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).
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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