Guide — Wound Care
Wound Dressing Fundamentals
Appropriate dressing selection is one of the most impactful decisions in wound management. Understanding moist wound healing, dressing properties, and clinical matching of wound characteristics to dressing type directly affects healing outcomes and patient comfort.
10 min read · Wound Care
Educational use only. Dressing selection should be guided by a comprehensive wound assessment, provider order, and wound care specialist input for complex wounds. Follow facility-specific protocols for dressing changes and wound care procedures. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.
Moist Wound Healing
The concept of moist wound healing was established by George Winter in 1962, demonstrating that wounds heal approximately twice as fast when kept moist compared to wounds left open to air. This is the scientific basis for modern wound dressings.
Why Moisture Promotes Healing
- Maintains a moist environment for cell migration across the wound surface
- Facilitates autolytic debridement — the body's own enzymes break down nonviable tissue
- Supports growth factor activity and cellular communication
- Reduces pain during dressing changes — dry dressings adhere to wound tissue
- Prevents cell death at wound margins from desiccation
- Promotes faster epithelialization compared to dry wound environments
Important balance: The goal is a moist wound environment — not a wet one. Excessive moisture causes maceration of periwound skin. The dressing must match wound drainage volume.
Goals of Dressing Selection
The ideal dressing for any given wound accomplishes all of the following goals simultaneously:
Maintain moisture balance
Keep wound bed moist while absorbing excess exudate to protect periwound skin from maceration
Manage exudate
Absorb drainage appropriate to wound volume — match dressing absorbency to drainage amount
Protect periwound skin
Prevent maceration, excoriation, and adhesive trauma to surrounding healthy skin
Prevent infection
Act as a barrier to external contamination; antimicrobial dressings for infected wounds
Support debridement
Facilitate removal of nonviable tissue — autolytic, mechanical, enzymatic, or surgical
Minimize pain
Allow non-traumatic removal without adhering to wound tissue; maintain comfortable temperature
Cost-effectiveness
Choose appropriate dressing for frequency of required change — fewer changes with advanced dressings can offset higher unit cost
Patient comfort and compliance
Appropriate for patient's lifestyle and ability to self-manage in the home setting
Dressing Selection Guide
| Wound Characteristic | Best Dressing Category | Examples |
|---|---|---|
| Dry wound / necrotic — needs moisture donation | Hydrogel | Curasol, Intrasite Gel, Dermagran |
| Light to moderate exudate — granulating wound | Hydrocolloid | DuoDERM, Replicare, Comfeel |
| Moderate to heavy exudate | Foam dressing | Mepilex, Allevyn, Biatain |
| Heavy exudate / bleeding / wet wound | Alginate | Kaltostat, Maxorb, Aquacel |
| Superficial wound / Stage 1 or 2 / donor site | Transparent film | Tegaderm, OpSite, Bioclusive |
| Infected wound or at high infection risk | Antimicrobial (silver/iodine) | Aquacel Ag, Mepilex Ag, Iodosorb |
| Wound needing packing / dead space | Wet-to-moist gauze, alginate rope, foam rope | Kerlix, Aquacel rope, Allevyn cavity |
| Dry, stable heel eschar — no signs of infection | Protect and monitor — do NOT debride | Dry gauze cover or leave uncovered per order |
Dressing Change Procedure
Gather supplies and verify order
Confirm dressing type, frequency, and any special instructions from the wound care order. Gather all supplies before approaching the patient to minimize interruptions during the procedure.
Perform hand hygiene
Wash hands with soap and water or ABHR before beginning. Don non-sterile gloves for removal of old dressing (clean technique). Sterile gloves for sterile dressing changes per facility policy.
Position patient and expose wound
Position to optimize wound access and patient comfort. Place absorbent pad under wound area. Ensure adequate lighting.
Remove old dressing gently
Lift edges of dressing carefully. For adherent dressings: moisten with normal saline to reduce trauma. Remove toward the wound center. Assess old dressing for exudate type, amount, and odor before discarding.
Assess the wound
Perform complete wound assessment: size, tissue type, drainage, wound edges, periwound skin, odor. Document findings.
Cleanse the wound
Use normal saline or an approved wound cleanser. Irrigate with enough pressure to remove debris without damaging tissue (5–15 psi — adequate with a 35 mL syringe and 19-gauge angiocath). Avoid cotton-tipped applicators on wound bed — fibers shed and impede healing. Change gloves after wound cleansing before applying new dressing.
Apply appropriate dressing
Select and apply dressing based on wound characteristics and provider order. Fill dead space with appropriate filler (packing strip, alginate rope). Secure primary dressing with secondary dressing or tape as appropriate — avoid tension on periwound skin.
Label and document
Label dressing with date, time, and initials. Document wound assessment findings, dressing applied, patient tolerance, and any provider notification. Record dressing change in medication administration record if scheduled.
Wound Cleansing
| Cleanser | Use | Notes |
|---|---|---|
| Normal Saline (0.9% NaCl) | First-line wound cleanser — all wound types | Isotonic, non-cytotoxic, safe for wound bed and granulation tissue |
| Commercial wound cleansers | Wounds with biofilm or debris | Surfactant-based — more effective at removing biofilm than NS alone; less cytotoxic than antiseptics |
| Povidone-iodine (Betadine) | Infected wounds — SHORT TERM ONLY | Cytotoxic to granulation tissue; do not use on clean, healing wounds; brief use only for infected wounds per order |
| Hydrogen peroxide | Avoid — not recommended | Cytotoxic to fibroblasts and granulation tissue; impairs healing; obsolete for wound cleansing |
| Dakin's solution (dilute sodium hypochlorite) | Highly infected / sloughy wounds — per order | Effective against many organisms; cytotoxic at full strength; dilute solutions (0.025%) safer; short-term only |
Infection Prevention During Dressing Changes
- Hand hygiene before and after each dressing change — ABHR or soap and water
- Use gloves throughout — change gloves between removing old dressing and applying new dressing
- Use sterile technique for immunocompromised patients, surgical wounds, and per facility policy
- Avoid cross-contamination — never return items to sterile field once removed
- Clean wounds top to bottom, inside to outside (cleanest area to most contaminated)
- Dispose of old dressings in biohazard waste per facility protocol
- Antiseptic dressings (silver, iodine) for wounds with confirmed or suspected local infection — not for routine clean wounds
- Systemic antibiotics only for cellulitis, systemic signs of infection, or osteomyelitis — topical antiseptic use does not replace systemic therapy when indicated
Documentation
Every dressing change must be documented. Required elements:
- Date, time, and wound location
- Wound assessment findings (size, tissue type, drainage, periwound skin, odor, pain)
- Wound cleanser used and method
- Dressing type applied and size
- Patient tolerance and response to procedure
- Patient or caregiver education provided
- Provider notification if wound shows signs of deterioration or infection
- Next scheduled dressing change date
NCLEX Pearls
- ✦Moist wound healing — keep the wound moist (not wet). Moist = faster healing. Dry wound = slower healing. Wet = maceration.
- ✦Normal saline is the first-line wound cleanser. Hydrogen peroxide and full-strength Betadine are cytotoxic — avoid on healing wounds.
- ✦Hydrogel = moisture donation (for dry wounds). Alginate = moisture absorption (for heavy drainage). Match the dressing to the wound.
- ✦Wet-to-dry dressing debrides — used for wounds with slough and necrotic tissue, NOT for healing wounds with granulation tissue.
- ✦Dead space in a wound must be loosely filled (packing) to prevent abscess formation — never tightly packed.
- ✦Do NOT debride dry, stable, intact heel eschar — assess for fluctuance, erythema, and infection; leave intact if no signs of active infection.
- ✦Sign in, sign out: label all dressings with date, time, and initials at each dressing change.
Related Resources
Standards & sources
Fact-checked Jun 21, 2026This page is written to align with NPUAP / EPUAP / PPPIA (pressure injury staging) · Wound, Ostomy and Continence Nurses Society (WOCN). It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →