Dialkyl Carbamoyl Chloride (DACC) Dressings for Wound Resolution in a Patient with a Recalcitrant Medical Device Related Pressure Injury to the Penis

Statement of the Problem: In older and immobile patients, the use of condom catheters to control urinary incontinence significantly increases the risk of medical device-related pressure injuries. Although antimicrobial dressings are commonly used to decrease bioburden and promote resolution of these types of wounds, treatment failure can occur, resulting in the development of a recalcitrant wound.

Purpose: This case study reviews the use of hydrophobic, dialkyl carbamoyl chloride (DACC) dressings to resolve a recalcitrant medical device-related pressure injury to the penis caused by a condom catheter used to control urinary incontinence.

Method: Three patients with similar wounds (Stage III device-related pressure injuries to the posterior proximal region of the penis caused by a condom catheter) were treated using antimicrobial dressings. Two of the patients experienced wound resolution within 12-weeks. The third patient developed a recalcitrant wound that was subsequently treated with saline irrigation and the use of DACC dressings over an eight-week period.

Results: Wound resolution for the patient treated with DACC dressings occurred during the eight-week treatment period suggesting that dialkyl carbamoyl chloride may provide a viable alternative for the treatment of recalcitrant device-related pressure injuries.

Conclusion: Dialkyl carbamoyl chloride dressings represent a novel approach to the treatment of nonhealing device-related pressure injuries. These dressings bind bacteria to the dressing’s surface thus promoting healing in wounds with bioburden. Their (DACC) hydrophobic attribute removes the microorganisms commonly found in most chronic wounds. Further investigation of DACC dressings for the first line treatment of device-related pressure injuries is warranted to evaluate their efficacy in wound care. This is especially true in light of antimicrobial resistance which can arise through the continued use of antimicrobial dressings.