Dear Mrs. Smith,
The Agency for Healthcare Research and Quality (AHRQ), a division of the U.S. Department of Health & Human Services (HHS), reviews, accepts and publishes guidelines that become standards of care for various conditions. In 2011, the National Guideline Clearinghouse published on the Internet the Association for the Advancement of Wound Care (AAWC) guidelines for pressure ulcers. In this guideline, they state that “using wet-to-dry gauze is considered sub-standard practice.”
The wet-to-dry (WTD) dressing has been used for almost a century because it was the most basic form of dressing to cover a wound. Whether in a battlefield or a motor vehicle accident, it provides a basic covering to a wound at very little cost. It has also been referred to as a “moist gauze dressing,” but there is a substantial difference between the two types of dressings.
The WTD dressing went from a basic wound covering to a method of mechanical debridement. Gauze saturated with saline or water is applied to a wound and left in place for 24 hours which allows enough time for the gauze to dry out and stick to the wound. After 24 hours, the dry gauze is literally ripped off the wound, taking necrotic tissue and some healthy bleeding tissue along with the gauze. After 2 or 3 WTD dressing changes, there is very little necrotic tissue left on the wound, leaving viable healthy tissue to be ripped away. This is far more painful than a bikini wax or ripping tape off a hairy arm. Some patients were given “bite-blocks” to bite down on when the dressing was ripped away from their body. Screaming during the process can easily be heard down a hallway. Using the WTD dressing as a form of mechanical debridement is a barbaric method that some refer to as inhumane or even torture.
The AAWC Guidelines for Pressure Ulcers 2010 are referring to the use of WTD dressing for the purpose of mechanical debridement. The entire statement reads: “Mechanical debridement using wet-to-dry gauze is considered substandard practice. (Evidence Level = C).” It is possible for this guideline to be cited for non-pressure ulcers and not just relating to mechanical debridement, as a “moist gauze” dressing has be shown to be identical or clearly similar. With so many dressing options to choose from today, hopefully the WTD dressing for debridement purposes will fade away into history.
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