Wound Dressing Guide

promoting
healthy skin
Champions for Skin Integrity

This project was funded by the Australian Government Department of Health and
Ageing under the Encouraging Better Practice in Aged Care (EBPAC) program
The Wound Dressing Guide can be accessed online via
https://research.qut.edu.au/ccm/csi-resources/
Champions for Skin Integrity
Wound Dressing Guide
Authors: Edwards H, Finlayson K, Parker C, Kaim K, Francis M. 2019
Brisbane: Queensland University of Technology. E: [email protected]

Acknowledgements: Gibb M, Jensen R.

ISBN 978-1-921897-79-5
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Table of contents

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Low-absorbent dressings . . . . . . . . . . . . . . . . . . . . . . . 27

Medical-grade honey dressings . . . . . . . . . . . 29
2 Dressings
Odour-absorbing dressings . . . . . . . . . . . . . . . . . . . . 31
Alginates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Paraffin gauze dressings . . . . . . . . . . . . . . . . . . . . . . . . 32
Antibacterial alginate gels . . . . . . . . . . . . . . . . . . . . . . . . . 8
PHMB dressings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Cadexomer iodine dressings . . . . . . . . . . . . . . . . . . . . 9
Semi-permeable films . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Foams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Silicone dressings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Gelling fibres . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Silver dressings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
High/super absorbent dressings . . . . . . . . . . . 16
Hydrocolloids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 3 Frequently asked questions . . . . . . . . . . . . . . . . . 42
Hydrogels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
4 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Hydrophobic dressings . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Hypertonic saline dressings . . . . . . . . . . . . . . . . . . . 27

Wound Dressing Guide 1

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2 Wound Dressing Guide

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Introduction Champions for

The purpose of this resource is to provide Dressing selection is based on:

a guide on commonly available wound
• Characteristics of the wound, including:
dressing products. Wound dressings are
designed to help healing by optimising - Location
the local wound environment. There - Extent of tissue damage (depth)
is little evidence that any dressing is - Wound size
superior to another. - Phase of healing
The main reasons that we apply - Level of exudate
dressings include the following: - Pain
• To
provide rapid and cosmetically
- Odour
acceptable healing - Infection

• To remove or contain odour • Factors affecting wound healing, e.g.

• To
- Cost-effectiveness
reduce wound-related pain
• To prevent or treat infection
-

-
Patient centered concerns
Many other factors
1
• To contain exudate
• Tocause minimum distress or When performing a wound dressing it is
disturbance to the patient not uncommon that you may need to use
a combination of dressings. The dressing
Before applying any dressing you should in contact with the wound bed is known
ask yourself these questions: as the primary dressing. If a dressing is
required to absorb leakage or to secure a
• What is the action of the dressing? primary dressing, it may be referred to as
• When should it be used? the secondary dressing.
• What are the limitations or The information contained in this
contraindications to its use? resource is not exhaustive or prescriptive.
• DoI know the correct method of This source is a guide only and does not
application and removal? replace clinical judgement nor does it
constitute endorsement of any product
• Do I have sufficient knowledge about
or organisation. For specific instructions
the dressing and have I been trained to
regarding use of dressing products
use it?
always refer to manufacturer’s directions.

Wound Dressing Guide 3

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4 Wound Dressing Guide

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Alginates Champions for

What are the properties of • For

moderately to heavily
exuding wounds
alginate dressings?
• For bleeding wounds
• Alginates are made from seaweed • For
Cavities/wounds with depth
• When the dressing comes into contact or undermining
with wound fluid it absorbs the fluid and
turns into a gel like substance
When should I avoid
• Thedressing is highly absorbent—it can using them?
absorb up to 20 times its weight
• Some of the alginate dressings (calcium • Wounds with minimal exudate
alginates) have haemostatic properties • Wounds with dry, hard, necrotic tissue
and are ideal for bleeding wounds
• Third-degree burns
• Heavily bleeding wounds
In what forms are
they produced?
2
How long should I use them?
• Ropes
If the wound is draining heavily, alginates
• Sheets in varying sizes may need to be changed daily or when
there is 70% strikethrough (visible
exudate) on the secondary dressing.
When should I use them? As drainage decreases, dressing
frequency can be reduced to every two
• Filling
irregular shaped wounds such
to four days or even once weekly.
as cavities, abscesses and sinuses
(see application tips on next page) When the drainage stops or the wound
• Alginate
bed looks dry, stop using the alginate
dressings are recommended
dressing and re-evaluate the wound.
in infected wounds providing the
patient has appropriate antibiotic
coverage, and chronic wounds for their
absorbency and ability to maintain a
moist wound environment

Wound Dressing Guide 5

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Application tip Champions for
Myth
• Before using an alginate dressing in
a cavity make sure that you are able  ou can pre-moisten alginate
Y
to see (visualise) the base of the dressings before you apply
wound bed them?
• Also,
if you use more than one
piece, document clearly how many
✘ False
Reason: The action of the dressing
pieces were used
is to absorb fluid so if you moisten
Reason: The dressing may slip the dressing then it will not be able
down into the base of the wound, to absorb any fluid.
or a piece may be missed and left
there at the next dressing change. I can use creams such as
This may then act as a foreign body Flamizine™ in conjunction with
resulting in delayed wound healing an alginate dressing?
and possible wound infection
✘ False
2
• Cut the alginate dressing to the size
of the wound surface and then cover Reason: Creams such as
with a secondary dressing Flamizine™ are antimicrobials which
• To
release a large amount of silver
reduce pain during
over a very short period of time
wound dressing changes it is
(approximately 12 hours). Alginate
recommended that you moisten the
dressings are designed to stay on
dressing to make removal easier
for at least 24 hours. Also if you
and less traumatic
combine these two dressings the
• Ensure you flush all alginate fibres Flamizine™ will form a ‘scum’ over
out of the wound at each dressing the wound surface. The alginate
change as retained fibres can be dressing will also be unable to do its
reabsorbed and negatively affect job of absorbing any exudate.
wound healing

6 Wound Dressing Guide

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Dressing examples:
healthy
Granulating tissue
Champions for
Dressing Supplier
Kaltostat Convatec
Melgisorb Monlycke
ActivHeal Sutherland
Alginate Medical
Algisite M Smith & Nephew Sloughy tissue

Cut dressing to wound size. Alginate

dressings laterally wick and this may
cause the surrounding skin to macerate
and breakdown. Venous leg ulcers

A secondary dressing will be required

e.g. foam or super absorbent dressing.

Granulating tissue

ADVANTAGES DISADVANTAGES
Provides a moist environment Can only be used on exuding wounds
Keeps nerve endings moist and Dressings can sometimes adhere
can reduce pain to the wound
May be used in sinuses and cavities (if
Requires a secondary dressing
able to see the base of the wound bed)
Sometimes mistaken for slough
Moderately to highly absorbent
in the wound
Suitable for bleeding wounds Can sometimes sting or cause discomfort

Wound Dressing Guide 7

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Antibacterial alginate gels Champions for

What are the properties of Dressing examples:

antibacterial alginate gels?
Dressing Supplier
• Hydrated alginate gel embedded with Flaminal Forte FlenPharma
antibacterial enzymes including glucose Flaminal Hydro FlenPharma
oxidase also found in honey and
lactoperoxidase. The glucose oxidase
converts glucose, oxygen and water When should I use them?
from the wound exudates into peroxide
ions. The peroxide ions are captured • Infected or highly colonised wounds
by the lactoperoxidase and converted
• Wounds with offensive odour
into reactive oxygen species thereby
exerting a bactericidal effect. This • Leg and diabetic foot ulcers
category of dressings is referred to as • Pressure injuries
enzyme alginogels.

2 • Abrasions

• Cancerous wounds
In what forms are they
produced?
• Alginate gel

ADVANTAGES DISADVANTAGES
Reduces odour May need a secondary dressing
Absorbs exudate May cause maceration
Some patients experience transient
Reduces bacteria
stinging or burning on application
Provides moist wound environment

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Cadexomer iodine dressings Champions for

What are the properties of In what forms are they

cadexomer iodine dressings? produced?
• Madeup of micro beads that contain • Paste

0.9% iodine • Powder

• The
cadexomer base absorbs exudate, • Sheet
swells and forms a gel
• Iodine
is released progressively into
the wound When should I use them?
• Iodine
exerts an antimicrobial effect
• Low to heavily exudating wounds
and bacteria are removed from the
wound surface by the process of • Can be used on infected wounds
capillary action

Application tip When should I avoid

using them?
2
• If
applying paste onto the wound,
remove the plunger from a 2ml
• During pregnancy or lactating women
syringe, put paste into the back of
• People with thyroid disease
the syringe, reapply the plunger
and gently squirt onto the wound • Suspected iodine sensitivities
surface. This will aid in more
accurate application of paste and
prevent cross contamination. How long should I use
• Alternatively,
you could moisten a them for?
cotton-tip and apply a small amount
of paste to the moist cotton tip and • Review every two weeks
then apply to wound • Treatmentduration should not
• Oryou could apply required exceed three months
amount of paste on to the surface • Until
clinical signs of infection are
of a secondary dressing and apply resolved i.e. nil odour, healthy red
directly to wound. Be careful not to granulating tissue, nil slough and not
apply onto the surrounding skin. hot to touch

Wound Dressing Guide 9

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Dressing examples:
healthy
Sloughy tiussue Champions for
Dressing Supplier
Iodosorb Ointment Smith & Nephew
Iodosorb Powder Smith & Nephew
Iodosorb dressing Smith & Nephew
(aka Iodoflex)
Venous leg ulcer

Diabetic foot ulcer

2 ADVANTAGES DISADVANTAGES
Contraindicated during pregnancy
or lactating women
Iodosorb paste and Iodoflex conform Contraindicated for people with
to the wound bed thyroid disease
Contraindicated for people with
suspected iodine sensitivities
The maximum single application
Absorbs exudate is 50 gram so cannot be used over
large wounds
Converts to a gel and promotes moist Transient stinging or burning
wound healing on application
Iodine is progressively released into the
Will require a secondary dressing
wound bed
Reduces the pH of the wound, enhancing
the antimicrobial effect

Effective at removing slough

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Foams Application tip Champions for
• If
the foam is non-adhesive the
dressing can be held in place with
What are the properties of tape, netting, tubular retention
foam dressings? bandage or undercast padding
• If
exudate levels are high this can
• Foam dressings are made from a
variety of different materials cause the surrounding skin to
macerate. To prevent this, skin
• Foamdressings are hydrophilic which preparation creams or protective
means that they attract fluid which aids barrier films may aid in protecting
in absorption the surrounding skin. Alternatively
• Foamsare not interactive, rather they you could consider a multilayered
are used for exudate absorption, absorbent dressing.
padding and to maintain thermal • Foams can be used in conjunction
temperature in the wound with other dressings to increase
absorption. For example, you could

In what forms are they

combine an alginate or a gelling
cellulose fibre with a foam.
2
produced?
• Foam dressings are available in a
variety of shapes, sizes and thicknesses When should I use them?
• They are available in sheets or cavity • Low to heavily exuding wounds
filling shapes
• Granulating and epithelialising wounds
• Foams
can come with an adhesive
boarder or as a non adhesive
When should I avoid
• Foamscan be impregnated with
chemicals such as antimicrobials, using them?
surfactants, or ibuprofen.
• Avoid
if known sensitivities to any of the
foam’s additives or components

Wound Dressing Guide 11

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Dressing examples:
healthy
Myth Champions for
Dressing Supplier
Allevyn Smith & Nephew  ou can apply a hydrogel under
Y
a foam dressing?
Biatain Coloplast
Lyofoam Monlycke ✘ False
Sutherland
ActivHeal Foam Reason: The action of the dressing
Medical
is to absorb fluid. If you moisten the
dressing with a hydrogel it will then
not be able to absorb any fluid.

Note the raised

Granulating
granulation
tissue.
tissue. A
polyurethane
2 foam dressing
will help
Dry, fragile
compress
surrounding skin
the tissue.

Chronic venous leg ulceration

ADVANTAGES DISADVANTAGES
Available in many different shapes and
The moist wound environment may not
sizes, non occlusive and semi occlusive/
be enough to allow autolysis to occur
water repellent dressings
May macerate the peri wound skin if it
Facilitates a moist wound environment
becomes saturated
Some of the foams e.g. cavity foams will
Highly absorbent
require a secondary dressing
Provides protection
Conforms to uneven body surfaces

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Gelling fibres Champions for

What are the properties When should I avoid

of gelling fibre dressings? using them?
• Gellingfibre dressings absorb exudate • Dry wounds
vertically. This aids in preventing the • Wounds with dry, hard, necrotic tissue
surrounding skin from becoming too
wet and causing damage to it.
How long should I
use them for?
In what forms are they
produced? • The dressing may be continued as long
as there is enough exudate
• Packing ribbon • If
there is low or nil exudate then an

2
• Sheets in varying sizes alternative dressing may be required
• If
the dressing is adhering to the wound
surface then an alternative dressing will
When should I use them? be required

• Moderate to highly exuding wounds

• Infected wounds
- There are gelling fibre dressings
which contain silver and are suitable
for infected wounds

Wound Dressing Guide 13

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Application tip Champions for
• When packing a cavity with a
gelling cellulose fibre dressing it
is advisable to leave a ‘tail’ of at
least 2cm at the surface of the
cavity to enable easier removal of
the dressing (see picture right). If
more than one piece is used, clearly
record how many pieces were used.
Reason: The dressing may slip
down into the base of the wound
and be left there at the next
dressing change, resulting in
Cavity right elbow. When packing ensure that
the dressing acting as a foreign a tail of at least 2cm at the wound surface is
body, which can result in delayed exposed to enable easy dressing removal.
wound healing and possible wound

2 infection
• Gelling
cellulose fibre dressings do
not need to be cut to the size of
the wound
• Because this dressing covers the
wound edge, as the edge heals
and dries the dresing will often stick,
(see p.13)

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Dressing examples:
healthy
Champions for
Granulating tissue
Dressing Supplier
Aquacel Convatec
Aquacel Extra Convatec
Durafibre Smith & Nephew
ActivHeal Sutherland
AquaFibre Medical

Gelling cellulose fibre dressings do not

need to be cut to the size of the wound.

2
Sloughy tissue

Mixed venous and arterial leg ulceration to the

right medial malleolus

ADVANTAGES DISADVANTAGES
Can only be used on wounds producing
Provides a moist wound environment
moderate to large amounts of exudate
Aids in preventing breakdown of the If there is not enough exudate the
surrounding skin dressings can adhere to the wound
Conformable: therefore can be applied to Requires a secondary dressing e.g.
irregular shaped wounds multilayered absorbent dressing, foam
The moist environment aids in the
The dressing may be mistaken for slough
debridement of slough and necrotic
in the wound
tissue

Wound Dressing Guide 15

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High/super absorbent dressings Champions for

What are the properties

of high/super absorbent Myth
dressings?  igh/super absorbent
H
dressings do not stick to the
• Madefrom a variety of materials with
wound bed.
an inner absorbent core capable of
containing moderate to high amounts
of exudate
✘ False
Reason: If the wound exudate
• Somedressings are coated with low- ‘dries out’ then the fluid may
adherent materials to reduce risk of adhere to the wound surface and
adhesion to the wound the dressing. When the dressing is
• Somehave a hydrophilic wound removed it can cause trauma to the
contact layer to facilitate transmission wound and also cause pain to the
of exudate into the dressing away from patient

2 the wound surface

Solution:
Consider an alternative
In what forms are they ✔ dressing or an interface to
produced? reduce risk of adhesion. Moisten
the dressing to decrease pain on
• Mostly non-adherent removal

• Broad range of sizes

When should I stop?

When should I use them?
• When exudate levels have reduced and
• Moderately to heavily exudating a less absorbent dressing is indicated
wounds

When should I avoid using

them?
• Low levels of exudate

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Dressing examples:
healthy
Application tip Champions for
• If
the absorbent dressing is non Dressing Supplier
adhesive the dressing can be Exudry Smith & Nephew
held in place with tape, netting, Mextra Monlycke
an undercast padding or tubular Sutherland
retention bandage Relevo
Medical
Zetuvit Plus Hartmann
Lohmann &
Vliwasorb
Rauscher
Sutherland
DryMax
Medical

A high/super absorbent dressing would be used as a

secondary dressing to absorb exudate.

Note the
maceration to
the surrounding
skin. A barrier
preparation
2
will assist in
protecting the
periwound.

Leg ulcer with high levels of exudate

ADVANTAGES DISADVANTAGES
Must be removed carefully as the
Reduce risk of maceration dressing is only low adherent not
non- adherent
Promotes moist wound healing Generally not suitable for dry or low
environment exudating wounds
If fluid dries then the dressing may
adhere to the wound
Some require fixation to secure

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Hydrocolloids Champions for

What are the properties of When should I use them?

hydrocolloid dressings?
• Wounds producing low to moderate
• Hydrocolloidsare a type of dressing levels of exudate
containing gel-forming agents, such • Maybe used as a primary dressing
as sodium carboxymethylcellulose or used as a secondary dressing with
(NaCMC) and gelatine a gelling fibre or alginate against the
• Hydrocolloidsare self adhesive and wound surface
water repellent
• In
the presence of wound exudate, When should I avoid
hydrocolloids absorb liquid and form using them?
a gel
• Hydrocolloidsare not recommended

2
for infected wounds
In what forms are
they produced?
How long should I use
• They are available in all shapes them for?
and sizes to accommodate small
and large wounds and there are • Hydrocolloid dressings only need
varying thicknesses depending on changing every three to five days, if they
exudate levels start leaking, or are 70% full of exudate

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Dressing examples:
healthy
Application tip Champions for
• When applying a hydrocolloid the Dressing Supplier
skin surface should be clean and dry Duoderm Convatec
• The dressing should be measured Comfeel Coloplast
to allow about a one inch (2.5cm) Replicare Smith & Nephew
margin from the wound edge
• After
you apply the dressing hold the Skin barrier wipes can be applied to
dressing in place with the palm of the surrounding skin for protection from
your hand (the warmth will assist the becoming too wet (macerated) and
dressing to mould to the skin) breaking down.
• Tryto avoid over stretching or too
much tension when applying the
dressing as this may cause trauma
Granulating tissue
such as blistering or breaks to the
surrounding skin
• If
the edges of the dressing keep
rolling the dressing may be secured 2
with adhesive tape, netting,
undercast padding or tubular
retention bandage Dry surrounding skin

Venous leg ulcers

Wound Dressing Guide 19

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ADVANTAGES DISADVANTAGES
healthy
Champions for
Care should be taken when using
Waterproof which allows patients to
hydrocolloids as they can encourage the
shower
growth of anaerobic bacteria
Absorbs low exudate Use with caution on fragile or
compromised skin as the adhesive may
cause trauma
Gel that forms from the wound fluid May be difficult to keep in place
provides a moist wound environment
Reduces pain Sometimes have a distinctive malodour
that is mistaken for pus
The moist environment promotes the
formation of new tissue

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Hydrogels When should I use them?
Champions for
Hydrogels can be used on wounds that
What are the properties have minimal to moderate exudate
of hydrogels?
• Gel
sheets can be used on flat, low-
• Hydrogelshave a high water content profile wounds.
and contain insoluble polymers • The
gel in the tube can be used on low
• Theyare designed to hydrate the to moderately exuding wounds and
wound and promote autolytic necrotic sloughy wounds
debridement • Hydrogel impregnated dressings are
non woven gauze that is impregnated
In what forms are they with gel. It is useful for packing low-
exuding cavity wounds
produced?
Hydrogels are available as: When should I avoid
using them?
• A gel in a tube (amorphous gel)
• Flexible sheets • Highly exudating wounds
2
• Hydrogel impregnated gauze • Sinusesor cavities where you cannot
visualise the entire base of the wound
bed
• Avoid
if you are intending to use an
absorbent dressing such as a foam
dressing
Reason: The foam will absorb the gel

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Dressing examples:
healthy
Application tip Champions for
• If
the surrounding skin looks Dressing Supplier
fragile or compromised it might
Amorphous Gels
be beneficial to use a skin barrier
preparation before applying the gel SoloSite Smith & Nephew
Duoderm gel Convatec
• Apply a moderate amount of gel on
Intrasite gel Smith & Nephew
the wound surface only. Try to avoid
Purilon gel Coloplast
getting the hydrogel onto the good
skin. ActivHeal Sutherland
Hydrogel Medical
Reason: It will result in macerating Normlgel Monclycke
the surrounding skin causing skin
breakdown Gel Sheets
Curafil Covidien/Kendall
• Make sure that you note the
manufacturer’s recommendations for Aquaclear Hartmann
storage and single use application Hydrosorb Hartmann
Lohmann &
2 • Some hydrogels contain
preservatives and can be used
Suprasorb G

Gel Impregnated
Rauscher

for multiple applications up to

28 days. Check manufacturer’s Intrasite Gel Smith & Nephew
recommendations. conformable
• Hydrogel dressings generally need Skin barrier preparations can be applied
to be changed daily. to protect the surrounding skin from
becoming too wet (macerated) and
breaking down.

Necrotic tissue

Arterial ulcer

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ADVANTAGES DISADVANTAGES
healthy
Champions for
Provides a moist wound environment Cannot be used if you cannot visualise
for cell migration all of the wound base
Rehydrates necrotic eschar which
Some of the dressings may require a
helps in its removal without harming
secondary dressing
good cell growth
Some gel sheets allow you to visualise
Maceration of the surrounding skin
the wound through the dressing
Reduces pain by keeping nerve Some people experience sensitivity
endings moist to the preservatives

Wound Dressing Guide 23

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Hydrophobic Dressings Champions for

What are the properties of Application tip

hydrophobic dressings?
• Do not use in combination with
• Hydrophobic dressings attract bacteria ointments and creams containing
and fungi to the dressing removing lipids as these will reduce the
them from the wound surface. The effectiveness of the product
hydrophobic coating on the dressing
is made from dialkylcarbamoylchloride
(DACC), a synthetically produced
derivative of a naturally occurring
When should I use them?
hydrophobic fatty acid.
• Infected or highly colonised wounds
• Fungal infections
In what forms are they
• Sinuses and abscesses
produced?
2 • Gel impregnated sheets Dressing examples:
• Absorbent pad
Dressing Supplier
• Gauze
Cutimed Sorbact BSN Medical
• Ribbon gauze Cutimed Sorbact BSN Medical
Gel

ADVANTAGES DISADVANTAGES
Reduces odour May need a secondary dressing
Absorbs exudate May cause maceration

Some patients experience transient

Reduces bacteria and fungi
stinging or burning on application

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Hypertonic saline dressings Champions for

What are the properties of When should I avoid

hypertonic saline dressings? using them?
• Cottonand/or synthetic gauze are • If the wound is painful
impregnated with hypertonic saline in • Dryhypertonic dressings are not
either a dry or wet form recommended for dry wounds or
• The
hypertonic solution creates an hardened eschar
osmotic action to cleanse the wound • Should not be used on bleeding or
by wicking away necrotic tissue and potentially bleeding wounds
purulent debris
• Avoid if bone, tendon or muscle is on
• The
hypertonic properties will inhibit view
bacterial growth
• Painful wounds

In what forms are they

produced?
When should I stop? 2
• Shouldbe discontinued in healthy
• Sheets
granulating or epithelising wounds
• Packing ribbon
• Gel

When should I use them?

• Moist necrotic wounds
• Draining and infected wounds
Application tip
• For optimal results the dressing
should be changed two to three
times per day
• A secondary absorbent dressing will
be required to secure the dressing

Wound Dressing Guide 25

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Dressing examples:
healthy
Champions for
Dressing Supplier
Mesalt Molnlycke
HypergelDressing Molnlycke
Curity Covidien/Kendall

Infected diabetic foot ulcer

Necrotic tissue

2
Sacral stage IV pressure ulcer

ADVANTAGES DISADVANTAGES
Reduces odour May cause stinging or discomfort
Dry formulations are not recommended
Maintains a moist wound environment
for dry wounds
Promotes removal of loose slough or
Increased dressing changes
eschar
Absorbs exudate and bacteria Will require a secondary dressing

Reduces wound oedema

Can reduce hypergranulation

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Low-absorbent dressings Champions for

What are the properties of

low-absorbent dressings? Myth
 ow-adherent dressings do not
L
• Made from a variety of materials such
stick to the wound bed.
as cotton/acrylic fibres & knitted
viscose ✘ False
• Some dressings are coated with low- Reason: If the wound exudate
adherent materials e.g. aluminium or ‘dries out’ then the fluid may
perforated films. The “plastic film” adhere to the wound surface and
is present to prevent the dressing the dressing. When the dressing is
adhering to the surface of the wound removed it can cause trauma to the
and is perforated to allow the passage wound and also cause pain to the
of exudate from the wound into the patient
body of the pad

In what forms are they

Solution:

✔ Consider an alternative 2
dressing. For example soft
produced? silicones for skin tears may be more
appropriate. Moisten the dressing to
• With and without adhesive tape decrease pain on removal
• Non occlusive and occlusive dressings
When should I stop?
When should I use them? • Whenthe dressing is unable to contain
the exudate and is requiring frequent
• Dry to medium exudating wounds
dressing changes
• To protect surgical incisions
• When the wound is fully healed and
• To protect recently healed wounds there is there is no risk of wound
breakdown

When should I avoid

using them?
• Moderately to highly exudating wounds

Wound Dressing Guide 27

 Low-absorbent dressings continued pr

Dressing examples:
healthy
Champions for
Dressing Supplier
Melolin Smith & Nephew
OpSite Post op Smith & Nephew
Primapore Smith & Nephew
Interpose Multigate
Telfa Covidien

2
Abdominal laparoscopy sites

ADVANTAGES DISADVANTAGES
Must be removed carefully as the dressing
Cheap
is only low adherent not non-adherent
Easy to use Skin maceration
Generally not suitable for highly
exudating wounds
If fluid dries then the dressing may
adhere to wound

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Medical-grade honey dressings Champions for

What are the properties of When should I avoid

honey dressings? using them?
• Comprisedof 82% carbohydrate, • Allergies to bees
enzymes and amino acids • Hypersensitivity reactions
• Acidic
pH between 3.2-4.5, which is • Transient
stinging/burning on
low enough to be inhibitory to many application
pathogens
• Medical-grade honey has been
sterilised When should I stop?
• Has antibacterial activity
• Should
only be used for short
• Is
regulated by pharmaceutical periods of time
standards and registered for medical
• Whenclinical signs of infection

2
purpose
are not apparent

In what forms are

they produced?
• Gels

• Ointments

• Sheets

When should I use them?

• For
use on infected or highly
contaminated wounds and
malodorous wounds

Wound Dressing Guide 29

 Medical-grade honey dressings continued pr

Dressing examples:
healthy
Champions for
Dressing Supplier
Medihoney Comvita
Apinate Dressing Comvita
Manuka Honey Comvita
Activon Tulle Advancis Medical
Algivon Advancis Medical

Mixed venous & arterial leg ulcer

ADVANTAGES DISADVANTAGES
If honey is not sterile there is a perceived
Promotes moist wound healing risk of wound contamination from the
presence of clostridium botulism
Promotes autolytic debridement May cause pain

Has an antimicrobial activity Could lead to skin maceration

Requires a secondary dressing

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Odour-absorbing dressings Champions for

What are the properties of Dressing examples:

odour-absorbing dressings?
Dressing Supplier
• Contain
activated charcoal which CarboFlex Convatec
absorbs odour, bacteria and exudate Lyofoam C Monlycke
Carbonet Smith & Nephew
• Mayalso contain silver and/or have Actisorb Plus Systagenix
an absorbant layer

In what forms are they

produced?
• Foams

2
• High/super absorbent pads
• In combination with alginates

When should I use them?

Fungating breast cancer
• Infected or highly colonised wounds
• Malignant/fungating cancerous wounds
• Wounds with offensive odour

ADVANTAGES DISADVANTAGES
Reduces odour May need a secondary dressing
Absorbs exudate Must not be cut

Can be used as a primary dressing

Wound Dressing Guide 31

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Paraffin gauze dressings Champions for
(Non-medicated and medicated with antiseptics)
What are the properties of When should I use them?
paraffin gauze dressings?
• Paraffingauze dressings impregnated
• Openmesh, cotton, rayon, viscose with antiseptics should only be used
or gauze with clinical signs of infection if the
person has the appropriate antibiotic
• Impregnated
with white or soft paraffin
coverage. The antiseptic contained in
and/or medicated antiseptic
medicated paraffin gauze dressings is
usually not in high enough quantities
to result in antimicrobial effect and you
In what forms are they would therefore need to consider an
produced? alternative product.

2
• Sheets in a variety of sizes
When should I avoid
• Some dressings are impregnated with
antiseptics e.g. chlorhexidine, povidine
using them?
iodine, silver
• Some paraffin gauze dressings may
leave paraffin or fibres in the wound
Myth which may act as a foreign body and
resulting in delayed wound healing
 ntiseptic paraffin gauze
A
dressings can be applied at
any time. When should I stop?
✘ False • If
the dressing is adhering to the
Reason: Research has wound surface
demonstrated that antiseptics
• If
the patient is experiencing pain or
are detrimental to cells in wound
discomfort
healing and should not be applied
to post-surgical wounds. However • If the patient has sensitivities
prudent use of antiseptics may be
indicated in the presence of heavy
bacterial colonisation or infection

32 Wound Dressing Guide

Paraffin gauze dressings continued pr

Dressing examples:
healthy
Champions for
Dressing Supplier
Bactigras (with Smith & Nephew
Chlorhexidine)
Inadine (with Systagenix
Iodine)
Xeroform Kendall
(with Bismuth
Gravel rash on an elbow Tribromophenate)
Adaptic Systagenix
Atraumann Hartmann
Jelonet Smith & Nephew

2
Skin graft on a leg ulcer

Paraffin gauze dressings aid in keeping

the skin graft moist.

ADVANTAGES DISADVANTAGES
Reduces adhesion and allows
Requires a secondary dressing
non-traumatic removal
Provides a moist environment that
Does not absorb exudate
facilitates epithelial cell migration
Requires frequent dressing changes
to ensure they do not dry out and cause
damage to good cells when dressing
is removed
Some products can shed fibres into the
wound which can act as a foreign body

Wound Dressing Guide 33

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PHMB dressings Champions for

What are the properties of When should I avoid

PHMB dressings? using them?
• PHMB (Polyhexamethylene Biguanide) • Sensitivity to the product
is a gentle yet effective broad • No response to therapy
spectrum antimicrobial agent which
is effective against gram positive and
Dressing examples:
negative organisms including some
strains of MRSA
Dressing Supplier
Prontosan Wound B Braun
Gel (hydrogel)
In what forms are they AMD (foam) Covidien/Kendall
produced? Telfa AMD Island Covidien/Kendall
Dressing
• Foams

2 • Low-adherent

dressings
primary contact
Excilon AMD drain
sponge (gauze)
Kerlix AMD
Covidien/Kendall

Covidien/Kendall
(gauze roll)
• Adhesives and non-adhesives
Tielle Foam Systagenix

When should I use them?

Application tip
• Infected
wounds in combination with
• Ensuredressing is at least 1.5cm to
systemic oral antibiotics
2cm larger than the wound margins
• Highly colonised wounds

ADVANTAGES DISADVANTAGES
Reduces odour May require fixation to secure dressing
Maintains a moist wound environment
Absorbs exudate and bacteria
Can reduce hypergranulation

34 Wound Dressing Guide

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Semi-permeable films Champions for

What are the properties In what forms are they

of semi-permeable film produced?
dressings?
• Sheets
which come in different shapes
• Semi-permeable film dressings are and sizes
made from a thin sheet of polyurethane
coated with a layer of adhesive When should I use them?
• They
are generally clear, adherent, and
• Suitable for superficial and shallow
non-absorbent
wounds
• They
allow moisture, vapour and gases
• Canbe used as a secondary dressing
to escape but are also impermeable
(water resistant) to liquids to secure a dressing

Application tip
When should I avoid
using them? 2
• The dressing should be measured
to allow a margin of approximately • Should
not be used on fragile or
2.5cm – 5cm margin from the comprised skin as it may cause trauma
wound edge when removed
• Gently
lay the dressing over the • Exuding wounds
wound; avoid wrinkling the dressing
• Tryto avoid over stretching or too
much tension when applying the
dressing as this may cause trauma
such as blistering or breaks to the
surrounding skin
• When removing a transparent
film from the skin gently stretch
the dressing to break the contact
adhesive bond, this will result in less
pain for the patient

Wound Dressing Guide 35

 Semi-permeable films continued pr

Dressing examples:
healthy
Myth Champions for
Dressing Supplier
 ransparent films are standard
T
OpSite Flexigrid Smith & Nephew
treatment in the management of
Tegaderm 3M
skin tears
Mefilm Monlycke
✘ False
Reason: It is important to assess
the patient’s surrounding skin
before applying a transparent film.
Transparent films strongly adhere to
dry skin. When it is time to remove
the transparent film dressing it can
cause trauma to the good skin by
tearing it.

Abdominal laparotomy incision

Solution:
2 ✔ A silicone dressing may be
more appropriate for this type of
skin as it is non adherent to the
wound and surrounding skin

ADVANTAGES DISADVANTAGES
Exudate may pool under the dressing
Permeable to gases
and macerate the surrounding skin
Care must be taken when removing the
Allows some moisture vapour to be
dressing as it can cause trauma to the
evaporated from the wound
good surrounding skin
Can reduce pain by keeping nerve
Reaction/sensitivity to adhesive
endings moist
Allows inspection of wound
through dressings

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Silicone dressings Champions for

What are the properties of When should I use them?

silicone dressings?
• Toprevent trauma to the wound and the
• Siliconesare polymers (long-chains) surrounding skin
with a structure that consists of • To reduce pain during dressing removal
alternate atoms of silicone and oxygen
• Traumatic wounds
with organic groups attached to the
silicone atoms • Prophylaxis
of skin radiotherapy burns
and prophylaxis for pressure injuries
• Siliconedressings are made from a
particular family of solid silicones, which • Toaid in the treatment of hypertrophic
are soft and tacky. These properties scars and keloids
enable them to adhere to dry surfaces
• Asoft silicone dressing is a dressing
coated with soft silicone as an adhesive
When should I avoid
using them?
or a wound contact layer

• Siliconedressings can be used on

2
infected wounds as long as there is the
In what forms are they
appropriate antibiotic coverage
produced?
• Some silicone products contain silver
Silicone dressings are produced as: for use on infected wounds
• If sensitivity to the product develops
• Silcone
foams with adhesive and non-
adhesive borders
• There
are silicone sheets with no
absorbent dressings attached
• There are also semitransparent films
with silicone as the interface

Wound Dressing Guide 37

 Silicone dressings continued pr

Dressing examples:
healthy
Application tip Champions for
• Because silicone dressings are quite Dressing Supplier
tacky they can make application
Sheet
difficult. If you wet your fingers or
forceps then handle the dressing Mepitel Molnkycke
this will prevent it from sticking Askina SilNet B Braun

• Thesilicone sheet does not have to Foam with adhesive

be cut to wound size. It can lie on Mepilex Border Molnkycke
the good skin and this can aid in Allevyn Gentle Smith & Nephew
dressing removal Border
Biatain Silicone Coloplast
Foam
Askina DresSil B Braun

2 Fragile surrounding skin

Skin tear

ADVANTAGES DISADVANTAGES

Easy to apply Cost

Not recommended for persons with

Reusable
allergies to silicone products
Atraumatic to the wound and Some silicone products require a
surrounding skin secondary dressing

Decreased pain on removal

38 Wound Dressing Guide

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Silver dressings Champions for

What are the properties of When should I use them?

silver dressings?
• Clinically
infected wounds or critically
• Silverdressings are a broad spectrum colonised wounds
antimicrobial agent and come in a • To
reduce the risk of wound infection
variety of mediums including foams, and to treat infected wounds
alginates and gelling cellulose fibres
• Toprovide sustained antimicrobial
• Theyachieve their antimicrobial action activity
by generating and releasing silver into
the wound in the presence of wound
exudate. Silver is a potent antimicrobial. When should I avoid
• Silverdressings are active against a using them?
variety of micro-organisms including
Staphylococcus aureus, methicillin- • Patients with known hypersensitivity to
resistant Staphylococcus aureus
(MRSA), Pseudomonas aeruginosa and
any of the components of the product.
If signs of a sensitivity reaction develop 2
vancomycin-resistant enterococi (VRE) during use, treatment should be
discontinued.
• Silver has anti-inflammatory properties
• Healthy granulating wounds with no
signs of critical colonisation or infection
In what forms are they
produced?
When should I stop?
• Silver-based dressings come in the
• Shouldonly be used for short
form of:
periods of time, two to three weeks
- Alginates
to reduce the risk of resistance.
- Gelling fibres The length of treatment should be
- Foams determined by the response of the
- Films wound and the individual.
- Hydrogels
- Parafin gauze

Wound Dressing Guide 39

 Silver dressings continued pr

Dressing examples:
healthy
Application tip Champions for
• The wound must be producing Dressing Supplier
enough exudate to activate the Biatain Ag Coloplast
silver. If the wound is dry the silver Aquacel Ag Convatec
dressing should be moistened with Mepilex Ag Monlycke
water to activate the silver. Do not
Acticoat Smith & Nephew
moisten with normal saline as this
Johnson &
will deactivate the silver. Actisorb Plus
Johnson
• Do not wet/pre-moisten alginate Atraumann Ag Hartmann
or gelling cellulose fibre silver Silvercel Systagenix
dressings
• Avoid using zinc or paraffin on the
wound as this may also deactivate
or reduce the effectiveness of the
silver

2
Silver dressings can be used on wounds with
clinical signs and symptoms of a wound infection
in combination with systemic antibiotic usage

ADVANTAGES DISADVANTAGES
Silver is a broad spectrum antimicrobial Should not be used with other
and is effective against MRSA & VRE antimicrobials
Do not use with normal saline

May mask the signs of infection

Should only be used for short periods

40 Wound Dressing Guide

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Champions for

Wound Dressing Guide 41

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Frequently asked questions Champions for

How do you stop a bleeding When doing a dressing how

wound and what dressings do I know when I need to
should be applied? use an aseptic technique or
a clean technique?
Answer
When an individual sustains a traumatic Answer
injury which results in bleeding the Aseptic technique includes strategies
following steps should be applied: which prevent the transmission of micro-
1. Apply direct pressure to the wound organisms and involves the use of sterile
surface for at least 10 minutes. equipment, fluids and dressings.

2. While applying pressure and, if Clean technique adopts the same

appropriate, elevate the limb above control of infection principles to prevent
the level of the heart. the transmission of microorganisms

3
but clean (rather than sterile) single use
3. Once the bleeding has subsided
gloves and/or tap water that is safe to
apply a cold pack to cause the bloods
drink is used.
vessels to vasoconstrict.
Once the bleeding has ceased, assess Aseptic technique is required when the
the wound type e.g. skin tear*. client is immunosuppressed, or when
the wound enters a sterile body cavity
The wound may initially be dressed (eg. nephrostomy tube).
with an alginate dressing if bleeding is
problematic as some alginates act as
haemostats. A secondary dressing will be
required to absorb exudate.
* Refer to the Champions for Skin Integrity Folder
for guidelines summary for skin tears

42 Wound Dressing Guide

Frequently asked questions continued pr

When should I use povidone What is exudate?

healthy
Champions for
iodine on a wound?
Answer
Answer Exudate is derived from fluid that has
Povidine iodine is an antiseptic. Generally leaked out of blood vessels and closely
the use of povidine iodine is appropriate resembles blood plasma.
for acute and superficial wound care use, Exudate contains a variety of substances
including simple burns and abrasions. including water, electrolytes, nutrients,
It is useful because it destroys viruses, inflammatory mediators, white cells,
yeasts, fungi and bacteria. protein–digesting enzymes, growth
Povidine iodine should not be used factors and waste products.
for the cleansing of clean granulating As a wound goes through the normal
wounds as it can damage tissue. phases of healing exudate is required to
Evidence also suggests that antiseptics promote wound healing.
such as povidine iodine are ineffective in
the presence of organic material such as

3
pus, slough, and necrotic tissue within
wounds.

Povidine iodine should only be used

in the treatment of acute superficial
wounds.

Antimicrobials, such as povidine iodine,

should not be used immediately on post-
operative wounds.

Wound Dressing Guide 43

 Frequently asked questions continued pr

What do the terms granulating, epithelising, slough and

healthy
Champions for
necrotic tissue mean?
Answer
Granulating, epithelising, slough and Epithelising/ Pink wound
necrotic tissue are all terms to describe
Appearance:
tissue present in the wound bed.
• final stages of healing
Granulating/Red Wound • pinky white tissue that migrates form
Appearance: wound edges or from the remnants of
hair follicles within the dermis
• bright red tissue
• superficial
• varies
in size, shape and amount of
• light exudate
exudate produced

Red granulating wound Epithelial tissue on a donor site

Red granulating wound

44 Wound Dressing Guide

Frequently asked questions continued pr

Sloughy/Yellow wound Necrotic / Black Wound

healthy
Champions for
Appearance: Appearance:

• coveredor filled with yellow • dehydrated, dead tissue

viscous tissue. • can be dry or moist
• collection dead cellular debris. • can
completely cover surface of the
wound or present as small patches at
base or margins of the wound

3
Black necrotic tissue

Sloughy tissue

Sloughy tissue

Wound Dressing Guide 45

 Frequently asked questions continued pr

How can I tell if a wound is What is a primary and

healthy
Champions for
getting better or worse? secondary dressing?
Answer Answer
A primary dressing is the dressing which
A healthy wound:
goes directly onto the wound surface
• Is pink or ruddy beefy red in colour e.g. hydrogel, alginate or hydrofibre.
• Has no obvious smell A secondary dressing is the dressing
• Exudates small to moderate amounts of that goes on top of the primary
clear or serous (light yellow) fluid dressing. A secondary dressing can be
used for a number of reasons including
• Surrounding skin is warm, (not hot or
extra absorption or securing a dressing
cold) to touch, is pink and healthy-
in place.
looks like normal skin
• No pain
• Free of infection

3 • Overtime a healthy wound may show a

reduction in pain, odour and/or exudate

• A
reduction of 30% wound area in four
weeks is indicative of a healing wound

Unhealthy wounds may be:

• Very malodouress (offensive smell)

• Greenish in colour, necrotic or covered
in thick yellow slough
• Producing large amounts of exudate
• Surrounding skin is red and hot to
touch
• Usually very painful or increasing pain
• Person feels systemically unwell,
increasingly tired, lacks interest in food
and normal activities of daily living,
feverish or hot/cold sweats

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Champions for

Wound Dressing Guide 47

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References Champions for
Australian Wound Management Association. 2011. Position Sussman C, Bates-Jensen B. 1998. Wound Care: A
Document: Bacterial impact on wound healing – from collaborative practice manual for physical therapists and
contamination to infection. AWMA. nurses. Maryland: Aspen Publishers.

Baranoski S. 2008. Choosing a wound dressing, Part 1. Thomas S. 2003. Soft silicone dressings: frequently asked
Nursing, 38:10-12. questions. www.worldwidewounds.com/2003/october/
Thomas/Soft-Silicone-FAQ.html
Barnaoki S. 2008. Choosing a wound dressing, Part 2.
Nursing, 38:14-15. Ulcer and Wound Management Expert Group. 2012.
Therapeutic Guidelines: Ulcer and Wound Management,
Beele H et al. 2012. Expert consensus on a new enzyme Version 1. Melbourne: Therapeutic Guidelines Ltd.
alginogel. Wounds UK, 8:64-73.
World Union of Wound Healing Societies. 2004. Principles
Carville K. 2007. Wound Care Manual. 5th Ed. Osbourne of Best Practice: Minimising pain at wound dressing-related
Park: Silver Chain Foundation. procedures. A consensus document. London: MEP Ltd.

Fletcher J. 2007. Dressings: cutting and application guide. World Union of Wound Healing Societies. 2019. Consensus
www.worldwidewounds.com/2007/may/Fletcher/Fletcher- Document: Wound Exudate. Wounds International
Dressings-Cutting-Guide.html
Wound Healing and Management Node Group. 2012.
Hess C. 2000. Clinical Guide: Wound Care. 3rd Ed. Evidence Summary: Wound infection – silver products and
Pennsylvania: Springhouse Corp. biofilms. Joanna Briggs Institute.

International Wound Infection Institute. 2016. Wound Wound Healing and Management Node Group. 2012.

4 infection in clinical practice. Wounds International.

NPUAP, EPUAP, PPPIA. 2014. Prevention and treatment

of pressure ulcers. Haesler E. (Ed) Osborne Park, WA:
Evidence Summary: Wound management: dressings –
alginate. Joanna Briggs Institute.

Wounds Australia. 2016. Standards for Wound Prevention

Cambridge Media. and Management. 3rd Ed. Osborne Park, WA: Cambridge
Media.
Probst A et al. 2012. Cutimed Sorbact made easy. Wounds
International, 3(2).

Selim P. 2000. The use of antiseptics in wound management:

A community nursing focus. Primary Intention, 63-66.

Sibbald RG. 2012. Special considerations in wound bed

preparation 2011: An update. Would Council of Enterostomal
Therapists Journal, 32:10-30.

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