How do we decide on wound dressings?
ARTICLE WRITTEN BY SYLVIE HAMPTON
There are 3000 dressings on the market and, in order to simplify dressing selection, the following rules can apply:
Wet dressings to dry wounds
Dry dressings to wet wounds
Antibacterial dressings to wounds with odour
Superabsorbent to wounds where the exudate cannot be controlled
Foam dressings to act as secondary dressing to any of the above and to act as primary dressing on a wound that is healing
There are exceptions to these rules and these will be explained later.
A. These dressings will be any dressing that provides moisture to a dry wound to rehydrate dead tissue. Hydrogel sheets; amorphous hydrogel, hydrocolloids, honey, iodine cadexomer etc. These will moisten hard and black tissue and autolysis will be supported. The body will do the work it is designed to do.
B. The exceptions to this rule would be any completely black toe and heels of someone with arterial disease. Also, those who are dying as any rehydration of the wound would open it to infection and, consequently, a malodour.
A. If the wound is exuding, it may require a drier dressing such as hydrofibres. Any wet dressing here will increase the fluid loss and increase risk of maceration
B. A foam can be used as secondary dressing. To check when it requires changing, if the wound fluid is seen in the centre of the dressing – leave alone. If the fluid is advancing to the foam dressing edges, then change it
A. Any wound that has an odour will be colonised with bacteria and bacteria cause the odour. They have their own individual odour and anyone who has dealt with Pseudomonas (bright green fluid) will know the odour of that individual and powerful bacteria.
B. There is a difference between colonisation of a wound and clinical infection. Wounds that have redness around are not necessarily (and rarely) are clinically infected. It is usually proteolytic enzyme damage where the wound fluid has spilled over onto the good skin and burned it – or it is a simple contact dermatitis from dressing sensitivity.
C. Dressing contact dermatitis will be the shape of the dressing. Clinical infection will be an irregular shape. Draw a line around the red outer edges. If the redness spreads beyond that line, then it is an infection.
D. Colonisation is where bacteria sit in the wound, reproduce and can cause devastation, but the bacteria is not in the host. This can be treated with antibacterial dressings such as honey, iodine cadexomer, PHMB, larvae and (particularly for Pseudomonas) silver dressings.
E. Should a clinical infection be suspected, then clean the wound until the wound base is exposed, then take a swab and zig zag it over the wound, twisting it as it goes. Many GPs are no longer asking for swabs, as the results are rarely indicative of what is in the host but will show the colonising bacteria on the wound surface. Therefore, the antibiotics may not be the correct ones for any invading bacteria.
A. Super-absorbent dressings are a new and exciting method of controlling exudate loss. Some have gel centres, others have absorbent fibres. Both will receive large amounts of fluid and, when squeezed, will not allow the fluid to exit the dressing.
B. Any wound that is a problem with requiring numerous dressing changes will do well with these. The only downside is that, when filled with fluid, they are heavy.
A. Foam dressings do not interact with a wound so will not heal a wound. There is little benefit in using it as a primary dressing for a very wet, malodorous or necrotic wound. However, foam dressings are perfect for a wound that is healing (as protection) or as a secondary dressing over the primary dressing.
B. There are silicone dressings with the silicone covering the dressing face, and there are foams with silicone edges that will not tear skin on removal. Silicone reduces pain on removal of the dressing. The downside is that the silicone covered foam will not absorb fluid as easily as the non-covered.
C. There is also a film covered foam that does not absorb as much fluid as some of the silicone foams, but is an excellent choice for anyone who wishes to shower or bathe.
A. There is no reason why a Client cannot be showered when they have a wound. Bathing may be difficult due to cross contamination from or to other clients. Nevertheless, a shower leaves a ‘feel good’ feeling and the showerhead can be used to irrigate a dirty wound.
B. A clean and healthy wound should never be exposed unnecessarily or subjected to irrigation as the very fragile buds of capillary loops in the wound bed can be injured and healing delayed.
C. It is always such a temptation to peek under the dressing or to change the dressing two or three times a week. If the wound is a healing wound, this can delay healing times. If the wound is full of dead tissue and bacteria, the irrigating it will do no harm.
D. Do not use forceps to clean a wound. There are products on the market that will debride wounds if required (i.e. Debrisoft).
E. Dressings that promote autolytic debridement (wet dressings) will ensure the wound is rehydrated and debridement occurs naturally.