STATEMENT OF CLINICAL PROBLEM: A one month old Hispanic male born with a rare, severe skin disease, Epidermolysis Bullosa. The baby has generalized wound care issues over his entire body, especially his extremities with large blisters and sloughing epidermis. The daily dressing changes are time consuming, painful, and overwhelming to the nurses and mother.

DESCRIPTION OF PAST MANAGEMENT: The infant was immediately started on routine wound care that consists of non-adherent dressings, moist wound healing and pain management that will be ongoing for the rest of his life.

CURRENT CLINICAL APPROACH: A detailed treatment plan was devised that included steps to increase the baby's comfort, encourage the mother's involvement, maintain baby's thermoregulation, expedite healing of the blisters, and prevent further skin trauma in an efficient manner. The dressing changes occurred daily with the goal of providing a non-adherent dressing with an absorptive layer that would last for 24 hours.

PATIENT OUTCOMES: The dressing change procedure took at least one hour every day, pain medication was given at regular intervals, and the nurses did become competent in the baby's care. The wound care was effective, as there was healing of the epidermis at various stages in the most affected areas. Although there were new blisters that occurred as part of the disease process, medical devices were limited and no additional trauma occurred. Once the treatment plan was established the infant was transferred back to the original hospital closer to the family's home.

CONCLUSION: Babies with this severe form of Epidermolysis Bullosa have very challenging wound care needs and benefit from the expertise of WOC nurses to provide an individualized wound care treatment plan.

FINANCIAL ASSISTANCE/DISCLOSURE: No financial assistance was received for this study.