Due to technological advances there has been an explosion in new wound care dressings in recent
years, which can leave nurses baffled as to which dressing to use on which wound. Here,
Kirsty Mahoney takes us through the various dressing options and outlines the criteria that
should be used when trying to choose the right product for a particular wound type.
How to choose the correct dressing...
BACKGROUND
Before 1960, wound dressings were
mainly limited to Gamgee and dry
gauze (Jones, 2006). It was believed
that allowing the wound to dry and
form an eschar was an effective
environment for healing (Turner
et al, 1986), and that a dry wound
would facilitate the death of bacteria
(Hinman and Maibach, 1963).
These beliefs were challenged by
the publication of a study by Winter
(1962), into how a moist wound-
healing environment had accelerated
healing rates in an acute animal
model. Winter’s research attracted
a lot of interest and his findings
became the basis for the concept of
moist wound healing; one which
has influenced many manufacturers
to develop the range of modern
dressings (Jones, 2005).
Since Winter’s findings, our
understanding of the wound-healing
process has continued to expand and
there has been a huge increase in
the number of products designed to
support wounds along the healing
continuum. However, the pure
variety and amount of dressings
that clinicians can be faced with
can make choosing the right one a
daunting task.
With the NHS under constant
pressure to provide cost-effective
treatment (Hamilton, 2008), it is
extremely important for nurses to be
able to justify the use of wound care
products and ensure that they are
used correctly and appropriately.
However, there is a lack of good
quality evidence to aid decision-
making around dressing selection,
(National Prescribing Centre, 2010)
and to recommend one dressing
over another (Palfreyman et al,
2006). Dressing selection should,
therefore be based on promoting
moist wound healing, addressing
issues identified within the wound
bed and surrounding skin, and using
the least costly dressing to meet the
requirements of the wound (Jeffcoate
et al, 2009).
However, most health
organisations have a designated
wound dressing formulary and
decision-making is influenced by
the products available and the local
prescribing guidelines.
Assessment
The cornerstone to treating a patient
with a wound is to undertake
an holistic assessment.Without
an assessment, as well as the
identification of any underlying
pathologies or potential barriers to
healing, wound care can become a
series of ritualistic dressing changes,
and become costly and ineffective.
A comprehensive wound
assessment can be divided into
patient-related factors and wound-
related factors. Patient related factors
start with identifying any underlying
conditions or circumstances that
may need to be addressed before
the wound will start to heal — these
may include vascular or venous
disease, rheumatoid arthritis, diabetes,
immunosuppressive or autoimmune
disorders, anaemia, poor nutrition,
smoking, interactions with medication,
immobility, and psychological status.
Wound-related factors include
how the wound occurred, its
measurements, the identification
of tissue within the wound bed,
assessment of surrounding skin, pain,
exudate, and odour.
Accurate documentation and
reassessment of these elements will
assist in determining the progression
of the wound and alert the nurse
to any circumstances — such as an
increase in the volume of exudate or
failure of the wound to decrease in
size — that may require the dressing
to be reviewed.
TIME
Overall, selecting an appropriate
wound dressing can be a complex
process and requires a good
knowledge of the wound, the
dressing and the patient. To help
clinicians identify the type of wound
bed environment they were dealing
with, Schultz et al (2003) suggested
an approach known as wound bed
preparation. Using the acronym
✔
Wound care facts...
✔
The role of a dressing is not
necessarily to heal the wound,
but to create an environment
within the wound bed that will
assist the healing process.
✔
Dressings do not always need
to be changed daily. Most
dressings can be left in place
for seven days, depending on
the level of exudate and what
you want the dressing
to achieve.
✔
It is important to consult
the manufacturer’s
recommendations, as well as
assessing the wound, before
deciding the frequency of
dressing change.
Kirsty Mahoney, clinical nurse specialist, Cardiff
andVale University Health Board
8
WOUND CARE TODAY
2015,Vol 2, No 1
DRESSING CHOICE
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