Dressing Change

Dressing changes are used any time a wound needs ongoing protection and monitoring during healing. The procedure is ordered for a wide range of wounds, from minor to complex.

• Surgical wounds after an operation, including incisions that have been closed with stitches or staples
• Chronic wounds (wounds lasting more than a few weeks) such as diabetic foot ulcers, pressure ulcers (bedsores), and leg ulcers caused by poor circulation
• Burns, from superficial to partial-thickness injuries
• Traumatic wounds such as cuts, abrasions (skin scrapes), or lacerations (torn skin) from accidents
• Wounds left open intentionally to heal from the inside out, known as healing by secondary intention

A routine dressing change on a healing wound carries very little risk, but the following issues can sometimes occur, particularly with complex or infected wounds.

• Pain or discomfort when the old dressing is removed, especially if it has dried and adhered to the wound surface
• Bleeding, usually minor, when the dressing is lifted or when fragile new tissue is disturbed
• Wound infection if the procedure is not carried out under clean conditions or if bacteria are already present
• Skin irritation or allergic reaction (redness, itching, blistering) around the wound from adhesives or dressing materials
• Accidental disruption of new tissue (granulation tissue) or stitches during removal of the old dressing

Most dressing changes require no fasting or special preparation from the patient. If your wound is painful and a healthcare provider will be doing the change, you can ask whether a pain reliever is appropriate beforehand. Your doctor or nurse will advise whether any regular medications, such as blood thinners, need to be adjusted around the procedure.

For routine outpatient dressing changes, no laboratory tests or imaging are usually needed. For complex or non-healing wounds, the care team may take a wound swab (a gentle wipe of the wound surface to test for bacteria) or order imaging to check whether infection has reached deeper tissue or bone.

The dressing change itself typically follows these steps, though the exact sequence can vary by wound type and setting.

• The healthcare provider washes their hands thoroughly and puts on clean gloves.
• The old dressing is loosened, using saline (salt water) or a wetting solution if it has dried onto the wound.
• The wound is inspected for signs of healing or infection, including color, odor, and the amount and appearance of any fluid.

After each dressing change, the main goal is to protect the wound, keep it clean, and watch for early signs of problems. The specific instructions will depend on the type and location of the wound, and the care team will tailor their advice accordingly.

• Keep the dressing dry and intact until the next scheduled change, unless it becomes wet, soiled, or starts to come loose.
• Avoid soaking the wound in water, such as in a bath or swimming pool, unless your care team confirms it is safe.
• Limit physical activity or pressure on the wound site as directed, to prevent reopening or disrupting new tissue.
• Watch for warning signs that need prompt attention: increasing pain, redness spreading away from the wound, swelling, warmth, foul smell, or fever.
• Attend all follow-up appointments so the care team can monitor healing progress and decide when dressing changes can become less frequent or stop.

The cost of dressing changes varies widely because no two wounds are the same. A simple post-surgical wound seen once in an outpatient clinic costs far less than a chronic diabetic foot ulcer requiring multiple visits a week, specialized wound materials, and additional tests.

• Wound complexity and stage: a deep, infected, or large wound requires more time, more skilled staff, and more expensive dressing materials than a small healing incision
• Frequency of changes: wounds that need daily or twice-daily dressing changes accumulate costs faster than those changed every few days
• Dressing material type: basic gauze and tape cost little, while advanced dressings such as silver-impregnated (antimicrobial), foam, hydrocolloid (gel-forming), or negative-pressure wound therapy (a device that uses suction to promote healing) systems are significantly more expensive
• Setting: inpatient (hospital admission) wound care costs more than outpatient clinic visits, which in turn cost more than community or home nursing visits
• Country and hospital class: private specialist hospitals in major cities charge more than district hospitals or community clinics, and costs differ considerably between countries