The big debate continues in regards to using wet-to-dry dressings. One thing that is for certain though is that this type of dressing is frowned upon in long-term care facilities per the National Pressure Ulcer Advisory Panel (NPUAP) Guidelines for pressure ulcers. However, long-term care facilities are put at risk for citations when using wet-to-dry dressings for any wound type.

I observe many orders from providers for wet-to-dry dressings, which are not open to changing the order to an alternative non-selective debridement type dressing. Many times the provider isn't aware of the long-term care arena being somewhat of a "different turf", and they change the order. When I am doing wound rounds in facilities, I try to suggest to the wound nurse to "nicely suggest" to the provider that it would be better to use wet-to-moist, or use moisture retentive dressings, in accordance with the NPUAP Guidelines. Most long-term care facilities have a wide variety of dressing types in stock, or that are billed to Part B insurance.

A Closer Look At Gauze Dressings

Gauze, which is most commonly used in wet-to-dry dressings, is a thin, translucent fabric with a loose open weave. In technical terms "gauze" is a weave structure in which the weft yarns are arranged in pairs. This weave structure is used to add stability. However, this weave structure can be used with any weight of yarn. Did you know gauze is also used to make dresses, blouses, curtains and baby carriers? Gauze apparel is perfect for the hot summer months!

There are a variety of gauze dressings for us to choose from. Think of fluffy gauze versus the thin gauze roll. Some gauze may feel soft, and some coarser. Those little gauze fibers can easily embed in the wound and make it their home. Lastly, biofilms LOVE gauze! They use it as a food source.

What is the Difference Between Wet-to-Dry and Wet-to-Moist Dressings?

Wet-to-Dry: This type of dressing is used to remove drainage and dead tissue from wounds. Deep wounds with undermining and tunneling need to be packed loosely. Without packing, the space may close off to form a pocket and not heal. This type of dressing is to be changed every 4-6 hours.

Wet-to-Moist: This type of dressing is used to keep the wound moist. This type of dressing is used to remove drainage and dead tissue from wounds. Deep wounds with undermining and tunneling need to be packed loosely. Without packing, the space may close off to form a pocket and not heal. This type of dressing is to be changed daily.

Disadvantages of Wet-to-Dry Dressings

• Clinicians moisten the dressing with normal saline during removal. This defeats the whole purpose of non-selective debridement.
• Labor-intensive, repeating every 4-6 hours
• Wound bed temperature is cooled
• Painful when removed
• Desiccation of viable tissue
• Increased infection rates
• Retained dressing particles
• Bioburden can embed up to 60 layers of gauze

Alternatives to Wet-to-Dry Dressings That Promote Moist Wound Healing

Providers can consider using impregnated forms of gauze dressings to prevent evaporation of moisture. These are readily available in most health care settings. I have listed the frequency per the Centers for Medicare and Medicaid Guidelines.

• Hydrogel gauze (daily)
• Hydrogel silver gauze (daily)
• Honey gauze (daily)
• Cadexomer iodine gel with high ply gauze
• Petrolatum gauze

Gauze Dressing Advantages

• Readily available, has been around for centuries
• Can be used as a primary or secondary dressing
• Sterile and non-sterile types
• Available with and without an adhesive border
• Woven and non-woven gauze dressings (Woven Gauze: typically means that the gauze contains layers of woven cotton layered together into multiple ply sheets. Non-Woven Gauze: usually synthetic material made to look like a woven dressing yet maintain the same aeration ability.)

About the Author
Cheryl Carver is an independent wound educator and consultant. Carver's experience includes over a decade of hospital wound care and hyperbaric medicine. Carver single-handedly developed a comprehensive educational training manual for onboarding physicians and is the star of disease-specific educational video sessions accessible to employee providers and colleagues. Carver educates onboarding providers, in addition to bedside nurses in the numerous nursing homes across the country. Carver serves as a wound care certification committee member for the National Alliance of Wound Care and Ostomy, and is a board member of the Undersea Hyperbaric Medical Society Mid-West Chapter.