Best practices for selecting and applying wound dressings in the management of acute wounds focus on promoting a warm, moist healing environment while avoiding materials that may delay healing or increase infection risk. For surgical wounds healing by secondary intention, use an appropriate interactive dressing designed to maintain moisture and support tissue repair, avoiding gauze, Eusol, or mercuric antiseptic solutions which are contraindicated NICE NG125. Employ an aseptic non-touch technique when changing or removing dressings to minimise infection risk NICE NG125. For wound cleansing, sterile saline is recommended up to 48 hours post-surgery, after which tap water may be used if the wound is open or draining NICE NG125.
Dressings should be selected based on wound characteristics such as exudate level, location, pain, and patient tolerance, aiming to maintain a moist environment that facilitates healing and reduces dressing change frequency NICE NG125,NICE CG179. Topical antimicrobial dressings may be considered in cases with clinical infection signs, such as spreading cellulitis, but routine use of topical antimicrobials or antiseptics is not advised to prevent resistance and unnecessary exposure NICE NG125,NICE CG179.
Recent literature supports the use of hydro-responsive and interactive dressings that align with the T.I.M.E. (Tissue, Infection/Inflammation, Moisture balance, Edge of wound) framework, simplifying wound management by adapting to wound exudate and promoting optimal healing conditions Ousey et al. 2016. In paediatric acute wounds, tailored approaches that consider the child's size, mobility, and pain tolerance are essential, with novel delivery methods improving adherence and outcomes Bernabe et al. 2014. For burns and traumatic wounds, guidelines recommend dressings that protect the wound, maintain moisture, and prevent infection, consistent with the principles outlined for surgical wounds Yoshino et al. 2016.
In summary, the best practice is to use interactive, moisture-retentive dressings selected according to wound and patient factors, apply them using aseptic technique, avoid routine antiseptics or gauze, and seek specialist advice for complex wounds or those healing by secondary intention NICE NG125. Emerging evidence supports hydro-responsive dressings and patient-centred approaches to improve healing outcomes Ousey et al. 2016Bernabe et al. 2014Yoshino et al. 2016.
Key References
- NG125 - Surgical site infections: prevention and treatment
- CG179 - Pressure ulcers: prevention and management
- (Bernabe et al., 2014): Management of Traumatic Wounds and a Novel Approach to Delivering Wound Care in Children.
- (Yoshino et al., 2016): The wound/burn guidelines - 6: Guidelines for the management of burns.
- (Ousey et al., 2016): Hydro-responsive wound dressings simplify T.I.M.E. wound management framework.