Applying Current Standards of Wound Care Practice: Improve Patient Outcomes and Save Precious Time
Submitted by Donna Boyer, RN, WCC
By applying the principles of moist wound healing, which is the current standard of practice in wound care, we have the opportunity to provide our patients with excellent care while at the same time saving precious time and resources. It's a win for everyone!
The principles of Moist Wound Healing (MWH) were first researched by Dr. George Winter in the 1960s. His research proved that if a wound is kept covered, allowing the wound bed to remain moist, the wound heals three to five times faster, is less likely to develop infection and causes less discomfort then wounds that are allowed to dry out. The wound will heal faster in a moist environment for several reasons. If a wound dries out a scab will likely form. It takes the body more time and requires more energy to break down the scab and heal the injury. A moist wound bed will enhance the migration of keratinocytes and preserve growth factors which are essential for wound healing. Autolytic debridement, the body's ability to self digest dead tissue, occurs in a moist environment which can help prevent wound infection. A moist wound bed also creates a hypoxic environment. Hypoxia in the wound promotes angiogenesis and decreases the wound pH which is inhospitable to bacteria which helps to reduce the risk of infection. Dry wounds and wounds that are infected tend to be more uncomfortable than moist, healthy wounds.
Now that we know these principles, how do we apply them to our daily practice?
I see a huge opportunity for us to make a positive difference if we consider the frequency of dressing changes. Every time a dressing is removed it results in water evaporation from the wound bed. That evaporation not only creates a drier wound bed it also reduces the wound bed temperature resulting in physiologic changes that slow down cellular activity and therefore slows the healing process. There was a time when a daily dressing change, or even a twice a day dressing change, was equated to quality wound care. In the vast majority of cases this is no longer true for the reasons we've just described. Yet, many, many clinicians are still working under this erroneous premise.
If we follow the principles of MWH, and reduce the frequency of dressing changes, not only will we be providing the best care possible to promote wound healing and prevent wound infection, we will be saving ourselves a significant amount of time and resources. This is truly a win-win situation.
It's important to follow the manufacturers' instructions for their specific products. Many advanced wound care products have the recommended wear time printed directly on the packaging. Of course there are circumstances that may warrant deviating from those recommendations. Each patient's plan of care must be individually and holistically evaluated on an ongoing basis.
In my own practice I have seen the principles of Moist Wound Healing positively impact many patients and nurses alike. I encourage you, and your integrated wound management team, to take a fresh look at wound care through the lens of Moist Wound Healing.
- Nuutila K, Eriksson E. Moist Wound Healing with Commonly Available Dressings. Advances in Wound Care Vol.10, No.12; 21 Sept 2021; https://doi.org/10.1089/wound.2020.1232
- Rippon M, Davies P, White R. Taking the trauma out of wound care: the importance of undisturbed healing. Journal of Wound Care Vol. 21, No 8; 1 Aug 2012; DOI:10.12968/JOWC.2012.21.8.359Corpus ID: 41276273
- Junker JP, Kamel RA, Caterson EJ, Eriksson E. Clinical Impact Upon Wound Healing and Inflammation in Moist, Wet, and Dry Environments. Adv Wound Care (New Rochelle). 2013 Sep;2(7):348-356. doi: 10.1089/wound.2012.0412. PMID: 24587972; PMCID: PMC3842869
- Baranoski S, Ayello E. (2020). Wound Care Essentials Practice Principles (5th ed.).Wolters Kluwer