Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Wound Care Dressings

Class 

  1. Films/Membranes
  2. Non-adherent
  3. Hydrogels
  4. Hydrocolloids
  5. Calcium alginates
  6. Composite dressings
  7. Foams
  8. Charcoal
  9. Hypertonic
  10. Hydrophilic fibres
  11. Antimicrobials
  12. Other devices
  13. Biologics

Class 
1. Films / Membranes

Description
Semi-permeable adhesive sheet. Impermeable to H2O molecules and bacteria

Local Wound Care

Tissue Debridement Infection Moisture Balance
+ - -

Where "+"indicates the appropriateness of the dressing to address tissue debridement, infection and/or moisture balance.
Where the local wound care situation is identified by "-", the dressing is not considered beneficial.

Care Considerations:
Indications/Contraindications

Moisture vapour transmission rate varies from film to film. Should not be used on draining or infected wounds.* Create occlusive barrier against infection.

* Use with caution if critical colonization is suspected.

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Class 
2. Non-adherent

Description
Sheets of low adherence to tissue. Non-medicated tulles

Local Wound Care

Tissue Debridement Infection Moisture Balance
- - -

Where "+"indicates the appropriateness of the dressing to address tissue debridement, infection and/or moisture balance.
Where the local wound care situation is identified by "-", the dressing is not considered beneficial.

Care Considerations:
Indications/Contraindications

Allow drainage to seep through pores to secondary dressing. Facilitate application of topicals.

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Class 
3. Hydrogels

Description
Polymers with high H2O content. Available in gels, solid sheets or impregnated gauze.

Local Wound Care

Tissue Debridement Infection Moisture Balance
++ - +

Where "+"indicates the appropriateness of the dressing to address tissue debridement, infection and/or moisture balance.
Where the local wound care situation is identified by "-", the dressing is not considered beneficial.

Care Considerations:
Indications/Contraindications

Should not be used on draining wounds. Solid sheets should not be used on infected wounds.

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Class 
4. Hydrocolloids

Description
May contain gelatin, sodium cabozymethylcellulose, polysaccharides and/or pectin. Sheet dressings are occlusive with polyurethane film outer layer

Local Wound Care

Tissue Debridement Infection Moisture Balance
+++ -/+ ++

Where "+"indicates the appropriateness of the dressing to address tissue debridement, infection and/or moisture balance.
Where the local wound care situation is identified by "-", the dressing is not considered beneficial.

Care Considerations:
Indications/Contraindications

Should be used with care on fragile skin. Should not be used on heavily draining or infected wounds.* Create occlusive barrier to protect the wound from outside contamination. Characteristic odour may accompany dressing change and should not be confused with infection.

* Use with caution if critical colonization is suspected.

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Class 
5. Calcium alginates

Description
Sheets or fibrous ropes of calcium sodium alginate (seaweed derivative). Have hemostatic capabilities.

Local Wound Care

Tissue Debridement Infection Moisture Balance
++ + +++

Where "+"indicates the appropriateness of the dressing to address tissue debridement, infection and/or moisture balance.
Where the local wound care situation is identified by "-", the dressing is not considered beneficial.

Care Considerations:
Indications/Contraindications

Should not be used on dry wounds. Low tensile strength – avoid packing into narrow deep sinuses. Bioreabsorbable.

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Class 
6. Composite dressings

Description
Multilayered, combination dressings to increase absorbency and autolysis.

Local Wound Care

Tissue Debridement Infection Moisture Balance
+ - +++

Where "+"indicates the appropriateness of the dressing to address tissue debridement, infection and/or moisture balance.
Where the local wound care situation is identified by "-", the dressing is not considered beneficial.

Care Considerations:
Indications/Contraindications

Use on wounds where dressing may stay in place for several days.*

* Use with caution if critical colonization is suspected.

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Class 
7. Foams

Description
Non-adhesive or adhesive polyurethane foam. May have occlusive backing. Sheets or cavity packing. Some have fluid lock.

Local Wound Care

Tissue Debridement Infection Moisture Balance
- - +++

Where "+"indicates the appropriateness of the dressing to address tissue debridement, infection and/or moisture balance.
Where the local wound care situation is identified by "-", the dressing is not considered beneficial.

Care Considerations:
Indications/Contraindications

Use on moderate to heavily draining wounds. Occlusive foams should not be used on heavily draining or infected wounds.*

* Use with caution if critical colonization is suspected.

 

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Class 
8. Charcoal

Description
Contains odour-adsorbent charcoal within product.

Local Wound Care

Tissue Debridement Infection Moisture Balance
- - +

Where "+"indicates the appropriateness of the dressing to address tissue debridement, infection and/or moisture balance.
Where the local wound care situation is identified by "-", the dressing is not considered beneficial.

Care Considerations:
Indications/Contraindications

Some charcoal products are inactivated by moisture. Ensure that dressing edges are sealed.

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Class 
9. Hypertonic

Description
Sheet, ribbon or gel impregnated with sodium concentrate.

Local Wound Care

Tissue Debridement Infection Moisture Balance
+ + ++

Where "+"indicates the appropriateness of the dressing to address tissue debridement, infection and/or moisture balance.
Where the local wound care situation is identified by "-", the dressing is not considered beneficial.

Care Considerations:
Indications/Contraindications

Gauze ribbon should not be used on dry wounds. May be painful on sensitive tissue. Gel may be used on dry wounds.

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Class 
10. Hydrophilic fibres

Description
Sheet or packing strip of sodium carboxymethylcellulose. Converts to a solid gel when activated by moisture (fluid lock).

Local Wound Care

Tissue Debridement Infection Moisture Balance
+ - +++

Where "+"indicates the appropriateness of the dressing to address tissue debridement, infection and/or moisture balance.
Where the local wound care situation is identified by "-", the dressing is not considered beneficial.

Care Considerations:
Indications/Contraindications

Best for moderate amount of exudate. Should not be used on dry wounds. Low tensile strength – avoid packing into narrow deep sinuses.

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Class 
11. Antimicrobials

Description
Silver or cadexomer iodine with vehicle for delivery: sheets, gels, alginates, foams or paste.

Local Wound Care

Tissue Debridement Infection Moisture Balance
+ +++ +

Where "+"indicates the appropriateness of the dressing to address tissue debridement, infection and/or moisture balance.
Where the local wound care situation is identified by "-", the dressing is not considered beneficial.

Care Considerations:
Indications/Contraindications

Broad spectrum against bacteria. Not to be used on patients with known hypersensitivities to any product components.

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Class 
12. Other devices

Description
Negative pressure wound therapy (NPWT) applies localized negative pressure to the surface and margins of the wound. Dressings consist of polyurethane or polyvinyl alcohol materials.

Local Wound Care

Tissue Debridement Infection Moisture Balance
- + +++

Where "+"indicates the appropriateness of the dressing to address tissue debridement, infection and/or moisture balance.
Where the local wound care situation is identified by "-", the dressing is not considered beneficial.

Care Considerations:
Indications/Contraindications

This pressure-distributing wound dressing actively removes fluid from the wound and promotes wound edge approximation. Advanced skill required for patient selection for this therapy.

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Class 
13. Biologics

Description
Living human fibroblasts provided in sheets at ambient or frozen temperatures. Extracellular matrix. Collagen-containing preparations. Hyaluronic acid. Platelet derived growth factor.

Local Wound Care

Tissue Debridement Infection Moisture Balance
- - -

Where "+"indicates the appropriateness of the dressing to address tissue debridement, infection and/or moisture balance.
Where the local wound care situation is identified by "-", the dressing is not considered beneficial.

Care Considerations:
Indications/Contraindications

Should not be used on wounds with infection, sinus tracts, excessive exudate, or on patients known to have hypersensitivity to any of the product components. Cultural issues related to source. Advanced skill required for patient selection for this therapy.

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