W

ound debridement refers to the removal of necrotic tissue from the wound bed and is essential in the care and management of healable chronic wounds. Debridement also removes other contaminants from the wound surface including foreign debris, leftover dressing material, and single or complex networks of bacteria (e.g., biofilm) all of which can stall the normal wound healing trajectory. Wound cleansing is but one example of wound debridement, as the purpose of cleansing a wound is to eliminate necrotic tissue and the above mentioned contaminants from the surface of the wound bed. Therefore, wound cleansing by either swabbing the wound with saline soaked gauze or via irrigation with normal saline can be classified as mechanical debridement.

Regardless of debridement being such a critical component of wound management, knowledge and practice gaps continue to exist across the continuum of care and within all health disciplines despite the recent publication of Debridement: Canadian Best Practice Recommendations for Nurses (NSWOC, 2021). Although written for nurses by nurses, these best practice recommendations can apply to, and can be implemented by, all health professionals in any health sector (e.g., acute care, long-term care, homecare) and should be supported by all system levels to optimize wound related outcomes and drive down complication rate and overall health system costs.

Key Findings Of The Best Practice Recommendations

The extensive scoping review conducted by the document’s task force resulted in the development of twelve national recommendations that were then approved by a panel of key opinion leaders via Delphi technique. The final document was then reviewed by a total of 38 peer reviewers from across all health disciplines as the care and management of wounds is best delivered by an interprofessional team approach. Overall, 89 per cent of reviewers stated they would recommend this document to their colleagues both at the bedside and at administrative levels (Rajhathy, Chaplain, Hill, Woo & Parslow, 2021).

The recommendations focus on six key methods of debridement and place patient and health professional safety as top priorities. Three recommendations focus on the health system, four focus on the health professional, and five focus directly on patient care. The recommendations intensely focus on requirements for initiating and performing competent debridement and in fact, led to the association of Nurses Specialized in Wound, Ostomy and Continence (NSWOC) developing a post graduate practice enrichment series education program dedicated entirely to the topic of advanced wound debridement (Figure 2). The planning of care for any wound must begin with a comprehensive patient and wound assessment by a health professional with advanced education and training in the field of wound healing (Rajhathy, Parslow & Hill., 2021). One key factor identified from the scoping review was the important element of the health professional completing an additional education program specific to debridement.

The course is competency based and adheres to a standard of practice. It is online and currently available to health professionals across Canada and from any health sector. It offers six weeks of paced, interactive modules, a rolling start time, access to course mentor with extensive experience in wound debridement methods, and a final examination. The flexibility in the start time, and online platform, make it optional for the working health professional. Although this program provides the theoretical requirements identified in the extensive scoping review, health professionals still require a practicum with a qualified health professional to become competent in advanced wound debridement. Hands-on debridement workshops are available to begin skills training during the NSWOC conference each year (Wound, Ostomy and Continence Institute, 2022).

Practice Implications

Moist wound healing first took hold in the 1960’s when research showed wounds healed best with optimal moist conditions (Junker, Kamel, Caterson & Eriksson 2013). Moist wound healing is autolytic debridement; defined as the body’s natural process for healing. This means any health professional involved in the application of a moisture donating or retentive dressing (e.g., silicone bordered foam or impregnated petrolatum dressings) is engaging in the controlled/restricted act of debridement. Without advanced education and training in chronic wound management and further education and training in debridement specifically, health professionals should not initiate dressing protocols that may facilitate debridement, as they may unintentionally place the patient at risk for potential harm. With additional risk in wound located on the lower limb and foot, this can lead to serious complications including infection, limb loss, and even death. Organizations lacking appropriate policies and procedures, or advanced directives, for debridement increase the risk of negative patient outcomes related to wound management and place their organization at risk of litigation.

Summary

Health professionals and organizations that provide professional services for the care and management of patients with chronic wounds need to ensure evidence-based policy and procedures are available to guide practice to ensure all risks associated with unintentional patient harm are mitigated. This can be achieved by ensuring debridement is well defined and health professionals are working within their scope of practice and have the necessary requirements to obtain the knowledge, skill, and judgement to initiate or perform debridement competently.