Hello Jaleva,
I?m afraid I will have to disprove your theories that surgeons or
medical staff forgo the use of antibiotic ointment, if indicated, AND,
that dressings are reapplied more frequently due to non-adhering
dressings. After an exhaustive search and my healthcare experience, I
conclude that your two strategies are a non-problem for medical staff.
I found no articles describing problems with ointments and dressings
falling off. Non-adherence of a dressing due to greasy ointments may
happen to us at home, when applying excess ointment, to be covered
with a band-aid, but it is not a problem for post-operative wounds
today. There are numerous medical products that can be utilized to
keep post-op dressings in place, designed to stay in place either by
adhering to dry skin further than the perimeter of the wound?s edge,
or a wrap around type of bandage. Wound dressing retention apparatus?
may be used as well.
In addition, if the wound is in a part of the body that makes
wrapping a bandage difficult, then health care personnel may decide to
use a water-soluble ointment to eliminate adherence problems. The
decision may be made to leave the wound undressed, with only an
ointment if deemed necessary. The use of water-soluble ointments, gels
or sprays may be utilized, or dressings with built in antibiotics. It
all depends on the type of patient, the type of wound, and the
location of the wound ? not due to the risk of the dressing falling
off.
Applying topical agents
?In many chronic wounds, topical agents are used to change the
environment of the wound bed. Many times, topical antibiotics or
antiseptic agents are applied. This will decrease bacteria while
allowing the natural healing processes to continue. If the wound is
too dry, moisturizing agents such as saline gels may be added. If
there is still necrotic tissue in the base of the wound, then mild
enzymes can be added to assist the body in removing this dead tissue
in allowing it to come out of the wound. The topicals are most often
applied with a cotton tip applicator or a wooden applicator stick
directly to the base of the wound. The base of the wound should be
coated with about as much topical as icing on a cake.?
http://www.maexamhelp.com/wound_dressg.htm
?Unlike ordinary gauze dressings or bandages, wound dressings are
special because they help keep an ideal level of moisture in the
wound. Decades of research have shown that the closer the wound?s
moisture level is to that of healthy skin, the better the wound?s
chance that it will heal. This concept is called moist wound healing.
Keeping wounds covered. Although you may think otherwise, keeping a
dressing in place for several days aids in the early healing process
because the wound is left undisturbed. This is important because it
provides a moist environment as well as keeps the wound at body
temperature--conditions necessary to promote healing. To explain
further, frequent dressing changes cool the temperature of a wound by
exposing it to the air. This slows the healing process until the body
can rewarm the area. So changing wound dressings less frequently
actually assists the healing process.?
?Note: Your doctor is the final judge in deciding which wound dressing
is best for your wound.?
http://www.clevelandclinic.org/health/health-info/docs/3800/3820.asp?index=12223&src=news
?Irrespective of the nature of the wound contact layer, most
dressings also require the use of a bandage or some form of adhesive
layer to keep them in position. This adhesive layer may be separate,
or be an integral part of the product itself, forming an island
dressing in which the low-adherent pad is located centrally on a sheet
of plastic, foam, or fabric, coated with adhesive. Whilst this
adhesive area does not come into contact with the wound and therefore
cannot cause damage to the newly formed tissue, repeatedly removing
and replacing such dressings can damage the surrounding skin,
especially if the patient is elderly or the skin is particularly
fragile.?
?In a second paper involving the management of hand wounds, Mepitel
was compared with paraffin gauze and Adaptic, an apertured cellulose
acetate non-adherent dressing coated with a petrolatum emulsion [16].
A total of 108 patients undergoing hand surgery were recruited to the
study and randomly assigned to treatment with one of the three
products under examination. The selected primary dressing was covered
with gauze and a crepe bandage together with a plaster of Paris splint
as appropriate.
The dressing was left intact until the first follow-up appointment.
The performance of each dressing was judged in terms of ease of
application and removal, amount of blood on secondary dressing,
appearance and condition of the wound and pain experienced during
dressing removal. Removal of Adaptic and Mepitel was reported to be
'very easy' for 88% and 84% of wounds respectively, compared to 57% of
wounds dressed with paraffin gauze. This difference achieved
significance for Adaptic but not Mepitel. Pain scores were also lower
for Adaptic-treated patients, 75% of whom experienced no pain compared
to 56% for Mepitel and 51% for paraffin gauze.
All dressings were more difficult to remove from raw tissue and
although Mepitel appeared to perform better than the other products in
this situation, insufficient numbers of subjects with this type of
wound prevented further analysis. The reason for the relatively poor
pain scores achieved with Mepitel was discussed by the authors who
suggested that this was probably due to the dressing adhering to the
intact but bruised or injured skin around the wound. The authors
concluded that of the three dressings, Adaptic had significant
advantages over the other products examined in terms of performance
and cost, and recommended it as the dressing of choice for this
particular application. Mepitel, they suggested, could be used with
advantage on wounds such as raw nail beds, as reported some years
earlier by Williams [17] who also described its use following
traumatic amputation of the fingers, and in the treatment of a
dehisced abdominal wound.?
?One Allevyn Adhesive dressing was sufficient for the treatment period
of one donor site in 18 out of the 44 patients. In six patients, half
the donor site dressed with paraffin gauze became infected and took up
to 14 days to heal, compared with the other half dressed with Allevyn
Adhesive which healed within 4 days. No infection occurred in the
trial site, suggesting that the risk of infection was reduced when
using Allevyn Adhesive for this treatment. The Allevyn Adhesive
dressing was shown to be cost-effective.?
http://www.worldwidewounds.com/2003/january/Thomas/Atraumatic-Dressings.html
?The necessary dressing changes several times a day and the
maintenance of an even moisture level in the dressings, in addition,
make considerable demands on nursing time, naturally associated with
great costs, and can only be offered to a satisfactory degree in
clinical care units disposing of a sufficiently equipped medical
staff. In ambulatory wound treatment, the use of this sort of moist
dressings is limited from the outset, because only one nursing visit
is usually scheduled per day, per patient or person in need of care.?
?Upon absorption of wound secretions, the hydrocolloid components of
the dressing start to swell and transform into a gel that expands into
the wound and maintains a moist environment. The gel remains absorbent
until the hydrocolloids are saturated. Sucking activity and absorption
capacity of the dressing thus depend on the properties and amounts of
incorporated hydrocolloid particles.
Due to the self-adhesive properties of the elastomer, Hydrocoll can be
applied to the wound like an adhesive bandage, which considerably
simplifies its handling. Upon gel formation, adhesion over the wounded
area declines, so that Hydrocoll remains attached only to the intact
surrounding skin, and is thus extremely gentle to the injured tissue.
Moreover, a protective gel-layer remains on the wound at dressing
removal, ensuring an absolute atraumatic dressing change.
Hydrocoll is self-adhesive. Because self-adhesion over the wounded
areas tends to decline, as has been mentioned before, the size of
Hydrocoll should be chosen so that the dressing exceeds the wound
edges by at least 2 cm. For larger wounds, several Hydrocoll dressings
can be applied in an overlapping manner, also exceeding the edges of
the wound by 2 cm each.?
http://www.hartmann-online.de/english/produkte/wundbehandlung/wundforum/sond1_1.htm
?A dressing is a clean cover over an incision. A gauze dressing is
secured to the skin with surgical tape. Some dressings are clear and
adhere to the skin without tape. The purpose of a dressing is to keep
the incision (or wound) clean, dry, and protected during the healing
process. A dressing also absorbs any drainage that may come from the
incision or wound. Sometimes dressings are used after a medication is
applied to the incision or wound; the dressing keeps the medication in
contact with the incision or wound.
http://patienteducation.upmc.com/Pdf/IncisionCare.pdf
You?ll find lots of information on wound care in this article, by
Hartmut Gross, M.D., FACEP, Medical College of Georgia:
?The basic principles of wound care are simple, as long as one keeps
in mind what the intent of the care being rendered is. First of all,
one must remember that the wound heals itself. If the patient is not
mortally wounded, then the wound will heal all by itself. The
physician who believes that he made the wound heal is deluding himself
and does not understand wound healing. So, what is the big deal and
what are the doctors good for if the wound is going to heal no matter
what? In essence, the objective is to restore tissue integrity, and
function, while avoiding infection and morbidity, and minimizing
scarring. To achieve this outcome, a thorough understanding of wounds
is necessary.?
http://www.mcg.edu/som/clerkships/EM/woundmgtManual.PDF
?Some wound coverings provide poor protection for the wound and
must be kept dry to ensure they continue to adhere to skin. This has
led to the development of occlusive dressings that greatly reduce the
potential for bacterial contamination and speed healing by creating a
bacteria-free moist environment, preventing the formation of scabs.
Band-Aid Liquid Bandage is a novel occlusive dressing that uses a
liquid adhesive formulation. This approach has been used successfully
in reconstructive surgery to provide suture-free superficial skin
closure, and it works rapidly to control bleeding and pain?
?Finally, patients should not self-treat any wound that requires more
antibiotic ointment than can cover the surface area of the tip of a
finger. Many patients misunderstand and apply medication to a wound
that is too large for self-treatment.?
http://scholar.google.com/scholar?hl=en&lr=&q=cache:6DLqpybQD-UJ:www.aphanet.org/JAPHA/marapr03pdfs/13-popovich-otcs_249-260.pdf+wound+dressing+%2B+adhering+%2B+neosporin
?Topical antimicrobial, antifungal, and antibiotic products are
available as ointments, impregnated into gauzes or other types of
dressings, and as sprays or powders. Some antibacterial dressings may
help decrease wound odor, although they also may emit a chemical odor
of their own.?
http://www.findarticles.com/p/articles/mi_qa3964/is_199905/ai_n8845496/pg_2
?Higher-tech dressings that can increase the time between dressing
changes are another component of the wound care program. Lower-end
dressings, like gauze, are not necessarily the best. "Many times we'll
find that gauze is the least cost-effective dressing because it has to
be changed too often," says Gill. "So we're looking at composite
dressings that can absorb drainage and provide odor control and keep
an ideal wound environment with less frequent dressing changes."?
?Even if topical antibiotics are included in the therapy, they will be
Bacitracin or Neosporin, which are both offered over the counter.
"Review of the literature feels that all it does is set the patient up
for MRSA because you're treating a broad spectrum of bugs that are
sitting on the wound," Gill says. "But unless they're there in
sufficient quantities to actually cause infection, you're just giving
antibiotics for no good reason. The other thing is, patients
oftentimes develop an allergy to long-term use with Neosporin or
Bacitracin because of the vehicle they're mixed in--(like) petroleum
jelly."?
http://www.infectioncontroltoday.com/articles/331topics.html
?May apply an antibiotic ointment, such as Bacitracin or Neosporin to
area, if not allergic.
10. Do not cover wounds on face. Leave open to air.
11. Apply a loose, sterile, non-adhering dressing, such as telfa, or
a band-aid until a firm scab forms. Then leave open to air.
12. Bathe (do not soak) or shower as usual and gently cleanse the wound daily.
13. Change dressing at least daily and it it gets wet. May need to
soak it off to avoid pulling off scab.?
http://72.14.207.104/search?q=cache:dTbrCNu7JvgJ:www.mckennan.org/hubs/ask-a-nurse/health_lib/lacerations.htm+wound+dressing+%2B+adhering+%2B+neosporin&hl=en&gl=us&ct=clnk&cd=8
?Dressings should be changed from 1 to 3 times daily, depending on
the amount of drainage. Hydrocolloids (DuoDERM; ConvaTec, a
Bristol-Myers Squibb Company, Princeton, NJ; Restore; Hollister Inc,
Libertyville, IL; RepliCare; Smith & Nephew, Largo, FL) may be left in
place for 5 to 7 days. Although transparent films (Tegaderm; 3M Health
Care, St Paul, MN; OpSite; Smith & Nephew, Largo, FL; POLYSKIN II;
Kendall, Mansfield, MA) do not adhere well to areas with skin folds,
they may have advantages when compared with hydrocolloids and
hydrogels.?
http://www.findarticles.com/p/articles/mi_qa3977/is_200209/ai_n9125760/pg_2
?CHANGE DRESSING:
? Wear time varies from 1 to 3 days according to amount of exudate.
? Easily removed with normal saline (or in the shower at home)
http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/SupportiveCare/ChronicUlceratingMalignantSkinLesions/RecommendedProducts.htm
?The vehicle in which the topical antibiotic is formulated also
provides some occlusive effect when liberally applied to a wound, but
this effect is not comparable to that provided by an occlusive
dressing. Some vehicles, such as petrolatum, may prevent the dressing
from adhering to the wound, thus lessening pain and soreness during
and after dressing changes.?
?Prophylactic topical antibiotic use makes particular sense for wounds
in which the risk of infection is high, such as those that are likely
to be contaminated (accidental wounds, lacerations, abrasions, and
burns). Because all traumatic wounds should be considered
contaminated, topical antibiotics are a logical measure to prevent
wound infection.?
When applied to skin that is free of chronic skin disorders, the
intermittent use of topical antibiotic for prophylaxis and treatment
of infection in minor skin wounds is not a clinically important issue.
There is a great need for controlled studies in individuals with
normal skin to provide the evidence needed to change the continuing
misperception that contact dermatitis is a risk with
neomycin-containing topical antibiotics. Data to date support that
this perceived risk, perpetuated by medical schools and held by a
large portion of the medical community, is grossly overstated.?
http://www.medceu.com/course-no-test.cfm?CID=997
?After application of the antiseptic, dry the wound and the
surrounding tissues, and apply an antibiotic ointment, such as
Neosporin Ointment, directly to the wound with a cotton swab to avoid
any contamination.
Select an appropriate bandage to cover the scrape with. Keep in mind
cost, location of the wound (i.e., knee) and amount of exudates. Any
hydrocolloid dressing would be appropriate for this patient since
there is little to no exudates. A product such as a flexible adhesive
bandage would allow flexibility at the knee.?
Page 4 of this document by Pharmacist Continuing Education and
Johnson and Johnson illustrates some of the newer bandages:
https://www.cedrugstorenews.com/userapp/lessons/page_view_ui.cfm?lessonuid=&pageid=981A479F3535604148321774019B8DF9
?Post-operatively, the patient had an infectious disease consult,
and, based on the culture results, had the intravenous antibiotics
changed. We provided local wound care by advancing the packing and
applying saline wet-to-dry dressings. After one week of this course of
treatment, the patient was discharged. We followed up with the patient
until achieving wound closure via secondary intention. Within 10
weeks, the patient was fully healed.?
http://scholar.google.com/scholar?hl=en&lr=&q=cache:wardvr5EBOcJ:www.mmhc.com/podtd/displayArticle.cfm%3FarticleID%3Dpod_200107f3%26type%3DA+wound+care+%2B+neosporin
Keep in mind that petrolatum based ointments are not always used.
?Proper wound care is essential to the prevention of surgical site
infections, such as those caused by MRSA and VRE. Wound dressings must
maintain a moist environment for optimal healing while creating a
barrier against harmful bacteria. Microban® antimicrobial product
protection is now built-in during the manufacturing process to FDA
approved wound dressings. Microban technology is effective against a
broad range of gram positive and gram negative bacteria, providing
continuous antimicrobial protection that prevents proliferatioin of
bacteria on and in the dressing.?
http://www.microban.com/americas/products/category.html?lang=en&CategoryID=5&SubcategoryID=174
?Silverlon® Wound Contact Dressings can be applied as a wound contact
layer between the wound surface and V.A.C.® (Vacuum Assisted Closure?)
porous polyurathane foam sponge. The V.A.C.® assists in wound closure
by applying localized negative pressure to the edges of the wound. The
Silverlon® Wound Contact Dressing is porous enough so as not to
interfere with the negative pressure generated by the V.A.C. device.
The Silverlon® Wound Contact Dressing should be changed when the VAC
sponge is changed..
? Silverlon® Wound Dressings Applied with Apligraf®
The Silverlon® Wound Pad may be applied on top of the Apligraf®
dressing. The Silverlon® Wound Dressings should be moistened with
water and changed every second to every day. The effectiveness of the
dressing is increased by keeping the Silverlon® pad moist.?
http://www.keomed.com/silverlon/silverlon_wound_protocol.asp
?Silver dressings are another option; because silver controls a broad
spectrum of pathogens, it helps prevent infection in the wound and
reduces time and costs associated with wound care.
More homeopathic remedies are sometimes incorporated to promote wound
healing. "Alginate, like Kaltostat, (is) a moisture absorber; it's a
dressing for the highly exudating," says Gill. "(In addition, you're
using) any kind of secondary -- it depends on what the goal of the
dressing is and what type of wound it is. We are more and more looking
to do less frequent wound care with higher tech products. A lot of
times we'll often put alginate on highly exuding wounds but put them
into a dressing we won't change for a week."
?This demonstrates the bulk dressing on the wound. The dressing should
be changed twice daily, and the wound irrigated with sterile saline in
an attempt to further remove any debris, including necrotic tissue.?
http://medstat.med.utah.edu/kw/derm/pages/wopu_7.htm
?This shows a bulky dressing applied on top of the non-adherent
dressing to absorb the bleeding that will occur over the next hour or
two after debridement. The wound should be gently cleansed once or
twice daily with dilute Hibiclens (one part Hibiclens and three parts
water), and then the Silvadene or Polysporin ointment can be applied
followed by the non-adherent dressing and a bulk dressing if
necessary.?
http://medstat.med.utah.edu/kw/derm/pages/woge_10.htm
?Dry the surgery site with a Q-tip or gauze pad
? Apply a thin layer of antibiotic ointment directly over the surgery
site. NEVER reapply ointment from the tube to a used Q-tip. Please
contact our office if you develop increased redness or itching from
use of your antibiotic ointment.
? Cut the Telfa (non-stick) pad to fit the size of the surgery site
and secure with paper tape.
? When you are inside, a bandage is not necessary as long as you have
adequate coverage with your antibiotic ointment.?
?After initial removal of your bandage, you may bathe normally (keep
any skin graft dry.
After showering, please dry the surgical area and proceed with your wound care.?
http://www.goslencenter.com/imagesGoslen/POSTOPINSTRUCTIONS.pdf
?The use of an occlusive dressing and an antibiotic solution to
maintain surface moisture is now a common approach to management of
the meshed skin graft (or excised wound)
The most common current approach is to use the moist wound healing
techniques using a topical antibiotic solution beneath an occlusive
dressing.?
http://www.journalofburnsandwounds.com/education/module01/module01_01.pdf
?The goal of wound dressings is to protect the wound from infection
and promote a moist environment. There are hundreds of dressing
products available. The dressing of choice depends on the wound. Skin
tears (partial-thickness wounds) are acute wounds secondary to tape or
transparent occlusive dressings and should be cared for using an
Adaptic-type dressing (without iodine/Betadine additives) that is then
covered with a Kling- or Kerlix-type dressing to avoid further tearing
of the skin. It is important to minimize the use of adhesives in all
forms for patients prone to skin tears.?
http://connections.lww.com/Products/morton/documents/pdfs/morton_ch52.pdf
?An ointment gauze, generally applied on top of a coat of
Polysporin ointment or Silvadene cream, helps to also keep the wound
moist.?
http://medstat.med.utah.edu/kw/derm/pages/woge_14.htm
?Tegaderm or other similar transparent dressings that allow for
transfer of gases, such as air and water vapor, but are impermeable to
liquids, are an excellent dressing for wounds that are not draining
much.?
http://medstat.med.utah.edu/kw/derm/pages/woge_18.htm
?Non-adherant Pads
Non-adherant pads are useful to cover open wounds such as burns and
abrasions. The brand known best is Telfa. The pad keeps the dressing
from sticking to the wound.
After cleaning the wound, antibiotic ointment is applied. Be sure the
patient isn't allergic to the antibiotic. The non-stick pad is placed
next, then a gauze pad to cushion and protect. A kling wrap keeps the
gauze in place.?
?Padding Roll Gauze
Padding roll gauze is very useful to cushion large wounds. It's often
called "Kerlix," which is a specific brand. It can be used in place of
a kling wrap in the dressing, and for many wounds provides enough
padding that gauze pads are not required. It absorbs ooze or blood,
and prevents dryness in an open wound.
The padding roll gauze can also be used for compression dressings, for
example to compress a sprained ankle. Apply it under the elastic
wrap.?
http://www.utahmountainbiking.com/firstaid/bandage.htm
Disregard the non-sterile technique of applying Neosporin in the
illustration. The photos are from a mountain biker?s site, and we?ll
grant them a bit of leeway for not having proper medical supplies for
applying an ointment! But notice how a gauze kling type of bandage is
used to hold the dressing in place.
?Place a non-stick pad over the wound. It should be large enough that
it can slide or shift a bit without uncovering the wound. Telfa and
Adaptic are sample brands.
If additional padding is needed, put gauze pads over the non-stick
pad to provide thickness, or use a padded roll gauze (sample brand
Kerlix) to cushion the area.?
http://www.utahmountainbiking.com/firstaid/dressing.htm
?After cleansing the wound, Treat the wound with a more long
lasting ointment or cream designed to provide long lasting protection
against skin irritation or infection. Swift Triple Antibiotic Ointment
is a combination of bacitracin, neomycin and polymyxin B, three common
antibiotics which are capable of killing various ranges of infection
including the most common strain: ?staph?. Embedded in a petrolatum
base (similar to petroleum jelly, ie; Vaseline) the triple antibiotic
ointment keeps the wound moist and provides long term infection
protection. Keeping the wound moist minimizes scabbing and as a result
minimizes scarring as well and shortens the time necessary for
complete wound healing. Additional ointment should be applied each
time a new bandage dressing is applied. Every workplace first aid
first aid kit should include triple antibiotic ointment.
First aid cream should be included in workplace first aid kits where
there is a possibility of scratches and large abrasions. The first aid
cream provides necessary moisture in a cream base that penetrates the
skin and aids in the healing process. Subsequent bandaging is not
required when utilizing first aid cream.?
http://www.firstaidsuppliesonline.com/news/?p=8
?Hydrogel dressings contain a large portion of water, often more
than 70-90%. They have some important characteristics of an ideal
dressing. Hydrogels can cool the surface of the wound, resulting in
marked pain reduction. Moreover, hydrogels maintain the moist wound
environment and are mostly suitable for use on dry or necrotic wounds
or on lightly exuding wounds. They are suitable for use at all stages
of wound healing except for infected or heavily exuding wounds.
Hydrogels are a good alternative for classic wet dressings. In some
cases, however, hydrogels may macerate the healthy skin (mostly wound
border areas), decreasing the keratinocyte reepithelialization ratio
or leading to overwetting of split-skin donor sites. Hydrogels are
available as sheet dressings or gels.?
http://www.emedicine.com/derm/topic826.htm
?The skin is covered with an occlusive dressing consisting either
of multiple layers of waterproof tape or petroleum jelly to prevent
evaporation of the phenol, allowing for increased penetration and burn
depth. The peeled skin is maintained by daily cleansing and consequent
reapplication of ointment, which keeps the surface moist and prevents
desiccation. If this protocol is followed, healing is completed within
5-7 days.?
http://www.emedicine.com/plastic/topic492.htm
You?ll have to obtain a free registration to read this entire article:
?The performance of dressings significantly affects wound healing and
quality of life for patients. Despite extensive collective nursing
care experience, uncertainty remains about the optimum choice of many
parameters that affect dressing performance, such as shape,
extensibility, and fixing position. A technique was developed to
investigate some of the parameters involved in the fixing of dressings
for acute and chronic wounds. Representative mobile areas in the upper
torso, neck, and leg were chosen for surface modeling. Digital surface
photogrammetry was used to obtain surface data for various sites in
young, middle-aged, and elderly subjects. In each case, landmarks were
used to identify a grid of points in a region of skin, and the
relative movements of the points were found following typical
movements of the appropriate body part. The amounts and orientation of
deformation of the skin were computed and displayed in such a way that
some preliminary hypotheses could be made concerning why dressings may
fail in practice.?
http://www.medscape.com/viewarticle/521450
All kinds of dressing supplies
===============================
http://www.sharedomaha.com/Catalog/08_Woundcare.pdf
http://www.medifair.com/woundcare.html
A small cut can use adhesive bandages with antibiotic ointment
embedded in the bandage:
http://www.drugstore.com/qxp12928_333181_sespider/band_aid_antibiotic/adhesive_bandages_with_antibiotic_ointment_assorted_sizes.htm
I hope this has helped! If this is not the information you are
seeking, please request an Answer Clarification, and allow me to
respond. I will pleased to assist you further, before you rate this
answer.
Sincerely, Crabcakes
Search Terms
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wound dressings + techniques
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wound dressing + adhering + Neosporin
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