Sunday, January 4, 2009

Occlusive vs Gauze Dressings–an Article Review

We all have our favorite dressings for wounds. As the cost of healthcare continues to be an issue, it is good to look at the effectiveness AND cost of dressings. This recent article (full reference below) in the Archives of Surgery attempts to look at both.

They compared the gauze dressings

gauze mostly has been used in local wound care, mainly because of its low price and simplicity. The rationale behind this conventional wound management is to absorb exudation from the wound to keep it dry and clean enough to avoid bacterial contamination (also known as the wet-to-dry approach).

and occlusive dressings

Around the 1950s, a new concept of wound management was introduced. This method aimed at occluding the wound to protect against bacteria while keeping it moist to supply growth factors and prevent crust formation, which would impede wound healing.

The study was limited to wounds in adult surgical patients who were admitted to the hospital and had open wounds that required local wound care. The patients were then randomly placed into the occlusive (141 patients) or gauze-based (136 patients) local wound care.

Excluded were patients with burn wounds or ulcerating malignancies, surgically closed wounds, wounds treated with vacuum-assisted closure devices, ostomies or drain openings, and pin holes from external fracture fixation materials and patients receiving chemotherapy or local irradiation therapy or with a life expectancy less than 6 months.

Pain, costs, and healing were all accessed. In their study, few patients in either group need analgesics for dressing changes. Pain in both groups were similar. The number of dressing changes per day was, of course, lower for the occlusive than the gauze dressing group by almost half. The median time needed for each dressing application was nearly the same (4.8 min for occlusive and 5.0 min for gauze).

All dressings used and materials needed for redressing the wounds were counted. Commercial prices of dressing materials and wages of nurses (nurse assistant, {euro}7.00 [US $10.98] per hour; trainee, {euro}11.25 [$17.65] per hour; registered and senior, {euro}19.15 [US $30.05] per hour) in the various working shifts as of January 1, 2005, were used to calculate material costs.

Daily costs of occlusive dressing materials were significantly higher. Nursing time costs per day were higher when gauze was used. However, the total costs were higher for the occlusive dressing group. The number of days spent in the hospital was longer for the occlusive group than the gauze dressing group.

occlusive, {euro}6.43 [US $9.95] vs gauze, {euro}1.85 [US $2.90]; P < .001)

nursing time costs per day (occlusive, {euro}1.28 [US $2.01] vs gauze, {euro}2.41 [US $3.78]; P < .001)

total costs per patient per day of hospital stay ({euro}7.48 [US $11.74]) when occlusive wound management was applied than for the gauze-based treatment ({euro}3.98 [US $6.25]; P = .002).

Median duration of hospitalization was 18 days (IQR, 8-36 days) in the occlusive dressings group, which was slightly but significantly (P = .02) higher than the 13 days (IQR, 6-27 days) in the gauze dressings group.

There was no significant difference in wound healing time found between the two groups. The authors conclusions would support using gauze dressings over occlusive ones.

The occlusive, moist-environment dressing principle in the clinical surgical setting does not lead to quicker wound healing or less pain than gauze dressings. The lower costs of less frequent dressing changes do not balance the higher costs of occlusive materials.

REFERENCE

Occlusive vs Gauze Dressings for Local Wound Care in Surgical Patients: A Randomized Clinical Trial; Arch Surg. 2008;143(10):950-955; Dirk T. Ubbink; Hester Vermeulen; Astrid Goossens; Raoul B. Kelner; Sanne M. Schreuder; Maarten J. Lubbers

 

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3 comments:

Bardiac said...

Wow, interesting.

Bikers (erm, cyclists, not motorbikers) try to figure out what works best for road rash (keeping it moist or keeping it dry); so to see that there's actually something among real medical folks about this.

What do you suggest for road rash? (I'm thinking not serious stuff.) (Alas, it's winter, so I haven't even had the chance to go out and fall.)

rlbates said...

Bardiac, for road rash I would most often suggest using keeping it clean with soap and water, then applying a layer of vaseline or aquaphor ointment. Reapply the ointment as needed to help keep the area "supple" so it doesn't "crack" as it heals.

Bardiac said...

Thanks!