Best practice recommendations for preparing the wound bed: update 2006.

This article updates the concept of Preparing the wound bed by considering the whole patient (treatment of the cause and patientcentred concerns) before treating the wound. Local wound care consists of tissue debridement, control of persistent inflammation or infection, and moisture balance before considering advanced therapies for wounds that are not healing at the expected rate. The best practice recommendations are based on scientific evidence and expert opinion, and should include patient preference. They are intended for translation into practice. This update of the Preparing the wound bed approach has the benefit of connecting the recommendations to the evidence as identified through the Registered Nurses’ Association of Ontario’s (RNAO) Nursing Best Practice Guidelines. To date, the RNAO has published three guidelines related to the treatment of wounds (pressure, venous and diabetic), and the components related to local wound care are included in this review. BY R. Gary Sibbald, MD, FRCPC; Heather L. Orsted, RN, BN, ET, MSc; Patricia M. Coutts, RN; and David H. Keast, MSc, MD, FCFP Introduction he concept of Preparing the wound bed was first described in 2000 by Sibbald et al. and Falanga. This approach to wound management stresses that successful diagnosis and treatment of patients with chronic wounds require holistic care and a team approach. The whole patient must be considered before looking at the wound itself. Figure 1 illustrates that wound bed preparation is the promotion of wound closure through diagnosis and appropriate treatment of the cause, attention to patient-centred concerns, and correction of the systemic and local factors that may be delaying healing. The Canadian Association of Wound Care (CAWC) best practice articles are not comprehensive but are meant to provide a practical, easy-to-follow guide or bedside enabler for patient care. The recommendations are based on the best available evidence and are intended to support the wound-care clinician and team in planning and delivering the best clinical practice. For more detailed information, refer to the following RNAO Nursing Best Practice Guidelines or the designated references. 15 Volume 4, Number 1, 2 0 0 6 Wound Care Canada C L I N I C A L P R A C T I C E Local factors can be represented by DIME (Debridement, Infection or Inflammation, Moisture balance and Edge of wound). A template is presented as a basis for the discussion of the evidence base and expert opinion corresponding to each step in the paradigm of preparing the wound bed (See Figure 1). Preparing the Wound Bed Paradigm FIGURE 1 Inflammation or Infection Control Edge of the Wound Active therapies • Biological agents (acellular and cellular) • Skin grafting • Adjunctive therapies Moisture Balance Debridement Local Wound Care Person with a Chronic Wound Treat the Cause • Address causes and co-factors affecting healing Patient-centred Concerns • Adherence to plan of care • Quality of life • Caregiver/family Adapted from Sibbald RG, Orsted HL, Schultz GS, et al. T