Wound Dressings for Infected Wounds That Don't Require Daily Changes
For infected wounds, sucrose-octasulfate impregnated dressings are recommended as they don't require daily changes and have demonstrated significant improvement in wound healing compared to placebo dressings. 1
Evidence-Based Selection of Wound Dressings for Infected Wounds
Primary Considerations for Dressing Selection
- Select dressings primarily based on:
- Exudate control
- Patient comfort
- Cost-effectiveness 1
- Frequency of dressing changes needed
Recommended Dressings for Infected Wounds
Sucrose-Octasulfate Impregnated Dressings
- Best evidence for reduced frequency of changes
- Demonstrated significant improvement in complete wound healing at 20 weeks
- Significantly faster estimated time to heal
- Increased percentage area reduction compared to placebo dressings
- Particularly effective for neuro-ischemic wounds 1
- Can be left in place for multiple days, reducing the need for daily changes
Antimicrobial Dressings with Extended Wear Time
- Medical-grade honey dressings
- Iodine-impregnated dressings
- Silver-based dressings
- EDTA-containing dressings 1
However, it's important to note that antimicrobial dressings should not be used with the primary goal of improving wound healing or preventing secondary infection, as evidence for this is limited 1.
Dressings to Avoid for Infected Wounds
- Collagen or alginate dressings (strong recommendation against use) 1
- Topical phenytoin (strong recommendation against use) 1
- Herbal or traditional medicinal preparations (strong recommendation against use) 1
Wound Management Protocol for Infected Wounds
1. Initial Wound Preparation
- Perform thorough debridement to remove necrotic tissue, planktonic bacteria, and biofilm 1
- Sharp debridement with scalpel, scissors, or tissue nippers is preferable to hydrotherapy or topical debriding agents 1
2. Infection Control
- Apply appropriate antimicrobial agents to destroy and inhibit microorganism growth
- Prevent biofilm formation and proliferation (biofilm can reform within 24-72 hours if left untreated) 1
- Consider stabilized hypochlorous acid to maintain wound pH between 4-6 1
3. Moisture Control
- For heavily exudating infected wounds: Use absorbent dressings
- For dry infected wounds: Consider hydrogels or hydrocolloid dressings 1, 2
4. Dressing Application and Frequency
- Apply sucrose-octasulfate impregnated dressing
- Change dressing every 2-5 days rather than daily 1
- Monitor for signs of deterioration that might require earlier dressing change
Important Caveats and Considerations
- The infected wound should be dressed in a manner that allows periodic inspection while maintaining a moist wound-healing environment 1
- No single dressing has proven superior for preventing infection or improving outcomes; match dressing to wound characteristics 2
- For diabetic foot ulcers, off-loading pressure is crucial to the healing process regardless of dressing choice 1
- Systemic antibiotics should be reserved for specific high-risk cases, not used routinely for all infected wounds 2
- Newer composite hydrogel dressings with antibacterial properties show promise for infected wound management but require further clinical validation 3, 4, 5, 6, 7
Remember that while the dressing choice is important, proper wound bed preparation, infection control, and addressing underlying factors (such as vascular status in diabetic wounds) are equally crucial for successful wound healing.