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.
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).
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.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.
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.
All dressings used and materials needed for redressing the wounds were counted. Commercial prices of dressing materials and wages of nurses (nurse assistant, 7.00 [US $10.98] per hour; trainee, 11.25 [$17.65] per hour; registered and senior, 19.15 [US $30.05] per hour) in the various working shifts as of January 1, 2005, were used to calculate material costs.
occlusive, 6.43 [US $9.95] vs gauze, 1.85 [US $2.90]; P < .001)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.
nursing time costs per day (occlusive, 1.28 [US $2.01] vs gauze, 2.41 [US $3.78]; P < .001)
total costs per patient per day of hospital stay (7.48 [US $11.74]) when occlusive wound management was applied than for the gauze-based treatment (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.
REFERENCEThe 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.