Subject: debridement

Debridement Policy

SUBJECT: DEBRIDEMENT

GOAL: To optimize efficacious wound care by removing non-viable (necrotic) tissue. 

RATIONALE: Devitalized tissue, such as eschar and slough promote growth of pathogens and inhibits wound healing. Consideration of patient goals, clinical condition and nature and amount of devitalized tissue is indicated when determining a method of debridement. The body produces proteases to break down and remove dead tissue via autolysis and white blood cells to engulf and digest debris via phagocytosis.  Individuals with chronic wounds often require external sources of debridement because their bodies are not able to debride the unhealthy tissue. There are several methods of wound debridement, all of which require a physician’s order.   

DATE EFFECTIVE: ___________________
DATE REVISED: _____________________
DATE REVIEWED: Annually
APPROVED BY: ______________________
ISSUING DEPARTMENT: ________________________
APPROVED FOR USE IN: ________________________ 

POLICY:

1. Consider the following debridement methods.  

2. Select the best debridement option in consideration with patient’s goals, clinical condition, type and amount of devitalized tissue and past benefit from debridement type, as applicable. 
3. Notify the physician or prescribing individual of the need for wound debridement and obtain orders.  
4. Monitor the wound for signs of infection (erythema, warmth, induration, increased exudate unrelated to debridement process). Notify physician of wound deterioration.  
5. Monitor wound for effectiveness of debridement type. Notify physician if method ineffective and obtain new orders.    
6. Notify physician when debridement complete and obtain new orders.

DEBRIDEMENT TYPE	CONSIDERATIONS
1.  Autolysis: Dressings may include hydrocolloids, hydrogels, transparent film, polymers. {List facility products}	1a. Complete debridement may take weeks.  1b. Do not use on infested wounds or wounds at risk for developing infection.
2.  Chemicals/enzymes: Pharmaceutical ointments. Collagenase digests denatured collagen in necrotic tissue, releases the necrotic tissue from the underlying healthy tissue. Papain-urea (protease + denaturing ingredient) digests and liquefies necrotic tissue.  {List pharmacy products used at facility}	2a. Removes non-viable tissue over time.  2b. Dressings changed daily to BID depending on product selection. 2c. Some people may experience a slight irritation of the skin next to the wound.  2d. Most topical antimicrobials are compatible with enzyme debriding agents. 2e. Refer to package insert.
3.  Mechanical: Wet to dry normal saline.	3a. Moisten one layer high mesh gauze with normal saline and wring out till just damp. Apply to wound. 3b. Used in larger wounds with moderate to heavy necrotic tissue.  3c.   Non-selective, may be painful if adheres to viable tissue at wound margin. 3d.  Generally change BID
4.   Biological debridement: Maggot Therapy	4a More than one application may be needed to fully clean the wound.  4b. Some people may experience a tickling sensation 4c.Remove and carefully discard maggots when removed.
5. Conservative sharps	5.  Requires skilled PT or nurse to perform. Refer to “Conservative Bedside Sharps Debridement” policy.

This policy is a guideline and educational tool for the provision of patient care. Deviations from this policy may occur as the situation warrants.