Pilot Study on New Wound Dressing Technique: A Comprehensive Review

This report details a pilot study investigating a new wound dressing technique. It begins with an introduction highlighting the prevalence of surgical wounds and the importance of effective dressing methods to prevent infections and complications. A comprehensive literature review is presented, covering the history of wound dressing, from traditional methods like gauze and bandages to modern techniques such as semi-permeable films, foams, hydrogels, alginates, and bioactive dressings. The review discusses the attributes of an ideal dressing and categorizes techniques as clean or sterile. The report then outlines the pilot study's aim, which is to gather experiences and perceptions from both patients and clinical officers regarding the new technique, to inform a decision on its adoption. The study utilizes both qualitative and quantitative research methods. The report provides a foundation for future research on wound dressing techniques, emphasizing the importance of selecting the most appropriate dressing type for the wound to facilitate healing and prevent infection.

Running Head: PILOT STUDY ON NEW WOUND DRESSING TECHNIQUE
Pilot Study on New Wound Dressing Technique
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PILOT STUDY ON NEW WOUND DRESSING TECHNIQUE 2
Part 1
Introduction
There are always millions of surgical procedures conducted around the world every year
that majority resulted in surgical wounds. Following the surgical wound closures, the wounds
always leak fluids within the first 24 hours as they are frequently covered with different types of
dressings such as glue-as- a-dressing aimed at providing the protection to the wound(Rodriguez-
Merchan 2012). Studies show that many surgical wounds receive poor dressing procedures
exposing the wounds to surgical sites infections that results in more complications and even to
deaths. Studies indicate that about seventy-seven per cent of the surgical patient deaths always
resulted from the infractions that are directly correlated to the open surgical wounds
(Vasconcelos & Cavaco-Paulo 2011). The Centers for Disease Control in the USA reported that
considerable advances have been made in the infection control practices such as sterilization
methods, using of advanced surgical techniques and antimicrobial prophylaxis, SSI is still a
significant cause of morbidity and prolonged hospitalization even deaths. Thus the recognition of
the best surgical dressing is the most important issues to address the issue.
Search strategy
The evidence of the study will be retrieved from various databases such as MEDLINE,
CIN NL, and Scopus databases systems. Other sources of the evidence search will be Google
Scholars that will be used to receive the literature on the topic under the study. Therefore, using
the search terminologies such as ‘surgical wound’ and ‘wound dressing techniques’, the
researcher came across 30 peer-reviewed journals and research papers that were between 2011

PILOT STUDY ON NEW WOUND DRESSING TECHNIQUE 3
and 2018. Applying the search criteria, the researcher found 20 that met the criteria for the
literature review and the pilot study.
Literature Review
Surgical wound refers to the cut made at the skin by the surgeon during the operation and
at the end, the cut is always joined back together through the use of stitches, strips or adhesive
dressings to allow the skin edges to come together and heal (Percival, Mayer & Salisbury 2017).
There are 2 major types of wounds following surgery: incisional wounds and excisional
wounds. , therefore, after every surgery, the choices of dressing facilitate the healing process of
the wound. The incisional wounds are made when the cutting goes through the skin, muscles and
fat so that the body part can be repaired or removed. On the other hand, the excisional wounds
are made when the surgeon wants to remove a cyst or any other types of tissues.
The dressing is a sterile pad applied on the wound majorly to absorb any leakage from the
wound, provide ideal conditions for healing, protect the wound until it is healed and prevent the
stitches from catching on cloth. The dressings are designed to be in contact with the wound thus
needs to be effective to prevent further infection and facilitate healing (Green 2013). When the
wounds are closed with appropriate dressing, they are continuously exposed to the protease,
complement, chemotactic and growth factors.
History of the wound dressing
Historically, people used wet-to-dry dressing methods that required debridement. During
the 1600 BC, Linen strips were soaked in either oil or grease and then covered with plasters and
used to occlude the wounds. In other societies, the wounds were cleaned using milk and water
prior to dressing with honey (Arslan, Murat, Aldemir, Kazaro & Gümü-derelio 2014). In the

PILOT STUDY ON NEW WOUND DRESSING TECHNIQUE 4
19th century, there was a breakthrough when the antiseptic technique was discovered that was
used to control infections. In the 20 the century, there was the invention of the occlusive
dressing, that provided a moist environment to the wound, facilitating the re-epithelialization
process, collagen synthesis and production of the angiogenesis. Among the techniques used was
the woven absorbent cotton gauze.
Some of the attributes of an ideal wound dressing include: the ability of the dressing to
absorb and contain the exudate without strike through and leakage; the ability of the dressing not
to leave any particulate contaminants in the wounds; the ability of the dressing to insulate the
wound from thermal ; the ability of the dressing to block the water and bacteria accessing the
wound; the ability of dressing to be used in different skin closures; ability of the dressing not to
cause wound trauma during the dressing process and ability of the dressing to aid visualization of
the wound(Broussard & Powers 2013). The surgical wound dressing is categorized under tow
major groups: clean and sterile techniques:
The clean techniques refer to free of dirt, stains or marks and involve all strategies that
are used to prevent any microorganism or reduce the transmission risk from one patient to
another (Xiao-ling Huang, Jing-qi Zhang, Shu-ting Guan, & Wu-jin Liang 2016). The clean
techniques include: hand washing, use of clean gloves and sterile instruments and is always
preferred for long-term home care and some clinic setting; for patients with low-risk infections;
and for patients receiving continuous dressing for chronic wounds such as venous ulcers.
Sterile techniques refer to strategies that reduce the exposure of the wound to
microorganism through the use of sterile gloves, sterile dressing, and sterile surgical instruments.
The rule here is that anything used must be sterile in cleaning and dressing the wound and is

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always considered the most appropriate in acute care hospital setting among high-risk infections
patients(Marston, Tang, Kirsner & Ennis 2016). Aseptic technique refers to free from pathogenic
microring nazism. The aseptic technique aims at preventing the transfer of organisms from one
person to another by reducing the microbe counts to a minimum. No touch techniques refer to
the process of changing the dressing surface without directly coming into contact with his
wound. In these techniques, clean gloves and sterile solutions are used to maintain the wound
and dress it.
Traditional wound dressing
The traditional wound dressing products include gauze, plaster, lint, bandages and cotton
wool that all aim at keeping the wound dry and protect from the contamination. The gauze
dressing is always made out of the woven and nonwoven fibers of cotton, polyester, and rayon
that have some sort of protection against bacteria. The sterilized gauze pads with the help of the
fibers have the ability to absorb the exudates and fluids in an open wound; however, the dressing
type requires frequent changing to protect maceration of the healthy tissues (Shimizu, Ishida,
Yamamoto, Kuroyanagi & Kuroyanagi 2014). Due to the wound leakage immediately after the
surgical process, the dressing becomes moistened thus becomes adherent to the wound resulting
into wound trauma. The gaze dressing is cost-effective since they are cheap, readily available
and easy to use.
The bandages are made out of natural cotton wool, cellulose and polyamide materials that
have various functions. For example, the cotton wool bandages are used majorly to retain the
light dressing, while high and short compression bandages provide sustained compression in
venous ulcers (Cirillo, Spizzirri, Curcio, Spataro, Picci, Nicoletta, & Iemma 2016). The Tulle

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dressing such as rage Batigras, Paratulle, and Jelonet are commonly referred to as the
impregnated dressing; since they contain paraffin that suitable for the superficial wounds.
In general, all the traditional wound dressing is designed for clean and dry wounds that
have mild exudate. Since most of the traditional dressing fail to provide a moist environment to
the fresh wounds, low ability to absorb more exudate, and difficulty in changing among many
others disadvantages, they have been replaced by the modern dressing that has advanced
formulations.
Modern wound dressing
The first modern wound dressing technique was discovered in the 1980s that aimed at
providing moisture and absorbing the fluids from the wound the modern wound dressing is based
on the synthetic polymers and is categorized either as passive or non-occlusive. The modern
dressings include:
Semi-permeable film dressing
The semi-permeable dressing is composed of transparent and adherent polyurethane that
allows the transmission of water vapour, oxygen and carbon (IV) dioxide from the wound as well
as provision of autolytic debridement of eschar and preamble bacteria. The first film was made
from the nylon derivatives that had an adhesive polyethylene frame for support (Okoye & Okolie
2015). the nylon derived film dressing are highly elastic and flexible making them conform to
any shape and do not require any tapping, secondly, due to the transparent nature the nylon
derived film dressing provided easy wound inspection without the removal of the wound
dressing. However, the nylon derived film was not used for highly exudating wounds due to their
inability to make maximum absorption, thus in most cases resulted into maceration of the healthy

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tissues thus they are mostly recommended for the epithelializing, superficial and shallow
wounds.
Semi preamble foam dressing
The semi-preamble foam dressing is made up from the hydrophobic and hydrophilic
foam that contains adhesive borders. The hydrophobic property protects the wound from the
liquid while the allowing gaseous exchange between the wound and atmosphere (Wibaux, Thota,
Mastej, Prince, Carty & Johnson 2015). The foam has the capability of absorbing various
wounds drainage depending on the wound thickness, thus are suitable fi leg ulcers and
moderately exudating wounds. However, the foam dressing is limitedly used because they
require frequent dressing.
Hydrogels dressing
Hydrogels are insoluble hydrophilic materials that are made from the polymers. These
materials have high water content about 70-90% thus helps the granulation tissues to have a
moist environment, thus facilitate the healing and removal of the dressing without further wound
damages (Choi, Kim, Kim, Kim, Yong, Cho & Choi 2016). The hydrogels have the ability to
decrease the cutaneous wounds temperature by providing a soothing and cooling effect thus is
suitable for the burns wounds, ulcer wounds. The major advantages of this type of dressing are:
nonirritant, nonreactive and are a preamble to metabolites. Some of the hydrogels dressings are
Initiate, Nu-gel, and Aquaform.
Alginate dressing

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Alginate dressing is made from the sodium and calcium salts that contain mannuronic
and guluronic acid salts. Alginate dressing has the absorption capacity that is derived from the
seaweed thus provide strong hydrophilic gel formation limiting the wound exudates and bacterial
contamination (Aderibigbe & Buyana 2018). The healing process of the wound is facilitated by
the ability of the alginates ability to activate the macrophages that initiate the inflammatory
signal. The ions from the alginate dressing are always exchanged with the blood to form a
protective film
Bioactive wound dressing
The bioactive wound dressing is produced from the biomaterials that are significant in the
healing process of the wound (Quirós, Boltes & Rosal 2016). The dressings have biodegradable,
biocompatible and non-toxic since they are generally derived from the natural tissues (Mohseni,
Shamloo, Aghababaei, Vossoughi, & Moravvej 2016). The bioactive dressing included collagen,
hyaluronic acid, chitosan, alginate, and elastin.
Evaluation of the evidence
The literature review aimed at making the researcher understand the background of the
surgical wound dressing. Findings from the systematic review and similar documents targeted
the researchers on the clinical field. The identified journals provided enough foundation for the
researcher to understand the history of the wound dressing, the traditional and modern
techniques, and factors considered for selecting an ideal wound dressing method.
Part two
Pilot study

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The pilot study refers to the research study conducted before the actual intended study.
The pilot study will use both the qualitative and quantitative research methods to collect the data
regarding the new dressing.
Aim
The aim of this pilot study is to collect the experiences and perceptions of both the wound
patients and the clinical officers regarding the new wound dressing techniques, this will enable
the researcher to make a decision whether to adopt the new technique in the hospital or to discard
it (Pettus, Dunnigan, Veeh, Howard, Scheyett & Roberts 2017). The results of the pilot study
will also work as a foundation for future research on the wound dressing techniques.
To collect reliable and accurate data, the researcher used the following research questions during
the study:
 Research Question 1: How best does the new wound dressing facilitate the healing
process?
 Research Question 2: How best does the new dressing protect the wound from
contamination?
 Research Question 3: How frequent does the new dressing requires change?
 Research Question 4: What is the reliability of the new wound dressing in terms to
nurses?
Research Approach
According to Wulfmeyer, et al., 2018), the research approach aids in collecting the most
accurate and relevant information that contain either experimented or observed data. The

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approach entails all the procedures of data collection, analysis, and interaction based on the
nature of the research problem, therefore, in this study, the researcher aims at determining the
superiority of the new surgical wound dressing. To accomplish the study, the researcher will
employ both the qualitative and quantitative rescue methods
Qualitative research approach
The qualitative research approach is associated with the social constructivist paradigm
that emphasizes the socially constructed nature of reality. The process entails recording
analyzing and attempting to uncover the experience of the participants with the reality. The
qualitative research app-arch is integrated into the pilot study to help the researcher with accurate
insights into the feasibility and potential design of the trial (Farghaly 2018). The study will use a
semi-structured questionnaire that will help in exploring the participant experience on the
acceptability of the new wound dressing technique, staffs experiences on using the new wound
dressing techniques and the perceptions of the stakeholders.
Quantitative research approach
The quantitative research approach generally focuses on collecting and converting data
into a numerical form to allow statistical calculation for a general conclusion (Kipanyula & Sife
2018). Based on the study questions the quantitative data concerning the percentage of the best
experiences, quick healing process among others will be investigated through the quantitative
research approach.
Research setting

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The setting of the research will be in this hospital and will be based on secondary care
that entails acute and maternity. The selection of our hospital is based on the capability to handle
wound patients, maternal health programs, critical care, and adequate staff and daily patients that
will successfully facilitate the data collection process. The population of the study will be
majorly the patients aged 18 years and above that are undergoing abdominal general surgery
such as small and large bowel resection, hepatic resection, and abdominal hernia surgery.
Sampling method
Sample size refers to the subset of the population under the study that helps in making a
general conclusion. The participants of the study will be randomly selected based on the word
dressing groups. The wound dressing groups will be based on the available dressing technique
and the newly proposed technique.
Recruitment
The participants of the study entail patients and the clinical officers that attend to the
wounds. The participants were recruited from various tertiary wound care clinics that carry
approximately 50 consultations per week. Prior to the recruitment, all the participants were
informed of the study purposes and given chance to decide whether they are free to participate.
The participants of the pilot test study were recruited directly from the hospital while others were
recruited through an email account (Mauro, Haxtema & Temesgen 2017). The convenient
sampling strategy was used to recruit the participants thus only those patients that had the
wounds or undergoing the superficial surgical process and that clinical officer with knowledge
about the wound dressing was approached.
Inclusion /exclusion criteria

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Inclusion
 All surgical patients that are above the age of 18 of both gender majorly the abdominal
and chest surgery.
 Nurses who had performed wound dressing using more than four techniques both the
traditional and modern techniques.
Exclusion
 Patients were excluded if they were younger than 18 years
 Patients with abdominal or major surgery that are less than three months before the index
operations will be ineligible
 patients that have inadequate consent capacity will be ineligible
 Patients that show an inability to complete a patient-reported questionnaire
 Nurses who have never performed any surgical wound dressing
Ethics
According to Sade (2017), the voluntary participation of the participants will be
considered to accomplish the pilot study. No participants will be coerced to participate and all
will be given the opportunity to quit whenever they feel. The participants will be told the need
and importance of the study and their consent received before the commencement of the study.
Furthermore, the researcher will acquire the approval from the relevant authorities before
proceeding and the ethical procedure will be approved by the Hospital Ethical Committee.
Data collection