Effective wound bed preparation is a cornerstone of modern wound care by helping to promote rapid healing and minimize the risk of complications such as infection. This guide provides wound care professionals with clear foundational knowledge of the evidence-based TIME framework for wound bed preparation, as well as the latest information on the principles and benefits of preparing the wound bed for optimal healing outcomes.

Preparing a wound for healing is key to ensure chronic wounds convert to healing wounds. Using the TIME mnemonic assists clinicians and bedside nurses to think critically when making decisions on treatment options. This webinar uses wound photographs paired with terminology to interpret what the wound is communicating. After reviewing the photos, various treatment options will be discussed. Presented by Martha Kelso, RN, HBOT.

Download A Fact A Day – Wound Bed Preparation and share it within your facility. This two-page fact sheet was created to support staff education on preparing the wound bed for proper healing. The print-friendly format is perfect for posting on the bulletin board or distributing to your nursing staff at in-service.

How much do you know about wound bed preparation? Take our 13-question quiz to find out!

Bacterial load/burden: Presence of bacterial pathogens in an open wound contributing to wound chronicity and persistence of inflammatory cycle. There are several points along the spectrum of bacterial presence in chronic wounds: contamination, colonization, critical colonization, infection, and sepsis.

Debridement: The procedural act of removing non-viable tissue, along with any debris, from the wound. There are multiple debridement modalities, some of which are selective for non-viable tissue and some which are non-selective (viable tissue is removed as well, e.g., mechanical debridement with gauze sponges): sharp (conservative or excisional/surgical), mechanical, autolytic, enzymatic/chemical, and biological.

Epithelial migration/epithelial resurfacing: Development and movement of epithelial cells across the surface of the wound bed/granulation tissue. This process can originate from the margin/edge and/or from any remnant dermal appendages (e.g., hair follicles).

Restoring the Wound Base: The Role of Tissue Management

Successful utilization of the TIME model for wound bed preparation requires a working knowledge of chronic wound tissue types. In addition, building on this foundational knowledge is the development of accurate wound assessment skills. These components combined will assist the clinician in implementing the appropriate interventions for each wound.

Controlling Bacterial Burden in Chronic Wounds

Bioburden in chronic wounds can be a principal contributor to inflammation, clinical wound infection, and further delayed wound healing. Clinically diagnosing infection in chronic wounds can be problematic because most individuals susceptible to developing chronic wounds are subject to physiological states that often blunt typical infectious responses in various ways. These responses include pain, erythema, febrile state, leukocytosis, edema and increased wound exudate, wound odor, etc.

Wound Bed Preparation and Therapeutic Interventions: Key Assessment Strategies

Before embarking on the journey of wound bed preparation, the goals for wound care should be carefully considered. A realistic look at the goals and expectations from the perspective of the patient as well as the wound care team is the first step in developing and implementing the appropriate plan of care. Is the wound healable? This requires that the individual’s body can support the phases of wound healing in an expected time frame. Treatment should be aggressive to prevent any delay the healing process that would stall wound healing or lead the wound to become chronic.

The Science of Healing: Wound Bed Preparation Actions and Effects

For wound healing to occur, a complex, well-defined cascade of events must take place in the body’s natural host processes. When this cascade of events is disturbed, a wound can fall into a state of non-healing or chronicity. In clinical practice, chronic wounds such as pressure ulcers, vascular ulcers, and neuropathic wounds behave differently and may be extremely slow to heal. A chronic wound, by definition, is a wound that has failed to progress through the “normal” healing process or is not responsive to management in a timely manner.