Dressing Guidelines for Infected Pressure Ulcers
For infected pressure ulcers (bedsores), use hydrocolloid or foam dressings as your primary dressing choice, as these are superior to traditional gauze dressings for reducing wound size. 1
Primary Dressing Recommendations
The American College of Physicians (ACP) 2015 guideline provides the most authoritative evidence-based recommendations for pressure ulcer dressings:
- Hydrocolloid dressings are superior to gauze dressings for reducing wound size (low-quality evidence)
- Foam dressings (hydrocellular or polyurethane) perform similarly to hydrocolloid dressings for complete wound healing (moderate-quality evidence)
- Both hydrocolloid and foam dressings should be used over traditional gauze 1
Important Caveat
The ACP guideline notes that while these dressings reduce wound size, the relationship between wound size reduction and complete healing is not well-defined. The evidence is weak (Grade: weak recommendation, low-quality evidence), but these remain the best-supported options available 1.
Adjunctive Therapies to Consider
Beyond dressings alone, the evidence supports:
Electrical Stimulation
- Use electrical stimulation as adjunctive therapy to accelerate healing in stage 2-4 ulcers (Grade: weak recommendation, moderate-quality evidence) 1
- This has the strongest evidence among adjunctive therapies
- Watch for: Skin irritation (most common adverse effect); frail elderly patients are more susceptible to adverse events 1
Nutritional Support
- Add protein or amino acid supplementation to reduce wound size, particularly in patients with nutritional deficiencies 1
- Note: This evidence comes from patients with baseline nutritional deficiencies and may not generalize to all patients
What the Evidence Does NOT Support
The guidelines explicitly state insufficient evidence for:
- Specific antimicrobial dressings for infected wounds
- Debriding enzymes compared to dressings
- Topical phenytoin
- Maggot therapy
- Negative-pressure wound therapy
- Hyperbaric oxygen
- Various biological agents 1
Practical Algorithm for Dressing Selection
- First-line: Choose either hydrocolloid OR foam dressing (they perform similarly)
- Add: Electrical stimulation if available and patient can tolerate
- Ensure: Adequate protein/amino acid supplementation if nutritional deficiency present
- Avoid: Traditional gauze dressings as primary treatment
- Reassess: If no improvement, consider multidisciplinary consultation, but maintain evidence-based dressing approach
Critical Pitfall
The question specifically asks about infected wounds, but the ACP guideline 1 does not differentiate recommendations based on infection status. The evidence reviewed focused on wound size reduction and healing outcomes, not specifically on infection control. In clinical practice, infected pressure ulcers require systemic antibiotics when indicated (cellulitis, osteomyelitis, sepsis), not just topical management. The dressing recommendations above apply to the wound care component, but infection management requires additional clinical judgment regarding antimicrobial therapy.
More recent guidelines from 2024-2025 2, 3 mention debridement, topical medications, and negative-pressure wound therapy with weak recommendations, but the 2015 ACP guideline remains the most methodologically rigorous for dressing-specific recommendations.