Wound Care: What's Really Cost-Effective?

Nursing Homes, April, 2001 by S. Kwon Lee, Gwen B. Turnbull

Labor costs. The amount of time required for dressing changes must also be considered when comparing gauze dressings to hydrocolloids. In a study conducted by Xakellis and Chrischilles, [15] healing rates were only slightly better for hydrocolloid dressings (9 days) than for wet saline gauze dressings (11 days), but there was a significant difference in median total cost: $25.31 for gauze versus $15.90 for the hydrocolloid. The higher purchase price of the hydrocolloid (3.3 times higher than for gauze) was offset by the fact that labor costs for its use were one-eighth of those associated with gauze dressing changes. This is an important difference, since nursing and physician time are the most costly aspects of wound care.

In another study comparing gauze and hydrocolloids in patients with Stage II and III pressure ulcers, conducted by Colwell et al, [16] the average number of dressing changes per week for the saline gauze group was 28.8, compared with 2.94 for the hydrocolloid dressing group. The difference in average daily cost was dramatically different: $12.26 for the gauze group and $3.55 for the hydrocolloid group.

Bolton and colleagues [17] developed a clinical model that illustrates the powerful effect of outcomes on the total costs of wound care. Regardless of wound type or the cost of supplies, dressings that facilitate healing are less expensive than dressings that do not.

For example, if there are 10 chronic wounds ma facility and wet-to-dry dressings are ordered two or three times a day, 140 to 210 dressing changes must be performed each week. On the other hand, if hydrocolloid dressings are ordered for the same 10 wounds, only 20 to 30 dressing changes a week will be needed. This represents a 7- to 10-fold reduction in the number of dressings, a tremendous savings in nursing time and costs.

Rates of healing. The findings of one study showed that hydrocolloids appear to improve the rate of wound healing. Mulder et al [18] studied fibrinolysis and the level of fibrin in wound margins (the byproducts of fibrin breakdown stimulate the production of collagen). The patients in this study had venous leg ulcers managed either with compression therapy plus a hydrocolloid or compression therapy alone. They found a significantly higher level of fibrin being broken down in the fluid under a hydrocolloid dressing than in wounds treated only with compression. Better and faster healing was observed--a result of increased fibrinolysis and collagen production in the moist environment under the hydrocolloid.

Choosing a Hydrocolloid

To say "all hydrocolloids are the same, so buy the cheapest one" is not only inaccurate, but it can also be a costly mistake. Dressings vary in composition, percentage of hydrocolloid, thickness of the hydrocolloid layer and indications for use. As with any category of wound dressings, it is important to read labels to differentiate between individual products. Although few studies have been done to compare various wound care products within categories, two studies do demonstrate significant differences in how certain hydrocolloids perform--because of varying thickness, ability to stay in place and incidence of leakage. There is also a product-to-product difference in the ability to stimulate the proliferation of human keratinocytes because of a natural growth factor effect.[19,20] The bottom line is that all products are not created equal.