Wound Dressings Diane L. Krasner PhD, RN, FAAN & Lia van Rijswijk DNP, RN, CWCN   Module #6 Revised September 2018

Disclaimer The Why Wound Care? education and recruitment campaign has been developed by our all-volunteer nursing and medical advisory boards. Website, logistics, marketing and exhibition support is provided by HMP with help from unrestricted educational grants from our corporate sponsors. A list of corporate sponsors can be found in the “About” tab. All educational materials were developed and are donated by our advisory board members. Neither HMP nor our corporate sponsors were involved in the selection, development, or content of these educational materials. Conflict of Interest: Dr. Diane Krasner and Dr. Lia van Rijswijk declare that they have no potential conflict of interest related to the content of this presentation. Only generic product descriptions are used.  

Objectives Appraise the general purposes of wound dressings Describe the relationship between wound characteristics and dressing selection List at least two types of dressings Correlate topical wound care to nursing concepts, nursing diagnoses and practice issues

Wound Dressings: General Purposes Protect wound against contamination and trauma Optimize local wound environment to facilitate healing Reduce pain Note: Topical care is only one of several components needed to help wounds heal. Other systemic and local factors that may need to be addressed include perfusion, pressure redistribution, nutritional support, glucose control, and caregiver/patient education. Care should be safe, effective, cost-effective and patient-centered.

Wound Dressings: Protect against Contamination and Trauma All wounds are contaminated (colonized) with regular skin bacteria. However, too many bacteria, contamination with highly infectious bacteria or the presence of necrotic tissue (slough or eschar) should be addressed by using appropriate dressings and dressing change technique. 2) Protect against trauma Friction from surfaces or clothing and dressings that adhere to the wound bed delay healing and causes pain. © AAWC Used with permission

Wound Dressings: Optimize the local wound environment to facilitate healing Necrotic tissue should be debrided (e.g. surgical, enzymatic, or autolytic [by keeping the wound moist]). For healable wounds, the wound bed should be moist at all times. Note: Dressing selection is based on wound assessment observations. As the wound status changes, the type of dressing may need to change. © AAWC Used with permission A dry cell is a dead cell

Wound Dressings: Optimize the local wound environment to facilitate healing & reduce pain Use absorptive dressings (e.g., alginates, foams or hydrofibers) and cover with moisture-retentive dressings (e.g. hydrocolloids, films, foams) Dry Use moisture donating dressings (e.g., hydrogels) and cover with moisture-retentive dressings (e.g. hydrocolloids, films, foams) Moist Wet A wet wound can cause skin maceration and frequent dressing changes which can be painful and delay healing A dry wound can be painful and cells die when dry

Wound Dressings: Optimize the local wound environment to facilitate healing & reduce pain Use moisture-retentive dressings (e.g., hydrocolloids or films) Moist Dry Wet Optimal dressing choices reduce dressing change frequency and resultant pain.

Wound Dressings Guidelines to help clinicians select optimal dressings are available. Optimal dressing choices are safe and effective: optimize the healing environment, reduce pain and suffering, and improve patient quality of life. Beitz, J.M., & van Rijswijk, L. (2010). A cross-sectional study to validate wound care algorithms for use by registered nurses. Ostomy Wound Management , 5694):46-59 Bolton, L.L., Girolami, S., Corbett, L. & van Rijswijk, L. (2014). The Association for the Advancement of Wound Care (AAWC) venous and pressure ulcer guidelines. Ostomy Wound Management, 60(11):24-66 Krasner, D.L., Sibbald, R.G., & Woo, K.Y. (2014) Wound dressing product selection: A holistic, interprofessional, patient-centered approach. In: Krasner, D.L. (Ed). Chronic Wound Care: The Essentials. Malvern, PA., HMP Communications . Downloadable at www.WhyWoundCare.com/Resources

Key Concepts Assessment Caring Comfort Ethics Evidence-based Practice Infection Infection Control Infection Prevention Pain Patient Education Perfusion Prevention Quality of Life Safety Self Care Deficit Thermoregulation Tissue Integrity

Key Diagnoses Potential for Alteration in Skin Integrity Potential for Alteration in Tissue Integrity Impaired Skin Integrity Impaired Tissue Integrity Oral Mucous Membranes, Altered Pain Knowledge Deficit r/t Self Care Deficit r/t

Key Practice Issues Patients who experience wound pain should be pre-medicated prior to dressing change (with enough time for the medication to take effect). Wound cleansing prior to new dressing application is the standard of care. Common solutions include normal saline, tap water and wound cleansers at body temperature to reduce pain. See Module 5 for more information on wound cleansing. Correct etiology is key to selecting the correct clinical practice guideline to follow for an individualized patient & wound plan of care

Websites for Further Information on Wound Guidelines Association for the Advancement of Wound Care (information and guidelines) www.aawconline.net National Institute for Health and Care Excellence Guidance documents www.nice.org.uk/guidance - National Pressure Ulcer Advisory Panel www.npuap.org - Registered Nurses Association of Ontario Best Practice Guidelines www.rnao.ca - Wound Ostomy Continence Nurses Society (information and guidelines) www.wocn.org - Wounds Canada www.woundscanada.ca/about

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