DRESSINGS AND WOUND-INFECTION

Wounds will readily acquire bacteria, unless protective measures are taken. The bacterial protection afforded by conventional absorbent cellulose dressings has been shown to be limited, particularly in the presence of serous exudate that may compromise dressing integrity. In addition, dressings may shed particles that remain in the wound. By contrast, many modern dressings are impermeable to bacteria, are removed completely, have been found to optimize reepithelialization rates and reduce the incidence of wound sepsis. Recently, it has been found that they could also play a role in preventing cross-contamination. Removing conventional cellulosic dressings from bacterially colonized wounds liberates wound bacteria into the air, and the numbers are slow to decline. However, using an in vitro wound model, use of the hydrocolloid dressing Granuflex (ConvaTec, Skillman, NJ) on experimentally colonized wounds resulted in significantly fewer numbers of airborne bacteria. Dispersal from wet conventional dressings was lower than from dry dressings; nevertheless, the numbers of bacteria per liter of air following removal of the hydrocolloid dressing were approximately 20% of those observed for gauze. These findings have also been confirmed in the clinic. To reduce the incidence of complications, wound care in general, and infection control procedures in particular, requires carefully disciplined team work.