The wound-ostomy-continence (WOC) nurse has ordered a debridement strategy for a sacral pressure injury covered with eschar. Which order is appropriate to include in the plan?

• A. Apply collagenase to wound bed as a debriding agent and cover with gauze
• B. Debride eschar with surgical scissors
• C. Use hydrogen peroxide to debride
• D. Apply petroleum jelly to keep eschar intact

Answer: (A)

The main concept is choosing a debridement method that targets nonviable tissue while preserving viable tissue, especially when a sacral pressure injury is covered with dry eschar. Enzymatic debridement with collagenase is appropriate here because it selectively digests necrotic tissue in the wound bed without causing trauma to surrounding viable tissue. Applying collagenase directly to the wound bed allows the enzyme to break down necrotic collagen, facilitating gradual debridement, and then covering with gauze helps keep the wound moist so the enzyme can work effectively. This approach is less invasive than surgical debridement and suitable when the eschar is dry or stable and the patient isn’t a candidate for immediate sharp debridement.

Hydrogen peroxide is not used for debridement because it can damage healthy tissue and delay healing. Keeping the eschar intact with petroleum jelly would prevent debridement from progressing and is not therapeutic for this wound. Debridement with surgical scissors is more invasive and is typically reserved for situations requiring sharp or rapid removal of necrotic tissue, which is not the prescribed plan in this case.