Table of Contents
Background Information
One of the cost-consuming challenges in the medical field worldwide is the treatment of open wounds (Guest, Ruiz, Mihai & Lehman, 2014). Historically, gauze has been preferred to other methods of wound care mainly because of its simplicity and lower price. This method is also referred to as the wet-to-dry approach entails absorbing exudation from the wound, which helps to keep the wound clean and dry enough to avoid bacterial infection (Guest, Ruiz, Mihai & Lehman, 2014).
A new approach to wound management was introduced in the 1950s. This approach is based on the occlusive principle and it entails occlusion of the wound against bacterial infection (Vermeulen, 2015). Unlike the gauze method, this approach keeps the wound moist to necessitate growth and limit formation of crust, which would slow down the healing process (Vermeulen, 2015). Since the discovery of the occlusive approach, many products have been developed and applied to different wounds despite the fact that this method was derived from a study on animals with acute and superficial wounds (Vermeulen, 2015).
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Summary
Clinical evidence supporting the use of occlusive dressing or gauze dressing is mainly based on case series, clinician perceptions, and cohort studies (Ubbink, 2012). These methods constitute a large number of publications but the overall level of evidence remains low. In context, these studies only provide a wide range of opinions with no standard guideline on the use of either gauze or occlusive dressing. High level evidence is relevant in three systematic reviews that suggest that gauzes cost effective but labor intensive and painful compared to occlusive dressings (Yamamoto & Kiyosawa, 2012). The purpose of this project is to obtain high-level evidence that would determine costs and effectiveness of occlusive and gauze-based dressing approaches.
Significance of the study
Surgical site infections not only lead to high morbidity rates but they are also associated with a high mortality rate (LESNEY, 2012). A recent study attributed 77% of deaths of surgical patients to surgical wound infection. The study by Kirkland et al established a relative risk of death of 2.2 attributed to wound infection compared to patients without infection (LESNEY, 2012). Internationally, the frequency of surgical site infection is difficult to monitor mainly due to lack of a uniform criteria of diagnosis (Jones & San Miguel, 2016).
A survey by the World Health Organization found the prevalence rate of nosocomial infections to be approximately 4% to 20%. According to the study, wound infection accounts for between 5% and 34% of the total infections (Jones & San Miguel, 2016). The report also indicates that hospital acquired infections in the U.S is as high as 15%, which costs the Health Department more than $1 billion every year (Jones & San Miguel, 2016). These statistics raise more questions on the subject of wound care especially considering that the data could be an underestimate of the true incidence because most wound infections occur after the patient is discharged. Furthermore, there is a chance of these infections going undetected in the hospital setting because they are treatable in the community without hospital notification.
Background Questions
- In surgical patients, what is the time to complete wound healing when using gauze-based dressing?
- In surgical patients, what is the time to complete wound healing when using occlusive dressing?
- In surgical patients, what is the total cost for wound care per patient per day during hospitalization under gauze-based dressing?
- In surgical patients, what is the total cost for wound care per patient per day during hospitalization under occlusive dressing?
- In surgical patients, what are the pain scores under gauze-based dressing?
- In surgical patients, what are the pain scores under occlusive dressing?
The research questions above were determined based on the objectives of the project, which is to compare the effectiveness and costs of gauze-based and occlusive dressing methods of wound care. The questions form a basis for literature review, which will help provide more evidence-based insight on the issue of wound care. All the questions are well represented in the PICOT question. By answering these questions, the research project will provide a basis for evidence-based decision making in healthcare settings and open doors for further research on the subject topic.
PICOT Question
In the surgical care population, is gauze based dressing cost-efficient and effective in wound care compared to Occlusive dressing over a 6 month time frame?
The variables that can alter the outcome of this research project include the cost of dressing, the time to healing of the wound, and the pain scores. These variables will be examined under both interventions in order to determine their cost efficiency and effectiveness in wound care. The best intervention will be the one with the lower cost, lower pain score, and lower time to healing of wound.
Keywords
The keywords that were used in my search were: Gauze, Occlusive, Surgical Wounds, Wound Dressing, Wound Infections, Costs, USA, Wound Care, Pain, and Healing. All these words were instrumental in identifying relevant literature for the research project. A search of each keyword yielded many results with a wider scope. A search of two or more keywords at a time was helpful in narrowing down to the most relevant research articles.
- Guest, J., Ruiz, F., Mihai, A., & Lehman, A. (2014). Cost effectiveness of using carboxymethylcellulose dressing compared with gauze in the management of exuding venous leg ulcers in Germany and the USA. Current Medical Research and Opinion, 21(1), 81-92.
- Jones, A., & San Miguel, L. (2016). Are modern wound dressings a clinical and cost-effective alternative to the use of gauze? Journal of Wound Care, 15(2), 65-69.
- LESNEY, M. (2014). Hydrocolloid Wound Dressing Outdoes Gauze in Healing Time. Hospitalist News, 5(12), 22.
- Ubbink, D. (2012). Occlusive vs Gauze Dressings for Local Wound Care in Surgical Patients. Archives of Surgery, 143(10), 950.
- Vermeulen, H. (2015). Occlusive vs gauze dressings for local wound care in surgical patients: a randomized clinical trial1). Nederlands Tijdschrift Voor Evidence Based Practice, 7(1), 15-16.
- Yamamoto, N., & Kiyosawa, T. (2012). Histological effects of occlusive dressing on healing of incisional skin wounds. International Wound Journal, 11(6), 616-621.