Made EasyHydrocolloids in practice

Hydrocolloids in practice

Pressure Ulcers, Skin integrity | Ousey K, Cook L, Young T, Fowler A

Hydrocolloids in practiceHydrocolloids are adhesive, pliable, absorbent and waterproof wound dressings that can provide an effective barrier to microorganisms. They create a moist wound environment, facilitate autolysis and promote granulation tissue formation (Fletcher et al, 2011). Hydrocolloid dressings have been available for many years and can be used on a wide variety of wound types to promote healing and can help meet quality agenda targets.

Hydrocolloid dressings and the quality agenda
In 2011, the Chief Nursing Officer (CNO) for England reported on the importance of reducing harm to patients and introduced the Safety Express, a national campaign. This aims to support the delivery of safe and effective care to help drive up standards and provide patients with a positive experience when accessing healthcare.

To meet the quality agenda, healthcare trusts in the UK have published locally developed CQUIN (Commissioning for Quality and Innovation) target schemes that include, but are not limited to:

  • enhancing recovery for patients undergoing major elective surgery
  • improving patient experience
  • improving end-of-life care for patients managed in the acute setting
  • reduction in healthcare associated infections.


Although these targets are not directly linked to wound management, it is clear that choosing the most appropriate wound dressing will help practitioners meet these targets. This should aim to promote the wound healing process, reduce the risk of infection, reduce pain and prevent readmission to hospital due to a wound infection (Shorney and Ousey, 2011).

Recently, it has been argued that wound care practitioners need to look further than the 'gold standard' randomised control trial to provide the required evidence for dressing selection, as large adequately-powered randomised controlled trials in patients with wounds remains problematic due to difficulties with recruitment, their costs and with the heterogeneity of wounds (Leaper, 2011).   

In light of the lack of clear evidence to support dressing choice, the practitioner should choose a dressing that protects the fragile wound tissue, provides the optimum environment for wound healing and is comfortable for the patient. Hydrocolloid dressings may meet these aims and provide a cost-effective option in the management of a wide range of wound types.

 

 

What is a hydrocolloid dressing?
Hydrocolloids have been described by Thomas (2010) as dressings that contain a gel forming agent, such as carboxymethylcellulose (CMC), pectin or gelatin. This is often combined with adhesives and tackifiers and applied to a polyurethane foam or film carrier to create an absorbent, self-adhesive sheet.

The dressings are capable of absorbing low to moderate levels of exudate and can be used to promote autolytic debridement of dry, sloughy, or necrotic wounds (British National Formulary, 2011). Thinner versions are generally used on wounds that are dry or have low levels of exudate (Fletcher, 2005). Additionally hydrocolloids are suitable for promoting granulation tissue (Fletcher et al, 2011).

Hydrocolloid dressings come in a variety of sizes and shapes. They are self-adhering and available with or without an adhesive border for application to wounds on the body, including the sacrum, heels, elbows and flatter surfaces such as the back.

There are also variations in the backing materials of some products. Those with a more 'slippery' outer surface help to reduce the friction coefficient between the support surface and the patient and decrease the amount of shear and friction transmitted to the underlying skin, reducing the risk of pressure ulceration (Fletcher et al, 2011).

 

How do hydrocolloid dressings work?
Hydrocolloid dressings create and maintain a moist wound environment that supports wound healing (Finnie, 2002). Moisture under occlusive dressings such as hydrocolloids can help to promote angiogenesis, increase the number of dermal fibroblasts, stimulate the production of granulation tissue, and increase the amount of collagen synthesised (Box 1).

In the presence of wound exudate the hydrocolloid forms a hydrophilic gel that facilitates autolytic debridement of the wound by gently softening and rehydrating necrotic tissue and slough (Fletcher, 2005). Some dressings form a cohesive gel, which is largely contained within the adhesive matrix; others form more mobile, less viscous gels that are not retained within the dressing structure (Heenan, 1998). As the gelling process takes place, the dressing becomes progressively more permeable - this results in the loss of water vapour through the dressing and increases the ability of the product to absorb exudate (Thomas and Loveless, 1997).

related links