Wound Care and Dressing

Core Concepts

The moist wound healing principle

Cells involved in healing divide and migrate best in a moist environment. A dressing that maintains moisture keeps epithelial cells alive at the wound surface, prevents scab formation that blocks cell migration, reduces pain by protecting exposed nerve endings, and keeps the wound at a temperature that supports cell activity. Moisture-retentive dressings achieve this. The counterpoint: too much moisture is also a problem. Wound fluid left against healthy skin for long periods softens and breaks down the skin (maceration), which is why exudate management is a core part of dressing selection.

Assess before you dress

Every dressing change starts with observation, and the observations drive the choice of dressing:

• Wound bed: what colors are visible — red (granulation/epithelialization), yellow (slough), black (eschar)?
• Exudate: how much (none, scant, moderate, heavy), and what type (serous, sanguineous, serosanguineous, purulent)?
• Dimensions: length, width, and depth; plus tunneling (a channel extending from the wound into tissue) and undermining (erosion beneath the wound edges).
• Odor and peri-wound skin: is the surrounding skin red, macerated, or breaking down?
• Pain: both at rest and during the change.

These observations are documented in consistent terms so the next nurse can compare, and suspicious findings (such as purulent drainage, spreading redness, or new odor) are reported.

Cleansing the wound

Cleansing removes loose debris, old dressing residue, and surface bacteria without damaging new tissue. The guiding principles are gentleness and avoiding trauma: use an appropriate solution per facility policy (normal saline is a common choice), apply it with enough pressure to rinse debris away but not so much that tissue is damaged, and avoid scrubbing the wound bed. Harsh antiseptics are generally avoided on granulating tissue in many guidelines because they can harm healing cells — but specific solutions, techniques, and products are governed by orders and institutional policy. The same rule applies to gloving and technique: facilities designate clean or sterile technique for different situations, and the nurse follows the policy.

Dressing families and what they do

Dressings are chosen by matching their properties to the wound:

• Gauze dressings — the workhorse: versatile, used for packing deeper wounds (wet-to-moist packing keeps the wound bed moist and allows removal without tearing new tissue), and inexpensive. Requires careful technique.
• Transparent films — thin, adhesive, waterproof sheets that let oxygen and moisture vapor through but not liquid water. Best for superficial wounds with little or no drainage; they also allow autolytic debridement of small amounts of slough.
• Hydrocolloids — adhesive wafers that gel when they contact wound fluid, providing a moist environment. Good for shallow wounds with light to moderate drainage; also cushion and protect.
• Foams — absorbent pads for wounds with moderate to heavy drainage; they keep moisture away from the surrounding skin and provide cushioning.
• Alginates — made from seaweed-derived fibers that absorb large amounts of fluid and form a gel; excellent for heavy-draining wounds and for packing cavities.
• Hydrogels — water-based gels or sheets that donate moisture to dry wounds; useful for wounds with eschar or slough and for painful wounds, since they are soothing.
• Antimicrobial dressings — dressings impregnated with agents such as silver that reduce bacterial load; used when infection or heavy bacterial colonization is a concern, per provider order.
• Negative pressure wound therapy (NPWT) — a specialized system that applies gentle suction to the wound through a sealed dressing, removing fluid and drawing wound edges together; managed by trained clinicians per protocol.

This is a map, not a rulebook: product availability, formulations, and facility formularies vary, and the provider or wound care specialist's order takes precedence.

Matching the dressing to the wound

The practical decision framework: How much exudate? How deep? What is in the wound bed? Where is it located? A dry, shallow wound with slough wants moisture donated (hydrogel). A deep, heavily draining cavity wants absorption and packing (alginate or foam, per order). A superficial wound with no drainage wants protection (film). A wound on a pressure point wants cushioning (foam or hydrocolloid). When the wound changes — more drainage, new slough, skin breakdown around it — the dressing changes with it.

Technique, infection control, and comfort

Hand hygiene, gloves, and proper disposal are non-negotiable. The change itself should be as atraumatic as possible: remove the old dressing gently (using adhesive remover rather than pulling skin when needed), support the wound, and let the patient control pain — offer scheduled or procedural pain management per orders, and pause if the patient needs a break. Cleanse from the least-contaminated area toward the most-contaminated, and never reach across a wound with a contaminated hand or instrument. Afterward, secure the dressing so it stays in place without being so tight it impairs circulation.

Documentation and education

Documentation follows the assessment: location, dimensions, depth, tunneling/undermining, wound bed colors, exudate type and amount, odor, peri-wound skin, pain, and the dressing applied — using the facility's charting format and consistent terminology. Education completes the loop: the patient and family need to know what the wound looks like when it is healing, what to watch for (increased pain, odor, drainage, redness), and what to do — often including who to call and when. For wounds managed at home, teach the exact routine the team prescribes and make sure the person can perform it or has help.

Common Confusions