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Home nursing · registered nurses

Home Wound Dressing and Pressure Sore Care

Chronic wounds, pressure sores and diabetic foot ulcers that are not managed properly can become deeper and slower to heal, and in some cases lead to a risk of amputation. Our Hong Kong registered nurses visit the home to dress wounds, using aseptic technique, and give professional assessment, cleaning and dressing, pressure relief and carer training for acute and chronic wounds, pressure injuries and diabetic foot ulcers.

  • Hong Kong registered nurses
  • Home visits across Hong Kong
  • $920 per hour · no minimum spend
  • Aseptic technique
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Further reading and other services

In-depth articles on wounds and pressure sores

Other home nursing services

Home wound dressing service in Hong Kong

What people commonly call wound washing covers, clinically, cleaning the wound, assessing it and changing the dressing. In the home wound dressing service, a Hong Kong registered nurse brings sterile dressings to the patient's home, care home or hospital, cleans the wound with aseptic technique, assesses healing progress, chooses dressings to suit the condition of the wound, and guides family members in daily observation and pressure relief. For patients with limited mobility, patients whose wound is somewhere hard to manage alone (such as a sacral pressure sore or a sole ulcer), or patients who need a dressing change every two or three days, a nurse visit is often more practical than travelling to a clinic each time.

Common situations that call for home wound dressing include: a surgical incision where the stitches have not yet been removed, dressings still needed at regular intervals after discharge, pressure sores from long-term bed rest, diabetic foot ulcers, venous leg ulcers, and chronic wounds that have not closed after four to six weeks. After the first home assessment, the nurse will explain the visit frequency, the type of dressing chosen, and what family members can safely do themselves in daily care.

Home wound dressing: cost and arrangements

The following answers the questions asked most often. For full pricing, see the pricing page.

CostRegistered nurse HK$920 per hour, with a lower rate for longer bookings: HK$400 per hour for 4 hours, $340 per hour for 8 hours and $300 per hour for 12 hours. No minimum spend, and a single visit can be booked as needed.
What is coveredWe provide assessment and aseptic dressing of acute and chronic wounds, pressure sore risk assessment and a pressure relief plan, and diabetic foot wound care. The nurse also teaches family members how to dress a wound and how to relieve pressure for the patient.
Areas servedThe service covers Hong Kong Island, Kowloon and the New Territories, and we can visit private homes, care homes and hospitals.
Who visitsThe service is provided by Hong Kong registered nurses who hold a practising certificate from the Nursing Council of Hong Kong. They assess the wound and carry out the care.
How to bookEnquire or book by WhatsApp, or call 5473 6204.

Why wounds need professional care

Wound care covers many different situations, such as surgical incisions, pressure injuries from long-term bed rest, diabetic foot ulcers, and chronic wounds caused by venous or arterial problems. If these wounds are not managed properly, they can turn into long-term problems that are hard to heal, keep getting infected and may even carry a risk of amputation. Clinical evidence shows that wound care led by a registered or specialist nurse can improve results.

12.8%
Prevalence of pressure sores in hospitalised adults
This figure combines 39 studies and more than 2.58 million patients. About 8.4% of pressure sores appeared only after admission (HAPI), which means a large share could in fact be prevented. (Li 2020; the prevalence is a pooled estimate across studies)
About 4 times
Effect of nurse-led chronic wound care
Chronic wound care led by a specialist nurse can raise the chance of a wound closing about fourfold and shorten the time in care. (Sili 2023, RCT; the abstract says "about fourfold" and gives no exact OR)
6.3%
Global prevalence of diabetic foot ulcers in people with diabetes
Because of neuropathy and poor circulation, these wounds are very hard to close, easily infected and often recur. (Zhang 2017; varies widely by region, a pooled estimate)
8% vs 13%
How turning more often helps prevent pressure sores
This study compared turning every 2–3 hours with turning every 4–6 hours. (Avsar 2020; the original paper states that the certainty of the evidence is low, so this should be read as helping to reduce them and not as absolute)

Do not wait until a wound has become a long-term problem, has damaged the deeper tissue, or carries a risk of amputation. A registered nurse can visit the home to check the wound, carry out aseptic wound dressing, set up a pressure relief plan and teach family members how to give care, so that wound problems are dealt with early.

Acute wounds, chronic wounds, pressure sores and diabetic foot ulcers

The cause of a wound and its healing speed directly decide the approach to care. Recognising the type of wound first allows the right treatment to be chosen:

Acute woundsAcute wounds include injuries and surgical incisions. If they are not infected, most close in about two to four weeks. The focus of care is aseptic dressing, preventing infection and keeping the wound moderately moist. For the care of wounds and stomas after surgery, see the page on home care after surgery.
Chronic woundsA chronic wound is one that has shown no clear improvement after more than four to six weeks. The cause is mostly poor circulation, continuous pressure, diabetes or an infective biofilm, and it needs professional assessment and systematic management.
Pressure injuries (pressure sores, bedsores)In people who are bedbound or use a wheelchair for long periods, the skin and underlying tissue are damaged by continuous pressure and shear, and a pressure sore forms. The severity can range from redness of the epidermis (Stage 1) to damage reaching muscle and bone (Stage 4), and deep tissue injury (DTI), which develops from the inside outwards, may also occur.
Diabetic foot ulcersIn people with diabetes, neuropathy removes the protection of pain, and circulation is poor, so even a very small wound on the foot can easily worsen and become infected. These wounds are very hard to close and often recur, which makes them high-risk wounds.

The four stages of wound healing

Understanding the physiological process of wound healing helps to follow progress and to notice early when healing has stalled:

  1. 1
    Haemostasis
    At the moment of injury, platelets quickly gather and clot to prevent too much blood loss.
  2. 2
    Inflammation
    White blood cells clear bacteria and dead tissue. During this period the wound is red, swollen, warm and painful. This is a normal immune response and does not necessarily mean infection.
  3. 3
    Proliferation
    The body begins to make collagen and grows red granulation tissue, and the edges of the wound slowly contract inwards.
  4. 4
    Maturation
    The collagen reorganises, the wound closes fully and forms a scar, and the toughness of the skin slowly recovers.

Wound management goals and what is assessed

Modern wound care follows the systematic wound bed preparation framework (Schultz TIME, 2003). The focus is on removing dead tissue, controlling infection and exudate, keeping moisture balanced and caring for the wound edge. At every visit the nursing team records the following measures carefully to make sure the care plan is working:

Three goals of wound management

  • Debridement: removing slough and eschar to make room for healthy granulation tissue to grow.
  • Infection and exudate control: choosing a suitable dressing, and using an antimicrobial when needed.
  • Moist balance: keeping the wound moist but not too wet, so that it heals more easily.

Ten wound assessment measures

  • Checking the position, size and depth of the wound (length × width × depth), and whether there is undermining or tunnelling (cavities under the skin).
  • Observing the state of the tissue (red granulation, yellow slough or black eschar), the exudate (amount, colour, smell) and the condition of the wound edge.
  • Checking the skin around the wound, the pain score (0–10) and signs of infection, and comparing with the last record to see how the wound is progressing.

Moist balance and choosing a dressing

The core principle is to keep the wound moist but not too wet, which helps it to recover faster. Animal experiments show that in a moist environment a wound re-epithelialises about twice as fast as in a dry scab (Winter 1962). A dressing should be chosen according to the actual condition of the wound and not the fame of the brand. For how the different modern dressings work (including alginate, hydrofibre, foam, iodine-containing and contact layer dressings), when each is suitable, and common questions such as whether keeping a wound moist encourages bacteria, see the separate article on moist wound healing.

Normal saline or antiseptic for cleaning a wound?

For an ordinary clean wound, normal saline (NS) does not harm tissue and is the safest and most commonly used solution. Antiseptics need particular care when they are used:

  • Normal saline (NS) is the safest and most commonly used solution for washing a wound. It does not harm tissue and suits everyday cleaning.
  • Chlorhexidine is usually used to disinfect the surface of the skin. It is toxic to deeper tissue in open wounds, so it is not suitable for long-term direct use on an open wound.
  • Povidone-iodine kills germs strongly, but laboratory tests show it is toxic to skin fibroblasts and may hinder wound closure, so it should not be applied directly to open granulation tissue over a long period.

Pressure injury stages and how to prevent them

Pressure injuries are graded by severity as Stage 1 to 4, unstageable, and deep tissue injury (DTI). Nurses assess a patient's risk of pressure sores using nutritional markers (such as albumin) and the Braden Scale. A review found that the Braden Scale has moderate predictive validity for pressure sore risk (sensitivity about 0.78, specificity about 0.72), so in practice it should be used together with professional judgement and the score should not be relied on alone. The key to prevention is reducing continuous pressure and shear. Specific measures include helping the patient to turn at set times, making good use of pressure-relieving equipment and giving enough nutritional support.

Pressure sores often start in the tissue under the skin and develop towards the surface. Even if the skin surface looks only slightly damaged, the underlying tissue may already be badly injured, which is a deep tissue injury (DTI). To learn how DTI is caused, how shear and reperfusion injury are related, how to recognise it on darker skin tones, and how to prevent it in detail, read the article on pressure sores and deep tissue injury.

Further reading: Pressure sores and deep tissue injury (DTI).

Why diabetic foot ulcers need particular care

Diabetic foot ulcers are quite common among people with diabetes (global prevalence about 6.3%). Patients often have peripheral neuropathy (so the protection of pain is lost) and poor circulation, so even a tiny wound on the foot can easily worsen, become infected and be hard to heal, and it often recurs. International evidence shows that care from a podiatry or multidisciplinary team is associated with a lower rate of major amputation (major amputation RR 0.45, although the original paper states that the evidence is still not enough to establish cause and effect). This shows how important it is to seek professional help early.

Risk factors for diabetic foot

  • Neuropathy removes the protection of pain, so often a small wound is found only after it has worsened.
  • Peripheral vascular disease reduces circulation, the wound gets too little oxygen, and it is very hard to close.
  • A high blood sugar environment lets bacteria multiply easily and also weakens immunity, so the wound is easily infected.
  • Diabetic foot ulcers recur very often, and anyone who has had a foot ulcer needs to have their feet checked regularly over the long term.

Points of care

  • Ask a professional early to check the depth of the wound, signs of infection and circulation, and to set up a suitable care plan.
  • Take pressure off the affected area (offloading) and keep blood sugar under good control.
  • Dress the wound with aseptic technique, watch for signs of infection, and refer to a podiatrist or doctor when needed.
  • Build a habit of checking both feet every day, and learn daily care to prevent another ulcer.

When to get help from a healthcare professional at once

According to the World Health Organization (WHO 2016 global guidelines), surgical site infection (SSI) is one of the most common healthcare-associated infections worldwide. If any of the following appear, contact the nursing team or see a doctor straight away and do not delay:

  • The redness and swelling at the wound edge keep spreading. This may be a sign of cellulitis.
  • The wound discharge suddenly increases, becomes thick, smells foul or contains pus. This means the wound is infected.
  • The patient has a fever, or the wound has not improved after two weeks.
  • A diabetic foot or leg wound turns black or gives off an odour, or the skin around the wound turns purple or pale.

How home wound care is arranged

The principles above, including TIME assessment, moist balance, choice of cleaning solution, pressure relief for pressure sores, monitoring of diabetic foot and recognising infection, all need a professional to carry them out continuously at home. Clinical evidence supports the value of this. A randomised controlled trial of 1,298 participants (per-protocol) (Sili 2023) found that chronic wound care led by a specialist nurse raised the chance of healing about fourfold, shortened treatment and reduced readmission. Our registered nurses provide a home-visit service to assess the wound, apply aseptic dressings, draw up a pressure relief plan and train carers, bringing the nurse-led care model that the research supports into the home.

Managing alone, without professional follow-up
  • Dressings and cleaning solutions chosen from experience or advertising, which may not suit the wound
  • Chronic wounds, pressure sores and diabetic foot ulcers often recur, and infection and worsening are not picked up early
  • Carers have no systematic guidance on dressing technique or pressure relief
Home care by a registered nurse
  • Systematic assessment with the TIME framework, a dressing chosen to suit the wound, and aseptic dressing technique
  • Braden risk assessment and a plan of regular turning for pressure relief, with regular monitoring and referral for diabetic foot
  • Teaching carers daily dressing, pressure relief and how to recognise infection, bringing professional care into the home

Frequently asked questions

What is the difference between a chronic wound and an acute wound? When is professional help needed?
Acute wounds, such as ordinary injuries or surgical incisions, usually heal in about two to four weeks as long as they are not infected. A wound that has shown no clear improvement after more than four to six weeks is a chronic wound. The cause is often poor circulation, continuous local pressure, diabetes or an infective biofilm, and a chronic wound needs professional care. Research shows that chronic wound care led by a specialist nurse raises the chance of healing about fourfold and shortens treatment (Sili 2023, RCT; the abstract says "about fourfold" and gives no exact figure).
How common are pressure sores (bedsores)? Are they always impossible to prevent?
Pressure sores are very common in clinical practice. A pooled analysis shows that about 12.8% of hospitalised adults have a pressure sore, and about 8.4% of these develop after admission (which suggests that a considerable share can in theory be prevented). The key to prevention is reducing continuous pressure and shear. Research shows that turning more often (every two to three hours versus every four to six hours) helps to lower the incidence of pressure sores (8% vs 13%, although the original paper states that the certainty of the evidence is low, so this should be read as helping to reduce them and not as absolute). Nurses use tools such as the Braden Scale to assess risk and then make a suitable repositioning and pressure relief plan.
Why should a wound on the foot of a person with diabetes never be treated as minor?
Diabetic foot ulcers are common among people with diabetes (global prevalence about 6.3%). Because patients often have neuropathy and poor circulation, wounds tend to heal poorly, become infected easily and often recur. International evidence shows that care from a podiatry or multidisciplinary team is associated with a lower rate of major amputation (major amputation RR 0.45, although the original paper states that the evidence is still not enough to establish cause and effect). The focus of care is early professional assessment of the wound, blood sugar control and good pressure relief, with referral to a podiatrist or doctor as needed.
Should a wound be kept dry or moist?
Contrary to the traditional view, keeping a wound moist but not too wet helps it recover. Animal experiments showed that a wound in a moist environment re-epithelialises about twice as fast as one in a dry, scabbed environment (Winter 1962). The key is for a professional to assess the wound and then choose a suitable dressing to keep the moisture balanced. How the different modern dressings work, and common questions such as whether a moist environment encourages bacteria, are covered in the separate article on moist wound healing.
What counts as a wound infection? When should professional help be sought at once?
According to the World Health Organization (WHO 2016 global guidelines), surgical site infection (SSI) is one of the most common healthcare-associated infections worldwide. Contact the nursing team or see a doctor promptly if any of the following appear: the redness and swelling at the wound edge are spreading, the discharge suddenly increases, becomes thick, smells foul or contains pus, there is a fever, or the wound has shown no progress for more than two weeks. Dressings changed with aseptic technique by a registered nurse, together with regular assessment, help to pick up signs of infection early.
Is normal saline or an antiseptic better for cleaning a wound?
For cleaning an ordinary wound, normal saline does not harm tissue and is the safest, so it is the first choice. Antiseptics such as chlorhexidine and povidone-iodine kill germs strongly, but laboratory tests show they are cytotoxic to skin fibroblasts in a concentration-dependent way and may hinder wound closure, so they should not be used long term directly on open granulating wounds. How they are used in practice should be decided by a professional.

Do a wound, pressure sore or diabetic foot ulcer need a registered nurse to visit for assessment, dressing or a pressure relief plan? Message us on WhatsApp for a free enquiry about care arrangements and an instant quote.

WhatsApp for a free enquiry and quote

Disclaimer: This article is general health information and is not professional medical advice. If you have any health concerns, please consult a qualified healthcare professional.

References

  1. Li, Z., Lin, F., Thalib, L., & Chaboyer, W. (2020). Global prevalence and incidence of pressure injuries in hospitalised adult patients: a systematic review and meta-analysis. International Journal of Nursing Studies, 105, 103546. PubMed
  2. Zhang, P., Lu, J., Jing, Y., Tang, S., Zhu, D., & Bi, Y. (2017). Global epidemiology of diabetic foot ulceration: a systematic review and meta-analysis. Annals of Medicine, 49(2), 106–116. PubMed
  3. Sili, A., Zaghini, F., Monaco, D., Dal Molin, A., Mosca, N., Piredda, M., & Fiorini, J. (2023). Specialized nurse-led care of chronic wounds during hospitalization and after discharge: a randomized controlled trial. Advances in Skin & Wound Care, 36(1), 24–29. PubMed
  4. Blanchette, V., Brousseau-Foley, M., & Cloutier, L. (2020). Effect of contact with podiatry in a team approach context on diabetic foot ulcer and lower extremity amputation: systematic review and meta-analysis. Journal of Foot and Ankle Research, 13, 15. PubMed
  5. Winter, G. D. (1962). Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature, 193, 293–294. PubMed
  6. Schultz, G. S., Sibbald, R. G., Falanga, V., et al. (2003). Wound bed preparation: a systematic approach to wound management (TIME framework). Wound Repair and Regeneration, 11(Suppl 1), S1–S28. PubMed
  7. Rueda-Fernández, M., et al. (2022). Cytotoxicity and wound closure evaluation in skin cell lines after treatment with common antiseptics for clinical use. International Journal of Molecular Sciences, 23(10), 5657. PubMed
  8. World Health Organization. (2016/2018). Global guidelines for the prevention of surgical site infection; Gulland, A. (2016). WHO launches global guidelines to stop surgical site infections. BMJ, 355, i5942. WHO · PubMed
  9. Avsar, P., Moore, Z., Patton, D., O'Connor, T., Budri, A. M., & Nugent, L. (2020). Repositioning for preventing pressure ulcers: a systematic review and meta-analysis. Journal of Wound Care, 29(9), 496–508. PubMed
  10. Huang, C., Ma, Y., Wang, C., et al. (2021). Predictive validity of the Braden scale for pressure injury risk assessment in adults: a systematic review and meta-analysis. Nursing Open, 8(5), 2194–2207. PubMed
  11. EPUAP/NPIAP/PPPIA. (2019). Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline (Haesler, E., ed.). internationalguideline.com