What You Should Know About Emerging Wound Care Dressings
Selecting the right wound dressing can be challenging given the wide variety of dressings on the market and the different stages of wound healing. Accordingly, these authors discuss an array of modalities ranging from hydrogels and collagen dressings to antimicrobial dressings and the use of advanced adjunctive modalities to help facilitate improved healing.
First of all, it is important to realize that the wound dressing is not the sole factor that heals lower extremity wounds. Debridement, offloading and other proper medical management all play a role in wound healing. The role of the dressing is to provide an optimal environment for that healing to take place. In the field of wound care, you will hear a motto, “it’s not what you put on, but what you take off.” This means that proper offloading (reducing pressure) and wound debridement (removing non-viable tissues) take priority before dressing selection.
The main goal for any wound care clinician is to achieve the fastest wound closure possible. Therefore, matching wound characteristics to the appropriate dressing is the first step to achieving your objective. The condition of each wound will determine the type of dressing best suited for achieving that immediate goal, whether it is exudate management, autolytic debridement, promotion of granulation tissue formation, etc.
Dressing selections can be based on many factors. Wound characteristics change over time and this requires flexibility with dressing selection as well. It is important to keep the dressings organized and minimize the inventory in your facility as most dressings have a shelf life of a few years listed on their sterile packages. One must also consider the cost of the dressing. If one is treating a hospitalized patient, the options for dressings may be limited to what is on the formulary.
Seeing patients in multiple settings and facilities can also present a challenge as one may have to change dressing orders if a patient gets transferred in the middle of treatment. Patients who are in home health situations are often further limited by access to dressings.
Current Insights On Moist Wound Healing And Medicolegal Concerns
It has been proven that a moist wound environment provides the fastest healing.1 However, wet wound beds can harbor bacterial overgrowth. On the other hand, a wound bed that is too dry can lead to tissue desiccation and the wound would not improve. The Cochrane Review, which is a widely available collection of clinical evidence, notes that hydrogels and hydrocolloids that maintained a moist wound environment healed diabetic foot ulcers faster than dry gauze dressing.1
Medicolegally speaking, Krasner and colleagues provide this insight: “National and international wound care guidelines and best practice documents mean that there is no longer a local standard of care. No matter where you practice, you will be held to a national/international standard of wound care practice. Some experts have argued that the selection of the wrong dressing is just as problematic as the administration of the wrong drug and the clinician would be just as liable in a court of law.”2 We second their statement and believe it is indeed malpractice and inappropriate to apply a dry gauze dressing or a “wet-to-dry gauze dressing” to every single wound without assessing the true needs of each patient.
Why The ‘Wet-To-Dry Gauze Dressing’ Is No Longer Acceptable
When it comes to surgery, “wet-to-dry gauze dressing” used to be the gold standard of surgical wound dressing. One would moisten gauze with saline, applying this over an open wound and then removing it forcibly after the gauze dries out. This kind of dressing change often occurs daily.