What should wound care professionals do when a physician orders wet-to-dry dressings? Be prepared and know the facts.
Those of us in wound care know that wet-to-dry dressing are considered substandard care. Some physicians, however, commonly order wet-to-dry dressings for patients, often leaving clinicians in a tricky situation. Do you feel conflicted as to how you should respond? It can be intimidating, but with a little preparation, it doesn’t have to be. By knowing the facts about wet-to-dry dressings, as well as effective and cost-efficient alternatives, you can handle such situations with confidence. Not sure where to start? We’re here to help.
What is Wet-To-Dry?
Let’s start with some background. Wet-to-dry dressings are a non-selective form of mechanical debridement, which is a method of removing non-viable tissue from the wound. The wet-to-dry technique begins when the clinician applies gauze (moistened with sterile saline or water) to the wound bed. As the moistened gauze dries, it adheres to surface tissues. Every four to six hours, the dry gauze (not re-moistened) is firmly pulled off the wound bed at a 90-degree angle. This pulls the adhered tissue – both viable and non-viable – from the wound.
The wet-to-dry technique comes with clear disadvantages:
- As a non-selective method, it often removes healthy tissues.
- The re-injury of tissue causes bleeding and pain for the patient.
- It has the potential to leave strands of gauze behind in the wound bed. Foreign bodies in the wound can lead to granuloma formation and/or infection.
- Local tissue cooling during the evaporation period causes vasoconstriction (narrowing of blood vessels) and hypoxia (deficiency in the amount of oxygen reaching the tissues). This will impede the wound-healing and increase the susceptibility to infection.
- The removal of a dry dressing may serve as an airborne vector for bacteria.
The drawbacks above apply even when wet-to-dry is used as intended, during the inflammatory phase of wound healing. Unfortunately, wet-to-dry techniques are often used improperly over granulation and epithelialization tissues in the proliferative phase, which disturbs collagen deposition, angiogenesis (the in-growth of blood vessels) and re-epithelization. This slows down healing and increases the risk of soft tissue infection and ultimately, osteomyelitis.
Once you raise your fact-based concerns about wet-to-dry dressings, follow-up with solutions in the form of effective and cost-efficient alternatives.
Debridement. In the WCEI blog, “Wound Care and Debridement: Know the BEAMS,” we discussed debridement types:
- The selective methods – autolytic, enzymatic, and biological – remove only the non-viable tissue and are much less painful for the patient while also promoting healing.
- The non-selective methods – mechanical and sharp – can also be useful, though they can remove healthy tissue. For example, consider using sharp debridement when there is a question of underlying infection.
Remember, though, that all forms of debridement should be used only during the inflammatory phase of wound healing.
Dressings. In the days when wet-to-dry was part of standard medical education, we didn’t have the same options we have today. Gauze was king, and widely considered to be the most cost-effective option – even as new dressings were being developed. However, gauze dressings require frequent changes and are less effective in maintaining an optimally warm and moist healing environment.
Today’s dressings can insulate the wound, donate moisture, protect from bacterial invasion, and absorb high levels of exudate or stimulate tissue development as needed. Many dressings even promote autolytic debridement. By allowing longer wear times, reducing infections, and promoting more rapid wound healing, these dressings can be much less expensive than gauze over the long haul.
Ready for More?
Are you ready to find out more about wet-to-dry dressings and their more effective alternatives? WCEI instructor Don Wollheim, MD, FAPWCA, WCC, DWC, is a Wound Care Certified surgeon who completed medical school when wet-to-dry was the standard. He understands why some physicians resist the shift in thinking, and arms you with the knowledge you need to counter this resistance. View his one-hour webinar, “Wet-to-Dry Dressing: The Good, the Bad, the Options” for free with the coupon code BLOG (education credit available).
What Do You Think?
What have your experiences been with wet-to-dry dressings? Have you ever initiated a conversation with a physician or fellow clinicians about their disadvantages and alternatives? If so, how did it go? If not, do you think you will? We’d love to hear about your experiences or suggestions – please leave your comments below.
Wound Care Education Institute® provides online and onsite courses in the fields of Skin, Wound, Diabetic and Ostomy Management. Health care professionals who meet the eligibility requirements may sit for the prestigious WCC®, DWC® and OMS national board certification examinations through the National Alliance of Wound Care and Ostomy® (NAWCO®). For more information see wcei.net.