Tools: Wound Cleansing Solutions and Dressings
Do you find the choice of wound dressings downright confusing? Do not despair; you are not alone. Most health care workers find it difficult to put these products into a system. Many of our colleagues get intimidated by this seemingly chaotic amount of products we have to consider. If you scroll a little down the page, you will find chapters on all categories of wound products. Spend some time looking through these to get an overview. Many products are available in Africa, although they may be prohibitively expensive.
The variety of wound care products on the market is enormous and downright confusing. The more economic resources you have, the worse it gets. When you can afford any type of wound care product, the choices may become too much to handle. This may be considered a luxury problem. It is more serious than that, however. In the western world, many health care professionals have resigned and don't want to get involved in wound care because they feel intimidated by the choices they have to make. We like to refer to this issue as the "dressing jungle." The jungle is made of endless varieties of wound care products, and if you don\t find a path, you may easily get lost. One of the reasons for this confusion is the attitude of the producers. Each producer wants us to believe that their product is highly superior to the competitors even though both products are very similar. If we take a closer look at polyurethane (PU) foam dressings, for example, there are at least 50 variations of these alone, and they have very similar properties.
Remember that most of our dressings do not release any chemical substances into the wound. Most dressings simply absorb and retain moisture while at the same time providing a moist environment for the wound. We are trying to say that most dressings do not contain any magical healing substances. There are, of course, exceptions to this, especially in the group of antimicrobial dressings. These often contain active ingredients which influence the cells of the wound. Examples of this are silver-coated dressings or dressings containing PHMB.
Much of what we do in wound care is not evidence-based because studies on especially chronic wounds in humans are taunting to carry out. Patients with chronic wounds are a very heterogenic group, and the numbers need to treat to get reliable results are often huge. Instead, we are faced with many flawed studies in many ways and usually have included all too few patients. When looking at research done in wound care, you have to be highly vigilant and keep a critical mind. Many studies are also sponsored by the manufacturers and have to be interpreted accordingly.
Which dressings we use is very often determined by experience and personal preference. These preferences may vary quite significantly from clinic to clinic. Some institutions, for example, routinely use medical honey-based products to treat most kinds of wounds, and other clinics may never use honey and rely more on silver-based dressings. When you are trying a new dressing, our advice is to test it extensively on many patients simultaneously. This will quickly give you an appreciation of how the dressing performs. This method of trying out dressings has proved invaluable and time-saving at our clinic. Often we can determine within a few weeks if the particular dressing is something we want to have in stock regularly.
Would it not be nice if there was one dressing that would solve the needs of most wounds? We have to disappoint you - this dressing does not exist yet. If it existed, you can be sure that you would have heard of it by now. The world is shrinking due to the quick and efficient exchange of knowledge through the internet and social media. News of the "super dressing" that works well in most wounds would have spread like wildfire. You really do not have a choice other than to sit down and get a basic understanding of the different product groups and when they should,/ should not be used.
When planning what types of dressing and wound cleansers you should have in stock at your workplace, keep in mind that you do not need many different products. You can often provide excellent wound care with only 3-4 dressings in your toolbox. Remember those other aspects of wound care like off-loading, compression therapy, taking care of the peri-wound area, and revascularization are often more critical aspects than the actual dressing to be used. Dressings are a piece of the puzzle in wound care but far from the most significant part.
Video 1 This video gives a good overview of the most common dressing types available. copyright:flemingmedical.
In the following chapters, you will frequently encounter the terms "primary-" and "secondary" dressings. A primary dressing is a dressing that is placed directly on the wound bed. A polyurethane foam dressing is a typical example of a primary dressing. Sometimes the primary dressing is of such a nature that it needs to be covered by another dressing. The outer dressing is then referred to as the secondary dressing. For example, we fill a wound with gauze soaked in povidone-iodine (PI) and cover this with an absorbent dressing. The PI-soaked gauze is the primary dressing, and the absorbent dressing on the outside is the secondary dressing.
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Product groups (Chapters)