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

2. 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.

3. 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

4. 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.

5. 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

6. 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

7. 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

8. 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.

9. 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

10. 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

11. 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

12. 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

13. Websites for Further Information on Wound Guidelines
Association for the Advancement of Wound Care (information and guidelines)
National Institute for Health and Care Excellence Guidance documents
- National Pressure Ulcer Advisory Panel
- Registered Nurses Association of Ontario Best Practice Guidelines
- Wound Ostomy Continence Nurses Society (information and guidelines)
- Wounds Canada