Spreading the Revolutionary Message of Modern Wound Management Principles: Facilitating Change Among Surgeons

Background: Published research support for moist wound healing has been available since the 1940s, and in the 1960s researchers provided strong evidence for faster epithelialization rates and decreased infection when wounds were kept moist. Yet, 50 years later, many surgeons worldwide still prefer dry wound management and use toxic antiseptics to prevent infection in open wounds.

Purpose: The program’s goal is to transition hospitals in developing countries to modern moist wound management principles. We wanted to replace antiseptic-and-dry-gauze-dressings with moist, nontoxic materials. We also wanted to emphasize improving nutrition and pain control.

Approach: Surgeons usually suture the wounds they create, incidentally protecting deeper tissues from desiccation. Dry suture lines give the impression that dry wounds heal well. Diplomatically exposing the fact that this overwhelmingly positive experience with apparent dry wound healing is illusory helped promote changes in attitudes and actions throughout the hospital.

Advancing a paradigm shift also facilitated the change: health care professionals do not heal wounds; only the body can heal. We support the body. Moisture facilitates movement of healing and infection-fighting substances across the wound surface. Improved nutrition and pain control further support the body’s ability to heal.

Other keys to success included:

1) Laying a strong foundation over time

2) Avoiding divisiveness by conversing directly with decision-makers

3) Choosing a spokesperson with strong credentials. Experience in a similar setting increased credibility

4) Coming prepared with solid research evidence

5) Answering questions respectfully and succinctly

6) Having realistic expectations – building trust in a new idea takes time

Outcomes: The surgical team immediately changed the way they manage wounds to implement moist wound healing principles. Surgeons supported nurses’ nutritional teaching and oral pain medications were prescribed earlier to provide more adequate coverage. Almost a year later, many of the changes in wound management have reportedly endured.