Traumatized by Road Rash

 Clinical Problem

 

Road rash / abraded skin occurs when moving skin collides with a non moving object such as asphalt, grass, or gravel.  These wounds do not bleed much but are usually quite painful and are highly susceptible to infection due to wound contamination at the time of injury.  Our hospital had no standardized protocol for managing this type of wound.  Infection prevention, pain management and efficient use of nursing time were our desired outcomes.

Description of Past Management

 

Most treatment regimens in the past centered on painful daily cleansing and coverage with antibacterial topical agents such as Silvadene or triple antibiotic solution. Many of these abraded surfaces were in contact with bed surfaces or adjacent to other surgical wounds making typical treatment regimens difficult. In addition, the dressing changes were often neglected due to other pressing physiological concerns.

Current Clinical Approach

 

A team approach between the CWOCN and the trauma surgeons led to our current protocol. 15 patients have been in the study.  Our goal is to treat 20 more.  The abraded skin is cleaned in the operating room or bedside within 24 hours of admission using a plain soft brush and mild cleanser.  Next, a silicone based antimicrobial foam dressing is applied with dressings changed every 3-5 days.

Patient Outcomes

 

Before standardization, care was inconsistent leading to wound infections and painful dressing changes.  Multiple supplies were used and dressing changes occupied valuable nursing time in the NTSICU.  After implementation, care was standardized, infections prevented and pain was easily controlled during dressing changes

Conclusions

 

There are multiple ways to treat abraded skin.  Our goal is to provide care for 25 patients  that reduces infection, reduces the need for additional pain medication, and utilizes the NTSICU nurses’ time efficiently.  With early cleaning and application of the silicone foam dressing, our outcomes were met.