Wound Care
Wound Care at Home and the Signs of Infection to Watch For
Most wounds heal well at home when three things happen consistently. The dressing is changed the way the doctor ordered, pressure is kept off the area, and someone looks closely at the wound every day. The fourth piece is knowing which changes mean "call the nurse today." Foul odor, pus, spreading redness, warmth, swelling and fever are the main signs of infection (MedlinePlus).
This guide covers the wounds home health nurses see most often, pressure injuries, diabetic foot ulcers and surgical incisions, and what families can safely do between visits.
Key Takeaways - More than 2.5 million people in the United States develop pressure ulcers each year (AHRQ). - Call the nurse the same day for foul odor, pus, spreading redness, warmth, swelling or fever. - Repositioning about every 2 hours in bed relieves pressure on bony areas (MedlinePlus). - People with diabetes should check their feet every day, including between the toes. - Call 911 for heavy bleeding, confusion, a very high fever with chills, or skin that turns dark and is spreading quickly.
The Wounds We See Most at Home
Pressure injuries
A pressure injury (also called a pressure ulcer, pressure sore or bedsore) is damage to skin and the tissue underneath caused by steady pressure, usually over a bony spot such as the tailbone, hips or heels. AHRQ reports that more than 2.5 million people in the United States develop pressure ulcers every year (AHRQ).
Pressure injuries are staged by depth. Stage 1 is intact skin that stays red when pressed. Stage 2 is a shallow open sore or blister. Stages 3 and 4 go deeper, into fat, muscle or bone. MedlinePlus notes that Stage 3 and 4 sores are usually managed by a provider (MedlinePlus).
Diabetic foot ulcers
A diabetic foot ulcer is an open sore, usually on the bottom of the foot, that forms when nerve damage and poor circulation keep a small injury from being felt or healing. These ulcers are common and tend to come back. A 2017 review in the New England Journal of Medicine found that up to one-third of people with diabetes will develop a foot ulcer in their lifetime, and as many as 40% have a recurrence within a year (ScienceDaily summary of Armstrong et al., NEJM 2017).
Surgical wounds
Incisions from hip and knee replacements, heart surgery and abdominal surgery are a large share of home wound care. Medicare lists "wound care for pressure sores or a surgical wound" as a skilled nursing service (Medicare.gov).
Signs of Infection, and Who to Call
A wound infection is an invasion of bacteria into the wound bed and the surrounding tissue, which triggers inflammation and can delay healing considerably. Not every red or sore-looking wound is infected, though. Healing wounds can look pink and a little tender. What matters is change. Use this table as a guide.
| What you notice | What to do |
|---|---|
| Wound looks the same or a little smaller, edges pink, small amount of clear drainage | Keep following the care plan |
| Foul odor | Call the nurse the same day |
| Pus or thick, cloudy drainage | Call the nurse the same day |
| Redness or tenderness spreading around the wound | Call the nurse the same day |
| Warmth or swelling in nearby skin | Call the nurse the same day |
| Fever | Call the nurse or doctor the same day |
| New blister or open area on the skin | Call the nurse the same day |
| Heavy bleeding that doesn't stop with pressure | Call 911 |
| Confusion, very high fever with shaking chills, fast heartbeat | Call 911 |
| Skin turning dark, purple or black and spreading quickly | Call 911 |
The same-day signs above come from MedlinePlus guidance on pressure sores (MedlinePlus) and on diabetic foot care, which also lists tingling, burning and pain as reasons to call (MedlinePlus).
One practical habit helps. Take a photo of the wound with a coin or ruler next to it at each dressing change, in the same light. Changes that are hard to judge day to day become obvious when you compare photos.
Caring for a Pressure Injury at Home
The goal is to take pressure off, keep the wound clean and protected, and prevent new sores.
Relieve pressure
- Turn and reposition about every 2 hours in bed, and about every 15 minutes when sitting in a wheelchair (MedlinePlus).
- Use pillows or foam wedges to keep knees and ankles from touching.
- Float the heels on a pillow so they don't rest on the mattress.
- Skip donut-shaped cushions. MedlinePlus advises against them because they can reduce blood flow.
Clean and dress the wound
Follow the exact instructions in the care plan. In general, MedlinePlus advises washing Stage 1 areas gently with mild soap and water, rinsing Stage 2 sores with saline, and avoiding hydrogen peroxide and iodine unless the provider says to use them (MedlinePlus). Don't massage the skin on or near the sore.
Protect the rest of the skin
Check the whole body daily, especially the tailbone, hips, heels and elbows. Keep skin clean and dry, manage moisture from incontinence quickly, and use lift sheets rather than dragging a person across the bed.
Caring for a Diabetic Foot Ulcer
Diabetic foot wounds need two things at once. The current ulcer needs care, and the other foot needs protection.
- Offload the wound. Wear the special shoe, boot or cast the doctor prescribed every time the foot touches the ground, even for a short trip to the bathroom.
- Check both feet every day. Look at the tops, sides, soles, heels and between the toes. Use a mirror or ask someone to help (MedlinePlus).
- Never go barefoot. Diabetes can dull the sense of heat and pain, so avoid heating pads and hot water bottles on the feet.
- Keep blood sugar in the target range. High blood sugar slows healing.
- Don't treat it yourself. MedlinePlus advises contacting the provider right away about any foot problem instead of self-treating (MedlinePlus).
When a Wound Vac Is Part of the Plan
Negative pressure wound therapy is a sealed foam or gauze dressing connected to a small portable pump that applies continuous, gentle suction to the wound. Most people call it a wound vac. Doctors often order it for deep or slow-healing wounds.
At home, the nurse changes the dressing on the schedule the doctor orders and checks the seal and the canister. Families can help with a few simple things.
- Keep the tubing free of kinks and keep the pump charged.
- Listen for the alarm. Most alarms mean a leak or a full canister.
- If the pump stays off for longer than the time your nurse specified, call the nurse. A dressing left without suction may need to be changed.
- Call the nurse for bright red blood in the tubing or canister, and call 911 for heavy bleeding.
How Home Health Nursing Helps Wounds Heal
A home health nurse measures the wound, changes complex dressings, manages wound vacs, teaches the family the simpler dressing changes, and reports changes to the doctor. The nurse also looks at what's slowing healing, such as nutrition, blood sugar, pressure from a chair or bed, and medications.
Wound care is one of the services Medicare covers under home health when the patient qualifies (Medicare.gov). See our guide to Medicare home health eligibility for the details, and our overview of what happens at a skilled nursing visit. If the wound followed a hospital stay, our first 30 days after discharge checklist may help too.
Sources and Methodology
Editorial note. This article draws on AHRQ, MedlinePlus (from the National Library of Medicine), Medicare.gov and a 2017 New England Journal of Medicine review summarized by ScienceDaily. Wound care is individualized, so always follow the orders from the patient's doctor and nurse. Learn more about Violet Home Care Agency.
This article is general information, not medical advice. If you think someone is having a medical emergency, call 911.
Wound Care Nursing in the San Fernando Valley
Violet's nurses provide wound and pressure injury care, including wound vac management, in Canoga Park, Woodland Hills, West Hills, Winnetka, Reseda, Chatsworth, Northridge, Tarzana, Encino, Van Nuys, Calabasas and Porter Ranch. If someone in your family has a wound that isn't healing or a new order for home wound care, contact our Canoga Park office at 20944 Sherman Way, Suite 206-A.
