Wound care at home: what a carer can do, and what the nurse does

The line is there to protect the wound. A surgical wound is a break in the skin, and the UK Health Security Agency's patient leaflet on monitoring surgical wounds for infection tells patients not to remove the dressing or touch the wound or a wound drain, because germs on fingers can pass into it. NICE's guideline on preventing surgical site infection, NG125, asks for an aseptic non-touch technique whenever a surgical dressing is changed or removed. That is a way of working that nurses are trained in, and it is why lifting a dressing to have a look is not something to do between visits, however well meant. The hospital discharge and post-operative care guide covers the rest of the weeks after an operation.

There is one exception worth knowing about. Some discharge advice tells the patient they may take a simple dressing off themselves after a few days. If the written advice says that, follow it exactly as written. If it says nothing, or you are not sure, ask the ward or the nurse before anybody touches it.

A carer can be trained to do a particular wound task for your relative, but only through formal delegation by a registered nurse, with the training, the sign-off and the care plan that go with it. Who can train a carer to do a healthcare task sets out how that works and who stays accountable. Pressure sores are the clearest case where the nurse leads. A carer helps prevent them by helping your relative change position and by looking at their skin, and preventing pressure sores at home, and when to call the district nurse covers the rest.

Before your relative leaves the ward, ask three things and write the answers down. Who will look at the wound, and where. When the first check is, and when the clips or stitches come out. The NHS page on recovering from a knee replacement says a nurse will take out stitches or clips after about 10 days, and other operations have their own timings. A heart bypass can leave a wound on the leg, where a vein was taken, as well as the one down the chest, and recovery at home after heart surgery covers looking after both. The third question is what number to ring if the wound worries you, in the day and at night. NICE asks hospitals to give patients and carers information on how to recognise a surgical site infection and who to contact if they are concerned, so it is fair to ask for that in writing. What to arrange before discharge day covers the rest of the list.

If getting to the surgery would be difficult, say so while your relative is still on the ward. A person who can manage a car journey on a good day may not manage it on day eight, sore and tired, and it is easier to set up a district nurse visit before discharge than after.

1. 1

   Read the discharge letter again

   First

   Look for the words district nurse, practice nurse, wound check or clip removal, a date, and a phone number. Photograph it so every carer who visits can see it too.
2. 2

   Ring the ward in the first few days

   Days 1 to 3

   Ask whether a district nursing referral was made, which team it went to and when the first visit is booked. If it was never made, ask the ward to make it now.
3. 3

   Ring the GP surgery

   The same day

   Say your relative has come home after an operation with a wound that needs nursing and that nobody has been. Ask for the district nursing team, or for a practice nurse appointment if they can get to the surgery.
4. 4

   Keep a short note of the wound

   Every day

   The date, what the dressing looked like from the outside, their temperature if you have a thermometer, and how they seemed. It gives the nurse something to work from when they arrive.
5. 5

   Use 111 when the surgery is closed

   Evenings and weekends

   If the wound looks worse and you cannot reach anyone, contact 111 by phone or at 111.nhs.uk. Do not wait for the nurse if you see the signs further down this page.

NICE's guideline on moving between hospital and home says a GP or community-based nurse should phone or visit people at risk of readmission 24 to 72 hours after their discharge. If your relative is older and frail, or lives alone, it is reasonable to mention that when you ring. Avoiding readmission after a hospital stay covers the wider first weeks, including what else sends people back into hospital.

A carer or a family member who sees your relative every day is often the first to notice, because they see the same dressing and the same person at the same time each day. Look at the skin around the dressing, notice any smell when you are close, and ask how the pain compares with yesterday. Tell the nurse on the day you notice a change, even a small one. The NHS says a wound infection after an operation is usually treated with antibiotics, and the nurse or GP can only start that once they know.

For an older person, the sign that matters most can be the one furthest from the wound. The NHS says to go to A&E or call 999 if someone suddenly becomes confused, and lists infection among the causes. A parent who was themselves yesterday and today is muddled, restless or not making sense needs help now, and it is not something to put down to the anaesthetic or tiredness. UTIs and sudden confusion in older people explains why an infection can show itself this way.

Sepsis is the reason not to wait with any of this. It is a life-threatening reaction to an infection, and its signs in an older person are not always the ones a family expects. The NHS page on sepsis lists the signs above as reasons to call 999 or go to A&E, and says not to drive to A&E. If you are worried a wound infection is turning into something more serious, ring 999 and say so.

None of this changes who does what. A slow wound, like a worrying one, goes to the nurse. What the people around your relative can do is help with the things on these cards: meals and drinks, moving a little, keeping skin clean and dry, and passing on what they notice. If your relative has diabetes, what diabetes is and how it affects the body covers the background, and the NHS quit smoking pages set out the free support.

Carers on PrimeCarers charge £18 to £25 an hour with our fee included, typically about £20, against £28 to £35 an hour through an agency. If the nights are the worry, a sleeping night starts at £130, and short-term night care after a hospital discharge covers that. Hourly care after a hospital stay sets out how a short run of visits usually looks, and caring for someone at home after surgery covers the other parts of recovery. If you need somebody there while the wound heals and to notice if it changes, you can search for carers near you and compare their rates.

PrimeCarers introduces families and self-employed carers to each other. We do not provide or manage care, and we do not check nursing registration, qualifications or training. Every carer has an identity check, a right to work check and an enhanced DBS check on the Update Service, and is interviewed online before their profile appears. Their insurance covers them while they work, separately from those checks. What a carer says about their experience of wound care is their own account on their profile, and it is worth asking about when you speak to them. A carer's experience does not make them your relative's nurse: a wound task is only theirs to do if a nurse has delegated it to them. Our pricing explains how the rate and our fee work.

If your relative goes back into hospital with the wound, tell the carer as soon as you can. The contract between a client and a carer says a visit cancelled by the client is payable in full, with unplanned hospitalisation, illness, or a reason the carer agrees as the exceptions. Notice on hourly care is 48 hours, and PrimeCarers charges nothing itself to cancel.