How Geographic Differences Can Impact Wound Care Protection Status

by Karen Zulkowski DNS, RN, CWS

In my last blog, I talked about cultural beliefs affecting care. But there are geographic differences in North America that do also; for example, temperature. Temperature as a concept in the Chinese culture balances hot and cold illnesses with corresponding foods. However, in macro terms outside temperature also affects care.

For instance, if the temperature is too cold a wound dressing or appliance may not adhere. Layering for warmth over a lower extremity wound dressing or NPWT device may be problematic as may the effects of cold on circulation overall. Conversely, being too warm means more perspiration and potential dehydration especially for the elderly. In many locations having the windows open means dust that can trigger asthma.

Well water versus city water is another consideration. Well water isn't tested for contaminates or minerals on a regular basis. In fact, knowing where and how to have the well tested is not common knowledge in most areas. While the person may see hard water spots, they don't see bacteria or algae that may be present in their drinking water. Some areas have high fluoride concentrations in their well water which can unknowingly lead to dental fluorosis. Wells vary in depth, and if shallow can have ground water contamination. City water can also be contaminated, but generally it has additives that kill bacteria. Most people do not know what is in their city water of if any of the additives have long term health risks. City dwellers can get their water supply from aging pipes that may leak. So even if the water has been treated by the city, what arrives at the home faucet can be contaminated. Improperly treated water can also contain bacteria that can infect any open area, wound or cut. Houses with older septic systems may have standing waste in the yard or leaching into the water supply.

Geographic differences can also impact care. In some areas of the west there are 5 persons per square mile and in Alaska this is as low as 1.2 (2010 census). Medical or dental care requires travel of long distance. This is a major problem during winter months. Therefore, much of the needed care is often provided in the home by the family or in critical access hospitals. Travel by ambulance for acute care is often over bumpy dirt roads and may mean the person has been on a hard surface for a long time (60 minutes or more) before getting to emergency care. The ER/OR time plus travel times means a higher risk of sDTI (suspected deep tissue injury) development.

When providing wound care it is important to look at the person in their entirety. Take into consideration where they live and the environmental and public health issues that may have affected their overall health. Ask who will be providing care and how they will get their supplies and medications. Wounds affect the total person and family, and sometimes what we don't know about where we live can significantly impact our health and that of our patient.

United States Census 2010. Available at: Accessed on September 9, 2013.

About The Author
Karen Zulkowski DNS, RN, CWS is an Associate Professor with Montana State University-Bozeman, teaches an online wound course for Excelsior College, and is a consultant for Mountain Pacific Quality Improvement Organization. She has served as a Research Consultant with Billings Clinic Center on Aging, and was the Associate Director for Yale University’s Program for the Advancement of Chronic Wound Care.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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