Home Wound and Incision Care: Dressing Care, Infection Signs, and Dehiscence
Teach hand hygiene before and after wound care, dressing changes exactly as taught, and showering only as the surgeon allows, with no soaking until the wound heals. Report spreading redness, warmth, purulent drainage, foul odor, a temperature of 100.4 F (38 C) or higher, or separation of the wound edges the same day. Call 911 for evisceration or heavy bleeding that does not stop with firm, direct pressure.
Who needs this teaching
Clients discharged with a surgical incision or another healing wound, and the caregiver who helps with dressing changes. A surgical incision with approximated edges heals by primary intention. Surgical site infection develops within 30 days after surgery, or within 90 days after some implant procedures. Diabetes, smoking, obesity, malnutrition, corticosteroid therapy, and older age delay healing.
The priority teaching points
- Hand hygiene. Wash hands with soap and water for at least 20 seconds, or use an alcohol-based hand rub, before and after touching the wound or dressing.
- Dressing care. Keep the dressing clean, dry, and intact. Change it on the schedule and with the technique taught. Leave adhesive closure strips in place until they fall off or the surgeon removes them. Apply no lotion, powder, or ointment to the incision unless prescribed.
- Bathing. Shower only when the surgeon allows. Let water run over the incision; do not scrub. Pat dry with a clean towel. Do not soak the wound in a bathtub, hot tub, or swimming pool until the surgeon confirms healing.
- Nutrition and glucose control. Wound healing requires protein, calories, vitamin C, and zinc. Include protein at each meal and drink adequate fluids unless restricted. Keep blood glucose within the target range; hyperglycemia impairs healing and increases infection risk.
- Smoking. Stop smoking. Nicotine causes vasoconstriction, and carbon monoxide reduces tissue oxygen delivery. Smoking delays healing and increases infection and dehiscence risk.
- Healing versus infection. Normal healing shows mild redness, swelling, and tenderness at the edges that decrease over the first few days, and small amounts of thin, clear or pale pink drainage (serous or serosanguineous). A firm healing ridge forms under the incision by the end of the first week. Infection signs are increasing or spreading redness, red streaks, warmth, swelling, or pain; purulent drainage; foul odor; and a temperature of 100.4 F (38 C) or higher.
- Activity and closure. Splint an abdominal or chest incision with a pillow during coughing. Avoid heavy lifting and straining for the period the surgeon sets. Keep the appointment for staple or suture removal on the date the surgeon sets. Report any separation of the wound edges (dehiscence).
- Evisceration. If the wound bursts open with tissue or organs protruding, call 911. Place the client in low Fowler's position with the knees flexed. Cover the tissue with a clean towel moistened with sterile saline or clean water. Do not push the tissue back. Give nothing by mouth.
Red flags the client reports
| Call the provider the same day | Call 911 or the local emergency number |
|---|---|
| Spreading redness, red streaks, warmth, swelling, or increasing pain | Wound edges burst open with tissue or organs showing |
| Purulent or foul-smelling drainage | Heavy bleeding that does not stop with firm, direct pressure |
| Temperature of 100.4 F (38 C) or higher | Fever with confusion, rapid breathing, or dizziness (signs of sepsis) |
| Separation of the wound edges, or loose staples or sutures | Sudden shortness of breath or chest pain |
Teach-back questions
- "Show me how you will change your dressing."
- "When will you wash your hands during wound care?"
- "When can you shower, and when can you take a bath?"
- "Which wound changes mean you call today?"
- "What will you do if the wound opens and tissue shows?"
Teaching tips
- Observe a return demonstration with the client's home supplies.
- Write the shower date, the removal appointment, and the surgeon's number on the handout.
- Describe normal drainage in plain colors so the client recognizes a change.
Read more on NCLEXPace
- Perioperative Nursing: Safety Across the Surgical Journey
- Sepsis: Recognize the Pattern and Act Fast
Sources
- Berrios-Torres SI, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017;152(8):784-791.
- World Health Organization. Global Guidelines for the Prevention of Surgical Site Infection. 2nd ed. WHO; 2018.
Why this matters for the NCLEX
Teaching is effective when the client states, "I wash my hands before and after I touch my dressing," and "I will call if the redness spreads or the drainage turns thick and smelly." Statements requiring further teaching include, "I will soak in the tub to clean my incision," "Some pus is a normal part of healing," and "If the wound opens, I will push it back together and tape it."
Frequently asked questions
Is some redness around a new incision normal?
Yes. Mild redness and swelling at the edges are part of the inflammatory phase of healing and decrease over the first few days. Spreading or increasing redness indicates infection.
Why does the client avoid baths and pools until the wound heals?
Soaking macerates the wound edges and exposes the incision to waterborne microorganisms. It increases the risk of infection and dehiscence.
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