Cath Lab Digest

  As we continue to use science to expose common nonsense, we ask, Have you ever seen controlled clinical trials that used gauze or impregnated gauze as a “standard of care” control? Half a century ago, we learned that chronic¹ and acute² human wounds heal faster if kept moist. Since then, considerable research showed that moist wound environments for acute or chronic, partial- or full-thickness wounds reduce infection rates,³ pain,^4,5 healing time,^5,6 and costs of care^7,8 compared to gauze. This is “old news.” In 2001, the United Kingdom’s National Institute of Clinical Excellence⁴ noted, “Adherent dressing materials such as “wet-to-dry gauze” cause pain on removal and are no longer recommended for routine use.” Even when gauze is consistently re-moistened every 4 to 6 hours to maintain a wound environment sufficiently moist to optimize healing, the process is so labor-intensive it is not cost effective.⁸ Yet studies still compare new wound products to gauze as a “standard of care.”

  Think twice before using gauze — once for the patient and once for yourself. For the patient’s sake, think of the extra pain, pain medications, exposure to organisms that quickly seep or swim through gauze, and the healing tissue it removes. For your own sake, think of the delayed healing and extra costs of care that will reduce your effectiveness as a clinician and waste the limited time and money you have to heal that patient’s wound. The credibility of well-designed studies is diminished by a gauze control that exposes patients needlessly to substandard care. Is it worth risking your reputation to participate in such studies?

  Before another day/year/decade/century slips by, let us replace the common nonsense that gauze is an acceptable standard of wound care with science-based standard wound dressings such as hydrocolloid dressings to seal and heal, hydrogels to add moisture when needed, or absorbent foam or fibrous dressings to manage excess wound fluid.⁹ Adopt an evidence-based “Golden Rule” standard of care, dressing wounds as you would wish for yourself or those you love.

References

1. Gilje O. On taping (adhesive tape treatment) of leg ulcers. Acta Dermatol Venerol. 1948;28:454.

2. Hinman CD, Maibach H., Effect of air exposure and occlusion on experimental human skin wounds. Nature (London). 1963;200:377.

3. Hutchinson JJ, McGuckin M. Occlusive dressings: a microbiologic and clinical review. Am J Infect Control. 1990;18(4)257.

4. National Institute of Clinical Excellence (NICE) Guidance on the use of debriding agents and specialist wound care clinics for difficult to heal surgical wounds. Technology Appraisal No. 24, London, 2001, reviewed 2004.

5. Wiechula R. The use of moist wound-healing dressings in the management of split-thickness skin graft donor sites: a systematic review. Int J Nurs Pract. 2003;9:S9–S17.

6. van Rijswijk L. Bridging the gap between research and practice: moist dressings are better than dry ones. Am J Nurs. 2004;104(2):28–30.

7. Kerstein MD, Gemmen E, van Rijswijk L, et al. . Cost and cost effectiveness of venous and pressure ulcer protocols of care. Dis Manage Health Outcomes. 2001; 9(11):51.

8. Colwell J, Foreman MD, Trotter JP. A comparison of the efficacy and cost-effectiveness of two methods of managing pressure ulcers. Decubitus. 1993;6(4):28–36.

9. Heyneman A, Beele H, Vanderwee K, Defloor T. A systematic review of the use of hydrocolloids in the treatment of pressure ulcers. J Clin Nurs. 2008;17(9):1164–1173.