An Eye on Advanced Wound Care Topical Interventions

After addressing assessment, documentation and interventions in my previous blogs, this installment focuses more specifically on advanced wound care topical interventions, one of the most confusing aspects of AWC.

The goal of topical intervention is to provide the ideal environment to support wound healing. Advanced wound care dressings are designed to absorb exudate in a draining wound, add moisture to a dry wound to help facilitate moist wound healing (or autolytic debridement if necessary), and reduce bioburden (when necessary).

Once the cause of the wound has been addressed (as discussed in my last blog), it is time to choose the topical intervention. The correct topical intervention can support wound healing; the incorrect topical intervention can cause a wound to stall or worse, deteriorate. Choices include:

  • Passive dressings (e.g., gauze)

  • Active dressings (e.g., silver and PHMB)

  • Devices (e.g., NPWT)

  • Biologics (e.g., leaches and maggots)

MediPlus™ Advanced Wound Care foam dressing

Foam dressings—such as the MediPlus™ Advanced Wound Care Foam dressing—are appropriate for wounds with moderate exudate.

The dressing chosen at the onset of treatment is rarely the same dressing will be used throughout the course of therapy, as the wound conditions will change—including its size, exudate amount, bioburden and tissue type (necrotic to clean to granulating)—as it closes. Thus, the dressing type should also change in order for the wound to continue moving through the phases of wound healing.

Additionally, dressing selection requires going back to the wound assessment for at least two pieces of information: size and amount of drainage (exudate). It should also fit the wound—usually with a slight overlap—to avoid leakage.

The exudate amount, type and sometimes wound bed tissue type should be assessed to determine if:

  • An absorptive dressing is needed.

  • A moisture retention dressing is needed, or a moist (donates moisture to the wound) dressing is needed.

As descriptions of exudate levels are subjective, they may overlap since there so many dressings that are appropriate for more than one exudate level. For instance:

  • Dry wound bed or dry eschar requires a moist dressing, e.g., hydrogels, transparent films or moist saline gauze (which requires many dressing changes because the dressing cannot not be allowed to dry out).

  • Minimal exudate (small amounts of drainage) needs some absorption, but not so much that it may dry out the wound bed. In this scenario, hydrocolloids, sheet hydrogels, hydrofibers and thin foams (autolytic debridement) may be used.

  • Moderate exudate (drainage is covering the wound bed) needs moderate absorption. Alginates, foams, and hydrofibers would work in this category.

  • Heavy exudate (tissues are bathed in fluid or fluid is pooling in the wound bed) needs to be absorbed and contained to prevent maceration of the tissues. Wounds with this level of exudate may require a primary and secondary dressing to control and contain the exudate. Alginates and foam, thick foam (layered) or a device like negative pressure wound therapy (NPWT) may be appropriate in this context.

  • Bioburden, patients at high-risk for infection (e.g. diabetics and the immune-compromised), and wounds that have the signs and symptoms of infection (e.g., redness, swelling, pain and increased exudate) may require a dressing with an antimicrobial component to decrease the bioburden in the wound and to kill bacteria in the exudate as it is absorbed into the dressing. Silver and PHMB are examples of antimicrobials used in dressings today.

The use of a standardized formulary and established guidelines and algorithms may:

  • Make choices less confusing.

  • Reduce the need for multiple education and training sessions.

  • Be more cost-effective, helping to reduce waste.

  • Changing the dressing protocol should be done based on the wound assessment and not from dressing change to dressing change, simply because each caregiver have a favorite dressing choice.

Additional Resources

There are many wound books on the market today that can help educate the novice wound care provider and/or serve as a reference.

I have just skimmed the surface of the topical therapy issues, and I know that this is a controversial topic, so please share your perspectives in the comments section below.

Next month’s topic will be address surveyors and citations.

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