Secondary Wounds and Covid-19

Social Distancing, Isolation and the Risk of Increased Wound Complications

Reducing contact with others by practicing social distancing (keeping at least 6 feet apart) as well as staying at home as much as possible is, to date, the most effective method for avoiding COVID-19 and reducing the spread, and this certainly applies to the most at-risk population, the elderly. Whether they are receiving in-home care or reside in an assisted living facility (ALF) or long term care facility (LTCF), seniors have been strongly advised to aggressively limit their contact with other people as well as refrain from engaging in any activity outside of their immediate environment that could bring them in contact with anyone outside of their primary caregiving team. While geriatric patients who are already confined to their beds with little to no mobility may not experience a change in their daily routines, new social distancing and isolation guidelines often mean that seniors who enjoyed a healthy level of activity or mobility prior to the pandemic may now be experiencing a dramatic decrease in their overall movement, whether in their own home or in their care facility. For example, a patient in an ALF who once moved between their room and other parts of the facility to either eat or socialize may now be solely confined to their room to avoid encountering or spreading the virus. Likewise, seniors receiving in-home care are likely isolating at home, and in most cases this decrease in overall activity means more time sitting or time spent in bed in their private living spaces. Nurses and caregivers for this demographic should be aware that a significant drop in patient mobility can have serious, negative health effects, contributing to and exacerbating wound development, particularly pressure injuries and other wounds caused by a lack of mobility, thus increasing the need for heightened wound care. Wounds that develop due to acute and sudden lack of mobility or chronic prolonged periods of immobility can cause significant health issues for the elderly and are one of the biggest challenges their nurses, doctors, and caregivers face on a daily basis. A lack of mobility can lead to the presentation and complication of pressure injuries, arterial insufficiency ulcers, venous ulcers, or, in the case of patients diagnosed with diabetes, diabetic neuropathic ulcers. Pressure injuries often develop in the elderly after prolonged periods of sitting or lying down leading to increased pressure at certain points in the skin where blood flow is disrupted and skin or tissue begins to break down. Pressure injuries are categorized by severity in 4 stages, and can present as a relatively minor wound to the epidermis with the skin still intact or as full thickness skin and tissue loss where bone may be exposed. Arterial insufficiency ulcers are a result of poor arterial circulation, and in patients who are experiencing decreased mobility due to COVID-19, caregivers and healthcare workers should take measures to increase arterial circulation when possible in order to prevent this type of wound development. Venous wounds, which typically appear in the pretibial area, are a result of venous hypertension or poor calf pump activity, both causes that can be exacerbated by a significant decrease in movement and activity. The presence of these types of wounds in an aging population, while common, are also general markers for poor health outcomes and can, due to infection, lead to premature mortality in some patients.

Steps Nurses can take to Prevent and Treat Wounds During Coronavirus

So, how can nurses and caregivers prevent and treat wounds due to lack of mobility, yet still encourage patients to follow social distancing and isolation guidelines to reduce their risk of contracting COVID-19?

• Awareness and risk assessment are key. It’s imperative for caregivers to quickly identify those patients who are at most risk for developing wounds due to their decreased activity levels and to develop a regular plan of care for the patient that includes wound care and management.

• Establish transparency. Because of social distancing, many elderly patients who live in ALFs or LTCFs may be cut off from their families and support systems, relying solely on their immediate nurses for all of their care. It’s crucial for nurses and other facility caregivers during this time to maintain transparent documentation and communication with staff and family members about wound care procedures and any new wounds that develop during isolation.

• Early intervention matters. By identifying and treating new or worsening wounds due to decreased mobility early and aggressively, nurses may be able to avoid serious infections in their patients and promote better health outcomes. For example, for pressure injuries, it’s crucial for a patient’s overall health that the wound be identified and treated at the earliest stage of development, before infection or tissue loss sets in.

• Encouraging safe mobility practices when possible. Caregivers to elderly patients should take measures to ensure the patient is engaging in as much activity as is physically recommended for their condition and that is safely following the CDC’s guidelines on social distancing and isolation for this vulnerable demographic. Even if they are confined to a somewhat small living area, geriatric patients should be encouraged by their caregivers to move around as much as possible in order to prevent wound development due to inactivity. When possible, discourage prolonged time spent sitting or lying in the same position, turn or reposition patients unless contraindicated, or consider adopting pressure-relieving devices if frequent movement isn’t possible.