Some wound care centers are closed because of the COVID-19 pandemic.

More patients are opting to perform their own wound care at home because they are concerned about venturing out and risking exposure to the virus.

We spoke with three wound care professionals to learn more about care provided in the home and teaching patients and families to care for wounds until life returns to normal. 

How one clinic embraces Telewound 

Michael Miller, DO, is the CEO and medical director of the Miller Care Group in Indianapolis, a frequent lecturer at our annual Wild on Wounds (WOW) conference and adjunct faculty member of the Marian University College of Osteopathic Medicine. 

“We provide comprehensive wound care for patients in our clinic, in long-term care and assisted living facilities, and also via house calls — both in-person visits and telehealth with our Telewound service,” Miller said. 

Miller’s wound care clinic remains open during COVID-19. However, his team ramped up existing Telewound services during the pandemic.   

“We continue universal precautions and have also implemented the CDC recommendations regarding COVID-19 screening of patients and staff along with the use of related PPE,” he said. 

Even if patients opt to perform their own wound care at home, Miller said these patients remain under the clinic’s care. It includes routine visits — either in-person or via Telewound — until the wound has completely healed for at least one to two weeks.

Power of telehealth

Telehealth is very effective, Miller said, when a clinician is with a patient and connects with the prescribing clinician during the visit.  

“With Telewound, the home health nurse contacts the prescribing clinician in real time during the visit,” he said. “This enables the prescriber to conduct ongoing assessment and diagnosis and prescribe the appropriate treatment. One example is asking a home health nurse to explore a wound at a specific location if new tunneling is suspected.”   

Several opportunities are provided to patients for observing their wound care performed by a nurse or clinician before they take on the task themselves, according to Miller.

Then, detailed instructions are provided to patients and families before they begin. “We need to make sure they understand all the necessary steps involved,” he said.  

On the flipside, sometimes there are concerns a patient and their family are unable to perform their own wound care at home. Two examples are if patients or caregivers have debilitating arthritis or cognitive issues, Miller said.   

“If this occurs, their wound care will continue to be performed with home health visits with nurses and house calls, Telewound or clinic visits by clinicians,” he said. 

Wound care at home instructions, supplies

You might be involved in teaching patients to care for their own wounds, especially now during the COVID-19 pandemic.

Here are some general recommendations to consider, according to husband-and-wife team Bill Richlen, PT, WCC, DWC, and Denise Richlen, PT, WCC, DWC, CLT. They are both clinical instructors with the Wound Care Education Institute (WCEI). 

The Richlens said important strategies for self-performed wound care at home include: 

  • Keep wound care and dressing supplies, along with instructions, in one place, preferably a container that protects them. 
  • Establish a clean, flat base to work from, such as a clean towel or drape. 
  • Place supplies needed on the base you create.  
  • Follow any instructions provided by your wound care clinician for cleansing and dressing placement. 
  • Wash hands before and after dressing changes. 

If no instructions were provided, the Richlens recommend the following steps: 

  • Apply gloves and remove old dressing, then discard it in a plastic bag. 
  • Remove gloves and discard in same bag as described above. 
  • Change into clean gloves. 
  • Clean wound with saline or commercial wound cleanser, which is preferred. 
  • Tap water can be used if nothing else is available.  
  • Redress wound as quickly as possible to limit time wound is open to air. 
  • Secure dressing as needed with tape, elastic bandage, Coban, etc. 

Wound care tips

The Richlens also offered the following informational tips for home wound care: 

Dressing types

The types of dressings needed should be based on exudate levels and frequency of necessary dressing changes. Then followed by appropriate securement products, such as tape, elastic net, tubular stockings, etc. Dressing supplies can be acquired from wound clinics or via third-party durable medical equipment providers that can deliver dressings to the home.   

Measurement devices

Since patients are not adequately trained in wound assessment, measurement would not be necessary. This duty would still fall to clinicians. 

When to seek help

Clinicians should teach patients and families about the signs and symptoms to look for that would require the wound to be seen by a professional.

Patients, wounds best suited for self-care

This varies and is based on the skill and availability of patients or caregivers. Wounds that are the easiest to manage are clean with little necrotic tissue, non-infected and those that require less frequent dressing changes.

Patients, wounds least suited for self-care

Any wound could be managed by the patients and caregivers. However, the important question is how well will it be done?  

Challenging wounds

Some wounds require more challenging wound care at home, such as: 

Complex wounds

Examples are those requiring significant debridement, compression bandages or certain offloading devices.

Infected wounds

These need appropriate diagnosis by a prescribing clinician, followed by antibiotics and effective topical agents. The greatest concern is prevention of sepsis. Knowing when to call a clinician is important. 

Explore our COVID-19 resource page.

Carole Jakucs, MSN, RN, PHN, CDCES

Carole Jakucs, MSN, RN, PHN, CDCES, is a freelance writer and diabetes educator. Her background in nursing includes tenures in healthcare management and as a care provider. She has worked in med/surg/telemetry, a pediatric emergency department and college health.

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