Wound Care & Dressing Guide

Every nurse does wound care. Few nurses do it well. The difference isn’t magic — it’s understanding what a wound needs at each stage of healing, and choosing the right dressing for the right wound at the right time. This guide gives you that framework.

If you’ve ever stood in a treatment room holding three different dressings, wondering which one to use, you’re not alone. Wound care is one of the most commonly performed — and most commonly misunderstood — nursing skills. There are hundreds of dressing products on the market, but the principles are simple. Once you understand the TIME framework, every dressing choice becomes logical.

Wound Assessment — The TIME Framework

Before you touch a wound, you assess it. The TIME framework is the UK standard for wound bed assessment, used by tissue viability nurses across the NHS [1]:

Always assess the surrounding skin too — maceration (white, soggy skin), excoriation (red, raw from exudate), or callus build-up around the edge will prevent healing. And always assess pain — wound pain is often undertreated. For analgesia choices before a painful dressing change, read my pain management pharmacology guide.

Types of Wounds You’ll See On The Ward

Acute Surgical Wounds

Closed surgical incisions heal by primary intention — edges approximated, sutures/staples/clips in place. Keep them clean and dry for the first 48 hours, monitor for signs of infection (increasing pain, redness, discharge, wound dehiscence). If a surgical wound breaks down, it becomes an open wound healing by secondary intention — and the TIME framework applies.

Pressure Ulcers

These are preventable injuries caused by unrelieved pressure. Prevention is always better than treatment — use your pressure ulcer risk assessment (Waterlow or similar), reposition every 2–6 hours depending on risk, and use pressure-relieving equipment. For full details on staging and prevention, read my pressure ulcer prevention and staging guide.

Venous Leg Ulcers

Caused by venous hypertension — usually on the lower leg, shallow, sloughy, heavily exuding, often surrounded by haemosiderin staining (brown discolouration). The gold standard treatment is compression therapy (4-layer bandaging or hosiery) — but only after arterial disease has been excluded by checking the ABPI (Ankle Brachial Pressure Index). Never apply compression without an ABPI result [2].

Arterial Ulcers

Caused by poor arterial perfusion — usually on the toes, feet, or lateral malleolus. Punched-out appearance, painful, pale, dry, with minimal exudate. The foot may be cold and hairless with weak pulses. Compression is contraindicated. These need urgent vascular referral — delayed treatment can lead to amputation [3].

Diabetic Foot Ulcers

Often painless (due to neuropathy), on pressure points of the foot (metatarsal heads, heel). High risk of infection and rapid deterioration. Any foot ulcer in a diabetic patient is high-risk — refer to the diabetic foot team immediately. Do not self-treat [4].

Wound Cleansing — What To Use, What To Avoid

The default cleansing solution for most wounds is tap water — yes, really. Multiple studies show tap water is as effective as saline for cleansing acute and chronic wounds, and it’s cheaper and more accessible [5]. For surgical wounds and fragile tissue, use normal saline (0.9% sodium chloride).

Cleanse gently — do not scrub. Scrubbing damages granulation tissue and causes pain. Irrigate with a syringe or pour gently. Pat dry the surrounding skin (not the wound bed) before applying the dressing. And always use aseptic non-touch technique (ANTT) — wound care is an aseptic procedure, not a clean one.

Dressing Selection — The Only Guide You Need

Dressing selection comes down to one question: how wet is the wound? Everything else follows.

Recognising Infection — When To Escalate

Not every red wound is infected. Not every wound with exudate needs antibiotics. The difference:

• Colonisation — bacteria present but no host response. Normal. No treatment needed.
• Critical colonisation — delayed healing, increased exudate, friable granulation tissue, unusual odour, pocketing. Treat topically (antimicrobial dressing). Review at 2 weeks.
• Infection — spreading cellulitis (redness extending beyond wound edge), increasing pain, heat, purulent discharge, malodour, systemic signs (fever, tachycardia, confusion, raised WCC/CRP). Needs systemic antibiotics and medical review. If systemically unwell — follow sepsis six. See my sepsis recognition and management guide.

Swabs should only be taken when there are clinical signs of infection — not routinely. A wound swab from a colonised wound will grow bacteria and lead to unnecessary antibiotic prescribing. Take a swab after cleansing, using the Levine technique (rotate swab over 1cm² with sufficient pressure to express tissue fluid) [8]. Check infection markers — CRP, WCC, neutrophils — by reading my understanding blood results guide.

Debridement — What You Can And Can’t Do

Debridement is the removal of dead, devitalised tissue. There are several types:

• Autolytic — the body’s own enzymes break down slough, assisted by occlusive dressings (hydrocolloids, hydrogels). This is what you’ll facilitate most often.
• Mechanical — wet-to-dry dressings (largely obsolete — painful and non-selective), irrigation.
• Sharp / surgical — scalpel or scissors. Only by trained, competent practitioners (tissue viability nurses, podiatrists, surgeons). As a student, you will observe and assist — never perform sharp debridement.
• Larval (biosurgery) — sterile maggots eat dead tissue. Specialist use only, but surprisingly effective [9].

Nutrition — The Forgotten Component of Wound Healing

A wound cannot heal if the patient is malnourished. Healing requires protein (1.2–1.5g/kg/day), vitamin C, zinc, and adequate calories. If a patient has a non-healing wound, check their BMI, recent weight loss, and food intake. Refer to dietetics. In older adults and those with chronic wounds, malnutrition is common and often missed. A pressure ulcer that won’t heal is often a nutrition problem, not a dressing problem [10].

Documentation — Measure, Photograph, Record

Every wound needs documentation. Record:

• Location — be specific (e.g., “medial malleolus, left leg,” not just “leg”)
• Size — length × width × depth (cm). Use a paper ruler. For tracking progress, consistent measurement matters more than absolute accuracy.
• Wound bed — % granulation, % slough, % necrosis
• Exudate — amount (none/scant/moderate/heavy), type (serous, serosanguinous, purulent, haemoserous)
• Surrounding skin — intact, macerated, excoriated, erythematous
• Pain — score at rest and on dressing change
• Dressing used — product name, size, any secondary dressing, and when it’s due to be changed

Photography (with consent, per trust policy) is increasingly used for tracking and for tissue viability referrals. If your trust uses it, follow the policy exactly — no personal phones, store on the trust system, document consent.

When To Refer To Tissue Viability

Refer to the tissue viability nurse if:

• The wound hasn’t improved after 4 weeks of appropriate treatment
• It’s a complex wound (cavity, sinus, undermining, large area)
• You suspect arterial disease (ABPI needed)
• It’s a diabetic foot ulcer
• There’s suspected infection not responding to treatment
• You’re unsure what dressing to use — that’s what they’re for

Final Thought

Wound care is a skill that rewards patience and observation. You don’t need to know every product — you need to know the principles: assess with TIME, match the dressing to the exudate level, recognise infection, know when to refer, and document properly. Get those right and you’ll be better at wound care than most qualified nurses. And if you’re ever unsure — ask. The tissue viability team would rather you called early than left a wound to deteriorate.