Question

Management can be summarised using the acronym TIME. Briefly explain what the acronym stands for:

30.1)   TISSUE

30.2)   INFLAMMATION AND INFECTION CONTROL

30.3)   MOISTURE BALANCE

30.4)   EDGE/ EPITHELIAL ADVANCEMENT

Answer 1

Ans) Management can be summarised using the acronym TIME.

30.1).Tissue, non-viable or deficient:

- The overall appearance of the wound
bed indicates the ‘health’ of the tissue
within the wound bed.
- Devitalised tissue provides an ideal
environment for microbial growth and,
in most cases, should be removed to
expedite healing.
Key actions:
» Mechanical debridement (e.g.
Debrisoft®) is recommended1
» Use a moisture-donating dressing
(e.g. ActiFormCool®) to soften
remaining devitalised tissue (if
needed) between dressing changes

Infection, inflammation or biofilm:
- Wounds contain bacteria, which may
proliferate and cause infection —
delaying healing, and increasing pain,
exudate and malodour.
- Even where infection is not apparent,
healing may also be impeded by the
presence of biofilm.
Key actions:
» Mechanically disrupt biofilm (e.g.
by using Debrisoft) to break it up
and allow antimicrobials to work
» After disruption, use an
antimicrobial dressing
(e.g. Suprasorb® X+PHMB)
for 2 weeks, then review

Moisture imbalance:
- Exudate is a normal part of wound
healing, and drying out can impede the
healing process.
- High levels of moisture (often
containing harmful proteases) can
break down new wound tissue and
macerate periwound skin.
Key actions:
» Dry wound: Mechanically debride
to remove loose dry skin; then
hydrate with a moisture-donating
dressing (e.g. ActiFormCool)
» High exudate levels: Mechanically
debride to reduce the body’s
automatic response to produce
moisture; then select an absorbent
dressing that retains exudate
effectively (e.g. Flivasorb®)

Edge of the wound/ non advancing, undermining:
- Lack of new, healthy tissue at the
wound edges, or the presence of rolled
edges, indicate wound healing is not
progressing normally.
- Key actions:
» Mechanically debride (e.g.
Debrisoft) encrusted exudate
at wound edges to remove local
barriers to healing
» Assess why the edge is not
progressing — consider biofilm
management (see I) or referral for
biopsy
» Protect delicate edge tissue
(e.g. dressing with Lomatuell® Pro)

Surrounding tissue:
- The wound management strategy may
effect the surrounding skin —
the condition of which can, in turn, affect
the wound healing process.
- Key actions:
» Address the causes of skin issues
» Manage hyperkeratosis/dry skin/
eczema/oedema/skin damage
» Mechanically debride hyperkeratosis
(e.g. using Debrisoft)3
» Protect the skin from further
damage in line with best practice
and local formulary guidelines
» Encourage self-care