There are hundreds of wound dressings, and choosing the wrong one can slow healing. The aim is to create the right environment for the wound to heal: usually moist but not wet, clean, protected and at body temperature. Start with a good assessment.
Assess the wound with TIME
| Letter | Ask | Aim |
|---|---|---|
| T – Tissue | Is the wound bed healthy (red granulation) or covered with slough (yellow) or necrosis (black)? | Remove non-viable tissue (debridement) where appropriate |
| I – Infection or inflammation | Are there signs of infection or a high bacterial load? | Treat infection; consider antimicrobial dressings |
| M – Moisture | Is the wound dry, moist or very wet? | Balance moisture: add it to dry wounds, absorb it from wet ones |
| E – Edge | Are the edges advancing, rolled or undermined? Is the surrounding skin macerated? | Protect the edges and surrounding skin |
Always ask why the wound has formed and why it is not healing: pressure, poor circulation, venous disease, diabetes, poor nutrition or infection. A dressing alone will not fix the cause.
Main types of dressing
| Dressing | Use for | Avoid or take care |
|---|---|---|
| Film | Superficial wounds, IV sites, protecting skin | Wet wounds; fragile skin when removing |
| Hydrocolloid | Light to moderate exudate, softening slough | Infected or very wet wounds |
| Hydrogel | Dry wounds and dry necrosis, adds moisture | Very wet wounds (can cause maceration) |
| Alginate | Moderate to heavy exudate, minor bleeding | Dry wounds |
| Hydrofibre (gelling fibre) | Moderate to heavy exudate | Dry wounds |
| Foam | Moderate to heavy exudate, cushioning | Dry wounds |
| Antimicrobial (silver, iodine, honey, PHMB) | Wounds with local infection or high bacterial load, for a limited time | Prolonged routine use; iodine in some thyroid conditions, pregnancy and large wounds |
| Negative pressure wound therapy | Selected complex or surgical wounds, under specialist direction | Untreated infection, exposed blood vessels, malignancy in the wound |
Signs of wound infection
- Increasing pain, redness, warmth or swelling
- Pus or increasing exudate, a bad smell
- A wound that stops healing or breaks down
- Spreading redness, fever or feeling unwell, which may mean spreading infection or sepsis and needs urgent review
Good dressing technique
- Clean your hands and use an aseptic non-touch technique
- Clean the wound with saline or drinking-quality water; routine antiseptic cleansing is not usually needed
- Measure and photograph the wound regularly to track progress
- Choose a dressing size with a margin of about 2–3 cm around the wound
- Protect the surrounding skin with a barrier product if it is wet
- Do not change dressings more often than needed, as this cools the wound and disturbs healing
- Refer to the tissue viability team when a wound is not improving within 2–4 weeks
Related: Pressure ulcer stages · Diabetic foot care
Sources: International Wound Infection Institute, Wound infection in clinical practice (2022 update); Wounds UK best practice statements; NICE guidance on antimicrobial dressings and chronic wounds.
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