In Indonesia, the incidence of injuries is quite high, along with the increasing prevalence of traffic accidents in recent decades. Wound care has also experienced very rapid development after the knowledge of the TIME concept (Tissue, Infection, Moisture, and wound Edge) in modern dressings. However, the difference in modern wound dressing is not yet known in terms of comfort, cost (cost-effectiveness), and wound healing compared to classic dressing. With this research, it is expected to be able to know the difference between modern wound dressing and classical wound dressing in terms of both direct and indirect costs, patient comfort and wound healing so that they can consider medical staff to provide the best service, especially for patients with injuries
This study is a purely observational study with prospective study design. A total of 25 research subjects were included with a consecutive sampling technique to evaluate wound development in terms of patient comfort, cost-effectiveness, and wound healing treated with modern and classical dressing. Patient satisfaction was assessed by the frequency of wound care performed and the pain scale using a visual analog scale (VAS). Cost-effectiveness is indirectly evaluated based on the length of stay (LOS) of each patient and directly based on the direct costs related to the materials needed for wound care and the drugs used to treat infections and relieve pain. Wound healing was assessed using the Bates-Jensen wound assessment tool (BWAT) score. Data were analyzed using a comparative test in the form of an independent T-test and Mann-Whitney test.
In terms of patient comfort, including the frequency of wound care and the scale of pain felt by patients during wound care, modern dressing has advantages over classic dressing. The number of wound care performed on patients using classic dressing is more often use compared to wound care using classic dressing. Besides, the scale of pain experienced by patients treated with modern and classic dressings is also different, where patients of modern dressings tend to be less painful than those who use classic dressings. The more regular wound care is done, the more likely the patient feels uncomfortable, and this action causes pain.
It is undeniable that pain can affect wound care procedures, and pain that is not appropriately resolved can harm wound healing and the quality of life of patients. The selection of the type of dressing that is not sticky to the wound base and can be easily removed will significantly help in reducing the patient’s pain. Unlike the veil, which is most likely to cause discomfort because it tends to be more sticky to the wound base, while Siltec is a type of silicone dressing that is more easily released when changing dressings.
In terms of cost-effectiveness, especially those related to indirect costs, it can be seen from the duration of the wound and ready to do soft tissue coverage (Length of Stay / LOS). In this study, it was found that the indirect cost of using classic dressing was more or less the same as wound care in patients using modern dressing, as well as the direct price. In other words, the costs incurred for the use of both types of dressings for wound care are not much different. According to Hutchinson (1990), the use of gauze for wound care is indeed cheaper, but the duration for subsequent dressing changes is too short and risks increasing the occurrence of infection in the wound.
In terms of wound healing, the BWAT score can give us an idea of the condition of each patient’s wound when first treated until the end of the injury is declared good and ready to do soft tissue coverage. By comparing the final BWAT score and the mean of BWAT score on wounds treated using modern dressing and classic dressing, different scores were obtained, where the final BWAT score showed better and significant healing in wounds treated using modern dressing.
Cutimed Sorbact is used as a primary wound dressing because the material is adequate for binding bacteria and other microorganisms from contaminated wounds, namely from dressings coated with dialkyl carbonyl chloride. According to Cutting and Mcguire (2015), the active ingredient has strong hydrophobic properties to bind microorganisms that have cell surface hydrophobicity (CSH) quickly and effectively, such as gram-positive bacteria such as S. aureus, Methicillin-resistant Staphylococcus aureus (MRSA), Streptococci, or gram-negative bacteria such as E. coli and P. aeruginosa, and types of fungi such as C. albicans As a secondary dressing, Cutimed Siltec is an absorbent silicone that is very useful for absorbing excess exudate in the wound. The research conducted by Rook et al (2019) states that silicone dressings (a type of modern dressing material) can reduce exudates, provide a moist wound environment for optimal healing, keep the tissue around the wound healthy and avoid maceration, and minimize pain.
Based on this research, we can conclude that modern dressing has the same cost-effectiveness as classic dressing, but is superior in terms of patient comfort and wound healing.
Author: Dr. Ferdiansyah Mahyudin, dr., Sp.OT (K) Dep. Orthopedics and Traumatology, Faculty of Medicine, Universitas Airlangga Journal Title: Modern and Classic Wound Dressing Comparison in Wound Healing, Comfort and Cost. Authors: Ferdiansyah Mahyudin, Mouli Edward, M. Hardian Basuki, Yunus Basrewan, Ansari Rahman. Published in: NERS Journal. 2020; 15 (1) Link: https://e-journal.unair.ac.id/JNERS/article/view/16597