An Examination of a Hydrophilic Zinc Oxide-Based Paste Dressing for Use in Difficult to Dress Wounds

BACKGROUND: Pressure ulcers and incontinence associated dermatitis (IAD) are costly to both patients and healthcare systems and associated with significant human suffering. While the etiology of IAD differs from pressure ulcers, both frequently coexist. This case study evaluated the efficacy of a zinc-oxide-based hydrophilic paste dressing in the treatment of skin damage due to moisture and pressure in difficult-to-dress areas such as the buttocks or gluteal cleft.  

METHODS: A prospective case study of three patients was conducted at an acute community hospital. The evaluation included wound measurements, descriptions of wound bed and periwound skin, amount of exudate, digital photography and assessment of wound pain. Staff nurses appraised the ease of application. A zinc oxide hydrophilic wound dressing was applied to stage 2 and stage 3 pressure ulcers in patient’s meeting the wound treatment criteria. As part of the hospital’s pressure ulcer treatment strategy, silicone foam border dressings are the treatment of choice for patients with pressure ulcers. However, in patients who are incontinent, or have an ulcer in difficult-to-dress areas, a zinc-oxide based dressing was shown to be more cost effective, reduced necrotic material in wounds and protected the periwound skin. The hydrophilic paste absorbed excess exudate, gently adhered to moist wound beds, and spread uniformly over the entire wound area.

RESULTS AND CONCLUSION: Nurses reported high satisfaction with use due to ease of application, decreased patient distress and reduced occurrence of medical adhesive-related skin injury (MARSI). This moisture control promoted moist wound healing and maintained tissue integrity of the periwound skin. Selective autolytic debridement reduced necrotic tissue. It is important to note that vigilant documentation of the plan of care was essential to promote communication, provide a rationale for decision making and to demonstrate the delivery of evidence based practice for the patient with wounds.