Transcript CON-Poster Template

Dressing Changes, Wet to Dry at UNMC Hospital
Lynne Ward, Patricia Pertuit, Svetlana Smith, and Colleen Lee.
Dana Samson, MSN and Kelly Gonzalez, PhD (clinical instructor).
University of Nebraska Medical Center, Omaha, NE
Introduction
Policy on Nursing Dressing Change, Wet to Dry
Page 1 of 1
Wet-to-dry dressing changes have been used historically as a means
for mechanical debridement of wounds, and for keeping wounds clean
and free of infection. However, the continuing use of wet-to-dry
dressing changes has been a subject of debate for the past 20 years
in nursing journals and in clinical settings. The major concerns raised
have been in relation to increased chance of infection for patients,
patient pain in relation to frequent dressing changes, patient expense
associated with skilled nursing care, and non-optimal healing
conditions.
Review of the literature for this project produced Level 2 evidence, in
the form of randomized clinical trials and guideline summaries, that
refuted these observations
Actual evidence must be produced to support ending the standard use
of wet-to-dry dressing changes; evidence-based practice maintains
support of continuing current clinical policy at UNMC.
Nursing Policy and Procedure Manual
■ System  Department
Section:
Subject:
Number:
Date Effective:
Date Reviewed:
Patient Care - Wound/Skin Care
Dressing Change, Wet to Dry
WDS-6
08/06
07/10
NURSING
DRESSING CHANGE, WET TO DRY
PURPOSE
To provide guidelines for the wet to dry dressing change.
POLICY
1. Registered nurses and licensed practical nurses may change the wet-to-dry dressing
with a physician order and when indicated (e.g., displacement, contamination).
2. Consider a wound consult if questions about dressing.
3. Notify surgical physician if significant changes or questions arise about wound
appearance.
RELATED POLICIES/PROCEDURES
The Nebraska Medical Center Policy/Procedure Manual
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Hand Hygiene, IC – 02
Prevention of Surgical Site Infection, IC – 17
Waste Handling, EC – 10
Pressure Ulcer Prevention Protocol , Wds-1
The Nebraska Medical Center Nursing Practice Guideline Manual
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Pressure Ulcer
GENERAL INFORMATION
1. Wet-to-dry dressing changes are performed utilizing the clean technique unless
otherwise ordered by physician.
2. The primary purpose of wet-to-dry dressings is to mechanically debride a wound. As the
dressing dries, it adheres to the wound and debrides the wound when the dressing is
removed.
Summary of RCAs
RCA for a Randomized Clinical Trial, “Occlusive vs Gauze Dressings for Local
Wound Care in Surgical Patients”:
The study showed no significant difference between using wet-to-dry dressing changes
and occlusive dressing on pain level or healing time, except for postoperative wounds,
where the occlusive group took longer to heal. Although more nursing time was needed
with the wet-to-dry dressings, the cost difference of the occlusive dressings still caused
overall costs to be higher for the occlusive dressings.
RCA for a Randomized Clinical Trial, “Moist wound healing compared with
standard care of treatment of primary closed vascular surgical wounds: A
prospective randomized controlled study”:
The study showed no significant difference between using an Aquacel dressing
(occlusive) or a Mepore dressing (gauze) in the length of hospital stay, comfort level, or
infection rates. There was a significant difference in the number of dressing changes
with the Mepore requiring more. Even with nursing costs factored in, the Mepore
dressing had a significant cost advantage.
RCA for a Qualitative Study, “The use of gauze: will it ever change?”
This was a compilation of results from many small studies. The article tried to guide
nurses to use hydrocolloid (occlusive) dressings instead of gauze. The cited studies
said occlusive dressings gave benefits with shorter healing time, decreases in ulcer
size, dressing changes, staff time, transportation to home visits, hospital stay length,
pain, and infection. The article did not give attention to cost factors.
RCA for a Rapid Critical Appraisal of Evidence-based Guidelines, “Standards of
wound management”
This was a comprehensive list of the latest standards for evidence based practice. This
Australian Wound Management Association (AWMA) study shows how to implement
goals of care and interventions that optimized the wound healing potential of the
individual.
RCA for a Critical Appraisal of Evidence-based Guidelines, “Wet-to-dry saline
moistened gauze for wound dressing”
The article reviewed many studies to find the best available evidence for the use of wetto-dry saline moistened gauze for wound dressing. The evidence showed that best
practice wound care should be used, the dressing should be moistened, not saturated,
with saline, the dressing should be in contact with all surfaces, but confined with the
wound margins, and the dressing should not shed fibers into the wound.
Conclusion & Recommendations
Conclusion
No current clinical research studies were found supporting the change
of existing policy, only Level 5 expert opinion articles suggesting the use
of occlusive dressings in place of gauze dressings.
Many articles did identify potential issues with use of saline-soaked
gauze dressings as patient discomfort, prolonged inflammation,
localized hypothermia, infection risk and increased costs.
Clinical studies (level 2) and Level 1 guidelines evidence support the
existing policy of wet-to-dry dressing changes. Therefore, evidencebased practice maintains support of continuing current clinical policy at
UNMC.
Recommendation
We recommend further generalized studies of wet-to-dry dressings vs.
alternative types of dressings assessing pain, infection control, healing
time, and cost effectiveness.
Gauze vs. Occlusive Dressing
In the Ubbink et al. study (2008), the researchers were able to show
that wound care using the traditional gauze dressings (wet-to-dry) were
comparable to the occlusive dressings in general healing time….
History of Wound Care
• Ancient Egypt - use of lint, animal grease, and honey as topical
treatments for wounds.
References
• The Greeks, who had a similar perspective on the importance of
wound closure, were the first to differentiate between acute and
chronic wounds, calling them "fresh" and "non-healing".
• There were limited advances that continued throughout the Middle
Ages and the Renaissance.
• Most profound advances, both technological and clinical, came with
the development of microbiology and cellular pathology in the 19th
century.
• The next advances would arise from the development of polymer
synthetics for wound dressings and the "rediscovery" of moist
wound-site care protocols in the mid 20th century.
Australian Wound Management Association. (2010). Standards for wound management.
Retrievedfromhttp://www.awma.com.au/publications/2011_standards_for_wound_management_v2.pdf
Examples of Dressing Supply Costs
In fact, the study showed that postsurgical wounds that used the gauze
dressing changes took less time to heal than the occlusive:
Healing and Management Node Group. (2011). Wet-to-dry saline moistened gauze for
wound dressing. Wound Practice and Research, 19(1), 48-49.
Jones, V.J. (2006). The use of gauze: will it ever change? International Wound Journal,
3, 79-86.
Ubbink, D.T, Vermeulen, H., Goossens, A., Klener, R., Schreuder, S.M., & Lubbers,
M.J.(2008). Occlusive vs. gauze dressings for local wound care in surgical
patients: a randomized clinical trial. Archives of Surgery, 140(10), 950-955.
Vogt, K.C, Uhlyarik, M., Schroeder, & T.V. (2007). Moist wound healing compared with
standard care of treatment of primary closed vascular surgical wounds: A
prospective randomized controlled study. Wound Repair and Regeneration, 15,
624-627.