… Patients/carers undertaking dressing changes will need to be educated about hand hygiene, cleansing and dressing change techniques, as well as dressing disposal. 184 Figure 3: Exudate management in the context of comprehensive and individualised wound management Comprehensive structured wound assessment Devise and document comprehensive wound management plan agreed with patient/carers • Short-term and long-term goals of treatment • Further investigations/specialist referrals • Planned interventions and rationale for each • Reassessment schedule Optimise patient Provide patient/ Management of the wound and the exudate condition and carer education quality of life • Reassure • Ensure psycho- • Explain rationale Manage factors Optimise wound bed Manage exudate to social support for goals of care contributing to and periwound skin achieve wound bed • Enhance nutrition • As appropriate, the wound and to moisture level • Optimise manage- explain moist abnormal exudate • Debride/cleanse appropriate for ment of comor- wound healing and quantity or as appropriate to treatment goals bidities, including mode of action of composition remove necrotic referring for additional treat- material and • Apply as appropri- specialist input as ment modalities, • See Table 5 slough ate: appropriate e.g. compression • Local factors – • Manage peri- • Dressing(s) • Address patient therapy, and risks e.g. infection or wound skin • Negative pres- concerns, includ- of non-compliance biofilm, venous problems – e.g. sure wound ing management • When and how to disease, sinus/ maceration, therapy (NPWT) of pain seek help fistula erosions • Fluid collection • For self care – • Systemic factors – devices – e.g. hand hygiene, e.g. cardiac failure ostomy/fistula cleansing, dressing • Practical factors appliances change technique, dressing disposal Prevent and treat other exudate-related problems • Leakage and soiling • Dressing adherence issues • Protein loss • Odour • Fluid and electrolyte imbalance Monitoring and reassessment of the patient and the wound Patient deteriorating and/or wound not Wound healed healed or deteriorating • Reassess • Implement preventative measures and • If the wound is not healing despite optimal management, follow up as appropriate consider second-line treatments 195 W O R L D U N I O N O F W O U N D H E A L I N G S O C I E T I E S CONSENSUS DOCUMENT EXUDATE The aims of exudate management are to: MANAGEMENT ■ Optimise wound bed moisture level as appropriate for the patient ■ Protect the surrounding skin ■ Manage symptoms and improve patient quality of life. …