According to the National Institute of Health, it is estimated that, on average, about 11% of long-term care residents suffer from chronic wounds. No other demographic group experiences chronic wounds to that degree. 

Wounds are considered chronic when they take longer than four weeks to heal. Chronic wounds typically include diabetic ulcers, arterial and venous ulcers, pressure ulcers and others. 

During the healing period, frequent assessment of the wound and maintaining wound site cleanliness are key factors contributing to quicker healing and to patient satisfaction. Currently, in most long-term care facilities, chronic wound care protocol requires changing dressings every 24 hours, especially for full-thickness wounds. This standard of care is supported by wound care experts and borne out by experienced wound-certified clinical staff working in more than 3,500 long-term care facilities located throughout the United States.

Recently, there has been talk in our industry about revising dressing-changing protocol from daily activity to changes every three days. Some companies have even adopted this new format in their facilities. The origination of this three-day protocol was a reaction to the effects of post-pandemic personnel shortages, inflation, and supply chain issues. 

Instead of addressing solutions to those issues, some have adopted a three-day plan, with potentially negative effects for patients. Proponents of the three-day change attempt to justify their reduction in patient care by citing wound care studies that survey a much broader survey group consisting of all wound patients.

But not all wounds are alike. Wound cause, wound type, patient age factor, recovery environment and other factors necessitate following different treatment protocols. For example, there are some post-surgery wounds experienced by the general adult population, where there may be justification for leaving a dressing undisturbed for a few days to promote healing. However, that protocol is not relevant to long-term care practice. Anchoring a treatment rationale using a broad clinical universe offers great potential to draw incorrect conclusions resulting in insufficient care. 

Three — not a lucky number

Chronic wounds suffered by long-term care patients are different from those of the general population. Not only is the skin durability and healing rate very different for geriatric patients, but the regimen patients experience during a typical day in long-term care has the potential to dramatically affect the wound dressing’s efficacy over time. Long-term care patients are moved and repositioned several times daily by caregivers. Repositioning can inadvertently cause friction or shearing, or even dislodging of the wound dressing. 

Also, wound dressing integrity can be affected over time if a resident is incontinent, has a compromised immune system, is on steroid/immunosuppressant medications, has compromised circulation, diabetes or other chronic illnesses, or resides in a setting where frequent colonization of a resident’s skin with bacteria occurs. Three days is too long to wait to deliver proper wound care.

Clean dressings also provide a safe and comfortable environment for new cell growth. Daily dressing changes help to promote the health of the tissues surrounding and at the edges of the wound site, as well as within the wound itself.  

Daily dressing changes also ensure that the wound is assessed every day for signs or symptoms of abnormal healing, the formation of necrotic tissues, and the presence of wound critical colonization or infection. Further, wound infections are not rare — up to 50% of acute wounds become infected. Daily observation of wounds will help to ensure that the signs or symptoms of wound infection will not be missed and can be more quickly attuned.  Gaining days on the growth of an infection will contribute significantly to its healing.

Unacceptable by any standard

Although everyone strives for care delivery perfection, in reality, sometimes dressing changes do get missed. Should that occur, if the stated protocol is daily, at most, the dressing would get changed within 36 to 48 hours. However, if a three-day protocol is used and the change gets missed, the actual dressing change can go to four days or more, which is unacceptable by any standard.

The danger to a patient is that if a localized wound infection is not recognized and treated promptly, it won’t heal as quickly and completely as it should. Without frequent care, there is the danger that the infection may ultimately spread via the bloodstream, causing a serious infection known as sepsis which can even lead to amputation or death.

Maintaining the highest standards of patient care also has great value when prospective clients are comparing your facility against others. Your commitment to one-day dressing changes is a powerful advantage over those facilities changing every three days. 

Ultimately, we as an industry are committed to providing patients and residents the highest quality, safest wound care possible. There is no doubt this includes the best practice of assessment and treatment of wounds on a daily basis.

David Navazio is President and CEO of Gentell, one of North America’s largest wound care dressing manufacturers, manufacturing and supplying efficient, affordable patient-specific wound care treatments to nursing homes, hospitals, home care, hospices and other providers. 

The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.