Removing Necrosis From A Wound Bed Using Debridement

Wound debridement is a fundamental concept in the wound bed preparation model. Both the removal of necrosis from a wound bed and the process of debridement are crucial to infection prevention and wound healing. As research uncovers the role of biofilm in relation to the chronic inflammatory state and stalled wound healing, the discussion of debridement has resurfaced in the wound care community.

Conservative sharp wound debridement (CSWD) can be done in many settings, including the patient’s home, ambulatory clinics, or in the acute care setting.¹ Many health care professionals can perform CSWD, provided that it is within the professional’s scope of practice. Factors such as infection control, pain management, control of bleeding, and differentiation among tissue types are crucial when debridement is performed. Poor technique can result in lacerations, infections, and possible amputation, and studies have shown that formalized training can result in fewer complications.² Some studies have shown that while increased formal CSWD training can improve patient outcomes, challenges exist when supervising clinicians are not well-versed in wound care or CSWD.³ One study utilized management algorithms and nurses to perform CSWD in diabetic foot ulcerations and displayed no complications to CSWD as well as cost savings when CSWD was performed by nurses.⁴

While it is advantageous that many clinicians can perform CSWD, there is no standardized training for this important skill, and the performance metrics remain unclear. There are a variety of courses to learn CSWD; however, the onus of developing this skill remains with the individual clinician or clinical overseers and organizations.¹ Many clinicians are self-taught CWSD on the job, without formal training or competency evaluation.

Students and wound care clinicians should be taught and evaluated using a range of methods, and attention must be paid to CSWD training. One emerging modality in medical education is simulation, where skills can be practiced in real-life settings without risk of patient harm.⁵ Social media, podcasts, videos, and other online resources provide educational content and technologies.⁶ The use of these modalities allows for efficient learning, often with built-in virtual reality and simulation scenarios.

Wound care clinicians recognize the importance of debridement, especially with emerging science on biofilm and its contribution to stalled wound closure. Employing standardized methods to teach CSWD stands to benefit patients and practices. The use of creative techniques such as simulation, virtual reality, and use of other technological resources to further CSWD effectiveness serves to further the field of wound care.

Reference

1. Coutts HP, Raizman R, Grady N. Sharp wound debridement: patient selection and perspectives. Chronic Wound Care Management and Research. 2018;5:29–­36. doi:10.2147/CWCMR.S146747
2. Grollo A, Morphet A, Shields N. Simulation improves podiatry student skills and confidence in conservative sharp debridement on feet: a pilot randomized controlled trial. J Am Podiatr Med Assoc. 2018;108(6):466–471. doi:10.7547/16-121
3. White-Chu EF, Le T, Cordrey R. Implementing a chronic wound care workshop for internal medicine residents. Adv Skin Wound Care. 2019;32(2):85–87. doi:10.1097/01.ASW.0000549609.21974.6f
4. Schumer RA, Guetschow BL, Ripoli MV, Phisitkul P, Gardner SE, Femino JE. Preliminary experience with conservative sharp wound debridement by nurses in the outpatient management of diabetic foot ulcers: safety, efficacy, and economic analysis. Iowa Orthop J. 2020;40(1):43–47.
5. Weeks KW, Coben D, O'Neill D, et al. Developing and integrating nursing competence through authentic technology-enhanced clinical simulation education: pedagogies for reconceptualising the theory-practice gap. Nurse Educ Pract. 2019;37:29–38. doi:10.1016/j.nepr.2019.04.010
6. Evans CH, Schenarts KD. Evolving educational techniques in surgical training. Surg Clin North Am. 2016;96(1):71–88. doi:10.1016/j.suc.2015.09.005