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Wound management and nutrition

  • Good nutrition reduces the risk of pressure ulcer development, optimises wound healing, aids immune function and reduces the risk of wound infection. Adequate energy and protein sources are essential to facilitate wound healing.  Malnutrition and clinically proven deficiencies are associated with delayed wound healing and increased risk of complications.
  • All patients at risk of pressure ulcers or with chronic wounds should be screened to detect those at nutritional risk using a validated screening tool (e.g. MUST). Screening tools may not identify malnutrition in overweight/obese patients with wounds therefore clinical judgement should be used.
  • Vitamin and mineral supplements should be considered when deficiencies are confirmed or suspected. Vitamin C, Zinc and Iron are all involved in the synthesis of collagen, an essential component of connective tissue which plays a crucial role in wound healing. A once-a-day multivitamin and mineral preparation should meet these requirements. If prescribing single agent vitamins please ensure an expensive unlicensed ‘special’ is not inadvertently prescribed.
  • If a nutritionally complete sip feed is necessary, and is being prescribed and taken in a therapeutic dose i.e. twice daily, it is unlikely that a multivitamin/ mineral preparation will be required in addition.
  • See below for further guidance on supplementation
General guidance on supplementation:

Vitamin C: supplementation should provide the RNI 75mg/day in adults, (additional 35mg/day may be considered for smokers). Note: tissue saturation occurs at 200mg/day.

Iron: supplementation should provide the RNI 8.7mg/day in men (and women over 50 years of age); 14.8mg/day in women (under 50 years of age).  Regular monitoring of iron profile should be undertaken and supplementation discontinued when stores are returned to normal levels. Note: excess iron intake can cause a metallic taste, affecting appetite.

Zinc: supplementation should provide the RNI 9.5mg/day in men; 7mg/day in women.  Note: doses >40mg/day can cause toxicity. Excess zinc reduces the absorption of other vitamins and minerals, which can reduce the immune response.