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

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

This has been a common wound care practice and treatment for many years; however, it is no longer acceptable practice and continuing to use these agents (and other similar agents) is actually harmful instead of helpful. 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. Use normal saline at a pressure between 4 and 15 pounds per square inch (psi).

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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