg, cleansers and dressings).
• Availability of training to staff for wound hygiene protocols.
• A lack of adoption by clinicians due to perceived complexity.

To ensure that wound hygiene remains an effective tool for wound healing, it's essential for collaboration between manufacturers, clinicians, and patients to develop ways to overcome these challenges.

Looking Toward the Future

Many potential developments could take place in the future with respect to wound hygiene. For example, innovations could take place in cleaning solutions, and dressings could be developed that are even more effective at preventing infection. Additionally, new methods of wound management could be explored to enhance wound hygiene. Ultimately, the goal is to reduce the incidence of wound infections and improve outcomes for patients.

Wound hygiene is essential to the healing process and preventing infection. There are various debridement and wound hygiene practices that are currently used, but more research is needed to determine the long term effectiveness of these practices and how to improve outcomes continually. Possible developments that could be implemented in the future include:

• More targeted and specific debridement methods to remove damaged tissue while leaving healthy tissue intact.
• Improved wound dressings that can promote healing and prevent infection.
• Enhanced communication strategies between health care professionals and patients to increase the effectiveness of wound hygiene strategies.
• More training and awareness of wound hygiene and related protocols may allow a wider variety and volume of wound care professionals to become confident in this practice.

What’s Next For Wound Hygiene?

As new products develop to facilitate these processes, clinicians must remain aware of their effectiveness and safety. Infection prevention is an ongoing conversation throughout the health care continuum, and those practicing wound hygiene must keep up with changes to the health care landscape to remain effective. The future of wound hygiene will depend on health care providers adapting to changing wound care trends and using evidence-based practices when treating their patients. As more people become aware of the importance of wound hygiene and confident in the practice thereof, hard-to-heal wounds will have more options for treatment and prevention.

References

1. Helling T, McNabney W. The role of amputation in the management of battlefield casualties: a history of two millennia. J Trauma. 2000;49:930.
2. Murphy C, Atkin L, Swanson T, et al. Defying hard-to-heal wounds with an early antibiofilm intervention strategy: wound hygiene. J Wound Care. 2020;29(Sup3b). doi:10.12968/jowc.2020.29.sup3b.s1
3. Atkin L, Bućko Z, Montero EC, et al. Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care. 2019;23(Sup3a):S1-S50. doi:10.12968/jowc.2019.28.sup3a.s1
4. Murphy C, Atkin L, Hurlow J, Swanson T, de Ceniga MV. Wound hygiene survey: awareness, implementation, barriers and outcomes. J Wound Care. 2021;30(7):582-590. doi:10.12968/jowc.2021.30.7.582
5. Wound Hygiene Survey: Awareness, Implementation, Barriers and Outcomes. J Wound Care. 2021;30(7):582-590.

The views and opinions expressed in this vlog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.