“GAUZE HAS NO CAUSE”
It’s true. The days of just putting anything on a chronic wound or what is called
“traditional wound care” need to come to an end. There is a wealth of data and clinical
research that shows that there are better materials and methods to handle this major health
care problem. There are huge differences in the characteristics of the acute and chronic
wound. This means that the typical gauze dressing that often may work for an acute
wound does not find the same degree of applicability for pressure ulcers or even most
legs ulcers. Consider these facts:
a) Wet-to-dry gauze dressings are a classic mechanical debridement
technique, not a healing technique. It is designed to remove necrotic tissue. However,
once the necrotic tissue has been removed from the wound, gauze dressings should be
discontinued. Otherwise it will adhere to healthy tissue and lead to injury by resulting in
bleeding and pain. This will lead to slow healing.
b) Foreign body reaction- Microscopic slides have shown that cotton fibers from
gauze can be left in the wound bed and cause a foreign body reaction/chronic
inflammatory state. That is why patients getting wet to dry dressings take a long time to
heal due to the chronic inflammation from the foreign body reaction. [1]
c) Gauze is dead material and leads to infection – Cotton fibers are dead
material and thus are ideal growth medium for bacteria. In fact, in a review of 69 studies
retrospective and prospective, gauze dressings resulted in a 7.1% infection rate vs. only
1.3% for hydrocolloid dressings. [2]
d) Gauze stops nothing – One of reasons for higher infection rates is that gauze
does nothing to prevent bacteria from getting into wound. Study showed 64 layers of
gauze allowed bacteria to be cultured through these layers in less than 15 minutes. [3,4]
e) Avoiding cytotoxic agents – The other problem with gauze dressings is that
associated use of cytotoxic solutions. Physicians must understand that putting cytotoxic
agents such as Povidone-Iodine, Hydrogen peroxide, acetic acid and Dakin’s solution
into a wound is not only harmful, but the practice has never been thoroughly evaluated.
Rodeheavor conducted an excellent review of this topic in Chapter 13 of Chronic Wound
Care. [5] His conclusion simply states “ even though there is not scientifically valid
documentation of the benefits, practitioners continue to use antiseptics in wounds because
of tradition. This tradition must stop. Antiseptics are toxic chemicals that, when used in
clean wounds, do more harm than good. The volume of literature that documents the
extreme toxicity of these agents is overwhelming.” Studies show that these agents are
indeed toxic to living cells. You must stress to them that your company due to legal
reasons will not use the use of these products as part of your protocol. The study by
Lineweaver clearly demonstrates the toxicity of these solutions as well. [6,7]
f) Povidone-Iodine grows Pseudomonas – If they still do not believe it then show
the data that documents that two stock solutions of Povidone-Iodine have shown to be
growing Pseudomonas. [8] There was a national recall by a company that included
Povidone-Iodine swabs, wipes and even central line kits due to this contamination. Thus,
you are not even protecting against the very thing you are trying to prevent: infection.
It is time to update our approach towards wounds among physicians. We have
fallen way behind in this field. The old thinking and opinion that chronic wounds
are a nursing problem is just that: OLD THINKING. We are not helping the
situation by using cytotoxic agents and traditional gauze dressings. Gauze has no
cause. Coming to this realization is not easy, but a necessity. Learn why moist
wound healing works and why it will help heal your patients better, faster and more
cost effectively.
S. Kwon Lee, MD FACS
Bibliography
1) Hughes M. Basic Wound Healing Science Now and in the Future. 4th Annual Oxford
European Wound Healing Summer School. Oxford, UK. June 1999.
2) Hutchison JJ, Occlusive dressings: A microbiologic and clinical review. Am J Infect
Contr. 1990; 18:257-268.
3) Lawrence JC. Dressings and wound infection. Am J Surg. 1994(suppl 1A): 21S-24S.
4) Mertz PM, Marshall DA, Eaglstein WH. Occlusive wound dressings to prevent
bacterial invasion and wound infection. J Am Acad Dermatol. 1985; 12:662-668.
5) Rodeheavor G, Wound cleansing, wound irrigation, and wound disinfection. In:
Krasner D, Kane D. Eds. Chronic Wound Care: A Clinical Source Book for Healthcare
Professionals, 2nd Ed. Wayne PA. Health Management Publications, 1997, 97-108.
6) Lineweaver, Cellular and bacterial toxicities of topical antimicrobials. Plast Reconstr
Surg 1985a; 75:394-396.
7) Lineweaver W. Topical antimicrobial toxicity. Arch Surg 1985b; 120:267-270
8) Burks RI, Povidone-iodine solution in wound treatment. Phys Ther. 1998; 78:212-218.