Wound Care for Home Health Aides: Pressure Injuries, Surgical Sites, and Red Flags

What the work looks like

Home health aides and CNAs do not perform wound care in the clinical sense (cleaning and redressing surgical wounds or stage 3-4 pressure injuries is a nursing task). You observe, report, and sometimes reinforce or replace a non-sterile outer dressing when the care plan permits. You are the eyes and ears on the wound between RN visits, which may be once a week or less.

What you will see:

• Pressure injuries (decubitus ulcers): stage 1 (red, non-blanching), stage 2 (shallow open skin loss), stage 3 (full-thickness, subcutaneous fat visible), stage 4 (exposed muscle, tendon, or bone), unstageable (covered by slough or eschar), deep tissue pressure injury (purple, intact skin).
• Surgical wounds with steri-strips, sutures, or staples.
• Diabetic foot ulcers (very common on the plantar surface of the foot).
• Venous stasis ulcers on the lower legs.
• Skin tears in frail elderly skin.

Job titles: CNA, Home Health Aide (HHA), Patient Care Technician (PCT). Pay $15 to $24 per hour.

Safety and tools

Prevention is your main job:

• Reposition bedbound patients every 2 hours, chair-bound patients every hour. Document.
• Keep skin clean and dry. Change briefs promptly after incontinence.
• Use barrier cream on at-risk skin (zinc oxide, dimethicone).
• Heel protectors or a pillow under the calves (not the heels) to offload pressure.
• Nutrition and hydration matter; report poor intake to the RN.
• Never massage a red or bruised area; it damages already-compromised tissue.

Observation and reporting (call the RN same day):

• A wound getting larger.
• New or changed drainage: color (yellow, green, brown, bloody), amount, odor.
• Surrounding skin redness or warmth extending more than a half inch from the wound edge (cellulitis).
• Increased pain.
• Fever.
• Black tissue (eschar) developing where there was pink tissue before.

Dressing changes you may do (per care plan): remove the outer secondary dressing (ABD pad, gauze wrap), leave the primary dressing in place, replace with a fresh outer dressing. Gloves on. Bag the old dressing in a red biohazard bag if saturated, regular trash otherwise. Hand hygiene before and after. Do not remove a primary dressing (the one in direct contact with the wound) unless the care plan and the nurse have approved it.

Tools: non-sterile gloves, saline (for the nurse, usually), disposable measuring tape or ruler (to track wound size in cm), a phone camera for nurse updates (only with consent and per HIPAA policy), biohazard bag.

Your first exercise

Look up the NPIAP (National Pressure Injury Advisory Panel) staging illustrations. Study the visual difference between stage 1 (red, intact), stage 2 (shallow, open), and stage 3 (deep, fat visible). The staging vocabulary is what nurses and doctors use; when you can describe what you are seeing in those terms, your reports become clinically useful.

Where to go next

Build on Wound Care with CNA Fundamentals (Introduction to CNA Skills), Catheter Care (Introduction to Catheter Care), Diabetes Management (Introduction to Diabetes Management), Infection Control, Hospice Care (Introduction to Hospice Care), and Pediatric Home Care (Introduction to Pediatric Home Care). Safety: Bloodborne Pathogens, HIPAA/PHI, Hand Hygiene.