Common Wound Care Practice- Not Always Evidence-Based

Old habits die hard. Sometimes we do things a certain way simply because it is the way it has always been done. This is true even in medicine. We often get stuck in a rut of practicing a certain way through habit, and for no other reason.

Common Wound Care Practice Across the Decades

Wound care is no exception. Many healthcare professionals continue to treat and dress wounds the way it has been done for years, despite the fact that new research shows this may not be the best treatment modality for the patient. This article will examine three common myths in wound care practice that have been found to delay wound healing, increase patient discomfort, and that may place you and your employer at risk for negligence.

Betadine & Peroxide

Do Betadine and peroxide help wound healing by reducing the bacteria in the wound bed?

A clean wound, free from dead tissue and wound debris, is necessary for healing to occur. Many commercial wound cleaners have some cytotoxicity, but they have surfactant properties that are often useful. Povidone-iodine, chlorhexidine, hydrogen peroxide, and 0.25% acetic acid have been shown to interfere with fibroblast formation and epithelial growth.  The selective use of these agents, particularly povidone-iodine and chlorhexidine, should be reserved for wounds that don’t have the ability to heal or for time-limited use in wounds in which bacterial burden is more important than cellular toxicity. (Wound Care Essentials: Practice Principles 2020, p. 423).

Cytotoxic Agents

Using cytotoxic agents to cleanse wounds can increase your patient’s discomfort, as well as delay wound healing.

Dallam et al (2004) reiterate this point: “Do not use cytotoxic solutions, such as Betadine or hydrogen peroxide, to cleanse wounds. They not only deter wound healing, but they may also cause burning and cold to patient discomfort”.

Common Wound Care Practice – Gauze Dressings

Gauze dressings are an effective and cost-efficient way to promote wound healing.

Ovington (2001) states that in order for gauze dressings to provide optimal healing, they must be changed frequently or, at the very least, remoistened frequently. This is labor-intensive for healthcare practitioners or caregivers and not cost effective in today’s healthcare climate. Most importantly, gauze dressings do not support optimal wound healing. Ovington points out that the use of wet-to-dry dressings is not acceptable, as the debridement that takes place with this method of management is not selective, often removing healthy tissue and causing reinjury to the wound bed, not to mention additional pain for the patient.

Frequent dressing changes with gauze dressings will reduce wound infections.

One study has shown that bacteria are capable of penetrating up to 64 layers of dry gauze, thus negating the idea that gauze provides an effective barrier to bacteria. Frequent dressing changes only provide more opportunity for bacteria to enter the wound. In addition, the labor that is involved with 2-3 times a day dressing changes is just not feasible in many cases.

The practices mentioned are not only harmful to the patient, causing delayed wound healing and increased pain, but are also a liability risk for the practitioner and agency who use these methods of wound management. They are no longer considered best practice and are no longer the standard of care.

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  1. OK, so it was stated NOT what to do but did not give alternative care for wounds. that would have been really helpful. OK, what to do for care of a wound?

  2. Thank you for this information. It will help me backup and re~enforce best practices.

  3. I believe the studies show that in-fact Betadine is cytotoxic. Please read information at Betadine’s own website where it says, “Betadine is no longer acceptable practice and continuing to use these agents … is actually harmful instead of helpful.”

    The Agency for Health Care Research and Policy (2008) states, “Do not use providone-iodine […] s they have been shown to be cytotoxic.”

    1. Thank you for your feedback. The purpose of this article is to reduce reliance on antiquated wound care practices and encourage health professionals to use evidence-based wound management, challenging these common examples in the article.

    2. I have used Povidine Iodine for 30 years and never seen any detrimental effects, but very positive ones, so therefore very interested in finding the source of this new information.
      There is nothing on Betadine’s website that states it is harmful, when I used the link given.
      My research lead me to believe the research claiming Betadine to be cytotoxic was only done at the in vitro level, and therefore not a good basis to suddenly ban it’s use.
      If the link doesn’t work, search – karger Asian perspective on povidine iodine in wound healing.

  4. I used Blue Iodine on my deep wound doctors created and were unable to heal it. After my treatment my surgeon claimed my healing to be a miracle

  5. It is good to use Betadine on sloughy wounds or infected wound. Stop using betadine when the wound is fully granulating because of its cytotoxic effects.

  6. I have used betadine and hydrogen peroxide for decades on any finger cuts or infections. It always make a huge difference. Yes it probably does a little cell damage but it clears out infection quicker than anything else. Sorry going to continue to use. Soaking a finger right now. FYI espresso cup works well tosoak cuts up to second knuckle.

  7. Where exactly is this article “The Agency for Health Care Research and Policy (2008) states, “Do not use povidone-iodine, iodophor, sodium hypochlorite solution, hydrogen peroxide and acetic acid as they have been shown to be cytotoxic.”?
    I cannot find it on their website:
    Can anyone?

  8. Hi Linda, the article is no longer available on their website. The information has been updated with content from “Wound Care Essentials: Practice Principles 2020, p. 423”.

  9. Hi Howard, the article is no longer available on their website. The information has been updated with content from “Wound Care Essentials: Practice Principles 2020, p. 423”.

  10. In the non-acute clinical setting, we teach patients to never use alcohol, betadine, or hydrogen peroxide on healing wound beds as these are all cytotoxic. We do use betadine on eschar covered wounds.

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