Wound care is one of the most common reasons a physician orders skilled nursing at home, and one of the areas where the quality of the care makes the most visible difference. A wound that is managed well heals. A wound that is managed casually becomes an infection, a hospital stay, and sometimes far worse.

The wounds we manage most often

• Surgical incisions — including care of drains, staples, and sutures after orthopaedic, abdominal, cardiac, and vascular surgery
• Pressure injuries — from immobility, often on the heels, hips, or lower back
• Diabetic foot ulcers — which can progress alarmingly fast and painlessly when neuropathy has dulled sensation
• Venous and arterial ulcers — usually on the lower legs, often requiring compression as part of treatment
• Skin tears and traumatic wounds — common in older adults on blood thinners or long-term steroids

What good wound care actually involves

Measurement, not impressions. A wound should be measured at every visit — length, width, depth, and the character of the tissue and drainage — and documented. "It looks a bit better" is not clinical information. A wound that has not improved over two to four weeks needs the plan changed and the physician informed.

Sterile technique. Hand hygiene, clean field, correct gloving, and single-use supplies. Dressings are not stretched to a second use.

The right dressing for the stage. Wounds change as they heal, and the dressing has to change with them. Foam, alginate, hydrocolloid, and negative pressure wound therapy each do a different job.

Treating the cause, not only the hole. A pressure injury will not heal without a turning schedule and pressure redistribution. A diabetic ulcer will not heal while blood sugar stays uncontrolled or the client keeps walking on it. A venous ulcer will not heal without compression.

Nutrition. Healing needs protein, calories, fluid, and often vitamin C and zinc. A client who is barely eating will not heal no matter how good the dressing technique is.

Signs of infection — call the nurse

• Increasing redness spreading out from the wound edges
• Warmth, swelling, or pain that is getting worse rather than better
• Drainage that becomes cloudy, green, or foul-smelling
• Fever or chills
• A wound that suddenly grows larger or turns dark
• In someone with diabetes: rising blood sugar with no other explanation, which can be the first sign of infection

What families should not do

Do not apply hydrogen peroxide, alcohol, or iodine to a healing wound unless a clinician has specifically told you to — they damage the new tissue that is trying to grow. Do not remove a dressing early "to have a look". And do not let a wound go unreported over a weekend because you do not want to bother anyone.

Our nurses teach family caregivers safe dressing technique step by step and ask them to demonstrate it back before we rely on them between visits. If you are caring for a wound at home and are not confident, say so — that is a reasonable thing to say, and it is what we are here for.