Appropriate Product Selection:

Avoid Sandwich
Dressing
WIDASARI SRI GITARJA, WOC(ET)N
KALBE ACADEMIA -
WOCARE CORPORATE UNIVERSITY
 Chair WOCARE Indonesian
Foundation - Senior Clinical
Nurse Sp., Lecturer, Researcher
and Director Program of
Indonesian ETNEP– WCET
(Enterostomal Therapy Nurse
Education Program)- Founder,
Owner, CEO of WOCARE Center
Indonesia – Corporate University
of WOCARE Indonesia and
ASEAN Wound Council
Representative

Widasari Sri Gitarja

◍  WIDASARI ◍  WIDASARI SRI •  WIDASARI SRI
PRAKOSO GITARJA GITARJA WIDA.ME

2
 Outline
1.  Introduction - Wound Healing Process: Basic
science
2.  Conventional vs. Advance dressing –
understanding the difference
3.  Challenges for healthcare professionals who are
managing wounds.
4.  Appropriate Product Selection: Avoid doing sandwich
dressing
5. Summary – and Future direction
1. Introduction - Wound Healing
Process: Basic science
ACUTE WOUND CHRONIC WOUND
HEALING – orderly – stuck in phase due to
sequence repair responsive cells and
molecular and cellular
processes disrupted
 CRITICAL Thinking
•  UNDERSTANDING WOUND
1 HEALING PROCESS

•  UNDERSTANDING MOISTURE
2 BALANCE CONCEPT

•  UNDERSTANDING WOUND BED

3 PREPARATION
TIME FOR healing in chronic wound
Projects Predicted Wound Healing

MATURATION
PHASE
2 WEEKS

PROLIFERATION
PHASE
3 - 6 WEEKS
WOUND BED
PREPARATION 2009. EVIDENCE PRACTISE
BASE ON WINNERS SCALE
2 – 4 WEEKS THAT ADOPTED FROM BETES
JANSEN SCALE

Time Spent ON 12 – 20 WEEKS

 MOISTURE balance
Moist wound healing is the practice of
keeping a wound in an optimally
moist environment in order to
promote faster healing.
 WOUND BED
PREPARATION

Goal: how to CONVERT

chronic wound into
acute wound and
NORMAL HEALING
WILL TAKE A PLACE
2 weeks left after
burned - hospitalized

3 days after autolysis

debridement TISSUE management
1. DEBRIDEMENT
2. DECREASE
BACTERIAL BURDEN
3. MANAGE WOUND
EXUDATE
2. CONVENTIONAL VS. ADVANCE
DRESSING Understanding the difference
Understanding the difference between the two can
help clinician choose the solution that’s best for their patient
wound healing process.
CONVENTIONAL dressing
•  These basic products
include gauze, lint,
plasters and wadding are
aimed at treating non-
severe wounds.

•  Serve to: Absorb fluids;

Stop bleeding; Protect the
opening from harmful
elements; Inhibit infection
and Dry the wound
ADVANCED dressing
Focused on keeping the wound
hydrated to encourage healing,
following the philosophy that a
moist microenvironment.

Advanced wound care

products : Keep temperatures
consistent; Protect the site from
exogenous infection; Remove
dead tissue; painless in
dressing changes
With the advancement in technology, currently, different types of
wound dressing materials are available for all types of wounds.
But the selection of a material for a particular wound is important to
achieve faster healing.

Wound dressings – a review. Selvaraj Dhivya, Viswanadha Vijaya Padma, Elango Santhini.
Biomedicine (Taipei) 2015 Dec; 5(4): 22. Published online 2015 Nov 28. doi: 10.7603/
s40681-015-0022-9
Pause before you used gauze
 3. Challenges for
healthcare professionals
who are managing wounds
In-Effective cost
Patient cost
Hospital cost
Nursing care cost

Takes time: 3 x /day

changing wound dressing

Wounds not really healed

or healed over time
 Wound care Challenges
•  Injury to the skin provides a unique challenge, as
wound healing is a complex and intricate process.

•  What we do know is that wounds are more susceptible to

healing in a moist, clean, and warm environment. A
moist wound bed will allow growth factors and
numerous cell types including epithelial cells to
migrate, facilitating wound edge contraction. To
create and maintain this environment, appropriate
dressings come into play.
Aditya Sood,Mark S. Granick,and Nancy L. Tomaselli. (2014). Wound Dressings and
ComparaEve EffecEveness Data. ADVANCES IN WOUND CARE, VOLUME 3, NUMBER 8.
 Wound care Challenges
•  COST- effectiveness is a central issue in
many wound care decisions.

•  There is a potential for a variety of

dressings to be used on a single
wound especially when a patient is being
visited by a number of wound clinicians /
staff.
JEANETTE MILNE. 2016. The challenge of providing cost-
effective wound care. Wounds UK. Volume 12.No 1, page 52 -
57
 ASSESSMENT AND
MONITORING

Through doing this in practice, it allows

decisions to be made on dressing
selection and the frequency of
dressing change, and it also helps
guide practice in noticing the signs or
risks of wound deterioration.

SERIAL – ASSESSMENT
A simple and easy method in doing
this is to document at each
dressing change the interaction
between the dressing in place and
the exudate level.
Full Thickness Wound
Tunneling
These are tunneled shafts
that run out away from the
wound.

Undermining
The erosion caused by shear
and friction leaves a shelf.
 Wound dressings performance characteristics (such as size,
adhesion, conformability and fluid-handling properties) and costs will
challenges for healthcare professionals who are managing
wounds.
8 times for dressing changes 20 times for dressing change
Nursing care
Challenges: 12
times dressing
changes and 9
weeks complete
wound healing
process
 5 WEEK HEALING – Nursing care challenges

•  Ask how a patient is feeling and sincerely care --- SCALE

HEALING FORM
•  Preserve their dignity
•  Educate your patients on the importance of self-care
•  Use non-pharmacological methods of pain control such as
imagery, relaxation techniques, and more
Nursing care Challenges: 4 times dressing changes and 11 days
wound healing process
Nursing care Challenges: 9
times dressing changes and 7
weeks wound healing process
 Nursing care
challenges:
PalliaLve wound care is a
relaLvely new field that focuses
the wound
on
treatment of
individuals at the
end of life, those with
terminal disease or those unable
to tolerate standard care.



 4. Appropriate Product Selection:
Avoid doing sandwich
dressing
Why Dressing is IMPORTANT?
•  To decrease wound size
•  To stimulate healing in
previously non-healing
wound
•  To increase granulation
tissue
•  To manage symptoms
patient related factors
•  To decrease / manage
exudate
•  To reduce or control bio
burden
DRESSING is important
1.  Basic Dressing
2.  Absorbent Dressing
3.  Alginates
4.  Antimicrobials
5.  Compression
6.  Films
7.  Foams
8.  Honey Dressing
9.  Hydrocolloids
10. Hydrogels
11. Odor Control
12. Protease Modulator
13. Scars
14. Skin Protection
15. Wound Contact Layers
16. Other Dressings
17. Negative Pressure
18. Other Medical Devices
DRESSING Selection
•  Dressing selection
should be SIMPLE
and promote MOIST
WOUND HEALING
DRESSING Selection.
•  Ensure that they are
SAFE and
RESEARCH BASE
 DRESSING Selection.

AVOID complex combination of dressings which may

be expensive and ineffective.
Case up-date: PROPHYLATIC dressing
DRESSING Selection.
•  Wounds need to be
RE- ASSESSED and
dressing selection
change accordingly.

06.08.14 – 18.08.14
5. Summary and FUTURE
direction
1.  Clinicians will be required to
think about cost effectiveness
including maintaining standards
and clinical outcome.

2.  There is NO UNIVERSAL

Wound dressing but the
dressing must be appropriate.

3.  The dressing must be RE-

ASSESSED for each phase of
wound healing
The world is changed by examples,
Not by opinions
References
References
•  Bryant, R. A., & Nix, D. P. (2012). Acute and chronic wounds: Current management concepts. St Louis,
MO :Elsevier Mosby.
•  Ruth Ellen Jones, MD; Deshka S. Foster, MD, MA; Michael T. Longaker, MD, MBA.(2018). MANAGEMENT
OF CHRONIC WOUND. JAMA Insights | CLINICAL UPDATE. Downloaded From: by a Stanford University
Medical Center User on 09/23/2018
•  Aditya Sood,Mark S. Granick,and Nancy L. Tomaselli. (2014). Wound Dressings and ComparaEve
EffecEveness Data. ADVANCES IN WOUND CARE, VOLUME 3, NUMBER 8.
•  JEANETTE MILNE. 2016. The challenge of providing cost-effective wound care. Wounds UK.
Volume 12.No 1, page 52 – 57
•  Carville, Kerlyn. Wound Care Manual. 5rd Ed. Western Australia: Silver Chain Foundation
(2013)