Choosing The Right Dressing

A wide variety of advanced wound care products are available to treat wounds, from simple dressing materials to sophisticated products. Selecting a wound dressing requires the clinician be knowledgeable in both the process of tissue repair during wound healing and the intended use of the dressing product selected to treat the wound.1

Dressings are used to:

  • facilitate healing
  • reduce pain
  • contain wound drainage
  • provide adequate moisture for wound healing
  • maintain normothermia in the wound bed
  • minimize bioburden
  • provide a cosmetic covering for the wound

The correct dressing will improve outcomes for wound healing. Dressing selections should be based on a complete clinical assessment addressing wound characteristics, clinical efficacy, and cost of the dressing.1

Wound Characteristics
Dressing selections should be based on the type of tissue present in the wound, wound drainage, bacterial burden, condition of the periwound skin and the wound location.2

Tissue Types: More than one tissue type can be present in a wound. Select a dressing that addresses the most prevalent tissue type in the wound bed. Necrotic tissue requires dressings that support debridement while managing wound drainage. Healthy granulating wound tissue requires dressings that support adequate moisture levels.1

Wound Drainage: Select a dressing that supports moist wound healing and manages exudate effectively. Dressings such as Hydrogels, Transparent Films and Hydrocolloids are designed to donate or retain moisture in the wound.4 Hydrogel and Transparent Film dressings work best for wounds with minimal to low wound exudate. Hydrocolloids address low to moderate exudate. Absorbent dressings such as Alginates, Foams, Gelling Fibers and Super Absorbent dressings are designed to be used for moderate to heavily draining wounds.2 Collagen dressings come in several forms and can be used for all drainage levels.

Maintain Wound Temperature: Cooling of the wound surface can impact wound healing. The cells and enzymes necessary to the wound healing process are negatively impacted by moisture loss from evaporation or inadequate moisture in the wound bed. This is due to the cooling effect moisture loss can have on the wound. Dressing removal can result in wound bed temperature variations that take over 4 hours to return to normal.7 Select wound products that minimize dressing changes and maintain wound temperature. Preparation for the dressing change can decrease the time the wound bed is exposed to room air reducing the effect of cooling on wound healing.

Bacterial Burden: Wounds exposed to bacteria can become colonized within hours of exposure to contaminents. Microbial burden in the wound can lead to delayed wound healing, infection and biofilm formation.3 Advanced wound dressings help prevent wound bed contamination. Dressings with antimicrobial additives, such as silver, help to minimize bacterial load in the dressing. Several types of antimicrobial agents are found in dressings. Silver is the most common antimicrobial additive to wound dressings and can be found in most dressing categories.6

Periwound Skin: Maintaining the health of peri-wound skin is an important part of wound dressing selection. Choose dressings that effectively manage moisture and promote skin integrity. Using a liquid skin protectant during dressing changes adds an additional layer of protection for periwound skin and can safeguard the skin from the effects of moisture and adhesive removal.

Location: Where the wound is located on the body will influence the dressing selection. Characteristics of the body such as body contour, moisture, or delicate tissue will impact the dressing choice. Some wound locations can be impacted by activity, so the adherent capabilities of the dressing should be considered.

Cost
The Agency for Healthcare Research and Quality estimates our national cost for pressure ulcer care to exceed $1.4 billion annually.5 Caregivers need to select dressings that achieve wound healing results and are cost effective. The number of dressing changes required as well as the cost of the dressing material further impact wound care costs.

References:

  1. Bennett-Madison, M., (2010). How to select a wound dressing. Clinical Pharmacist, Vol. 2. Retrieved from http://www.pharmaceutical-journal.com/files/rps-pjonline/pdf/cp201011_practice_tools-363.pdf
  2. Green, B. (2013). Wound care: Making an informed decision: how to choose the correct wound dressing. Professional Nurse Today, 17(1), 6-13.
  3. Thomas, Stephen. “A Structured Approach to the Selection of Dressings.” A Structured Approach to the Selection of Dressings. World Wide Wounds, 14 Nov. 1997. Web. 12 May 2017. Retrieved from http://www.worldwidewounds.com/1997/july/Thomas-Guide/Dress-Select.html
  4. http://www.wounds-uk.com/wound-essentials/wound-essentials-5-how-to-choose-the-appropriate-dressing-for-each-wound-type. Retrieved on June 16, 2017.
  5. Soon, S., & Chen, S. (2004). What are wound outcomes. Wounds, 16(5). Retrieved from http://www.medscape.com/viewarticle/478970_2
  6. Sood, A., Granick, M., & Tomaselli, N. (2012, April 1). Wound dressings and comparative effectiveness data – Europe PMC Article – Europe PMC. Retrieved from http://europepmc.org/articles/PMC4121107
  7. McGuiness, W., Vella, E., Harrison, D., (2004). Influence of Dressing changes on wound temperature. Journal of Wound Care, 13(9), 383-384.

Deeper Dive

Want to learn more about this topic? In addition to the reference links above, here are some great articles and resources that you can explore.

  1. https://blog.wcei.net/2009/05/temperature-effects-on-wound-healing. Retrieved on June 16,2017.
  2. https://www.wound-doc.co.uk/therapies/essentials-of-wound-healing. Retrieved on June 16, 2017.
  3. Expert Working Group, (2012). International concensus: Optimising wellbeing in people living with a wound. Retrieved from http://www.woundsinternational.com/consensus-documents/view/international-consensus-optimising-wellbeing-in-people-living-with-a-wound
  4. Sussman G. Technology update: Understanding film dressings.Wounds International 2010; 1(4). Retrieved
    from: http://www.woundsinternational.com/ product-reviews/technologyupdate-understanding-filmdressings
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