Abstract

Knowledge about practice patterns and optimal usage criteria for topical antimicrobial dressings is limited. A retrospective data analysis was conducted to evaluate: 1) the length of time these dressings are applied in a typical episode of wound care, 2) the number of episodes of antimicrobial dressing use, and 3) whether antimicrobial dressings are applied in consideration of signs and symptoms of infection. Wound care registry data from a level-4 electronic medical record were analyzed, providing information on 3,084 patients older than 17 years seen from July 2003 through December 2008 in 26 hospital-based, outpatient wound centers in 14 states. The 5,541 recorded wounds ranged in size from 0.3 to 225 cm2. One antimicrobial dressing use episode was recorded for 71% of wounds (4.7% had four or more). Mean treatment episode length was 32.5 days (median 21 days). Clinicians used these dressings for a longer period of time if patients had multiple comorbidities (P = .0001), a refractory wound (P <.00001), or were prescribed oral antibiotics (P <.0002); first dressing use was more common in wounds with signs and symptoms of infection (P <.00001). During an average of 16 (median 10) visits and a follow-up time of 269 days, 61.4% of wounds healed (range 42.2% for flaps or grafts to 67.9% for surgical wounds of all 5,541 wounds). Antimicrobial dressing use for 2 to 4 weeks was associated with a higher proportion of healed wounds, but in wounds that healed, longer dressing use was associated with a longer healing time. The practice pattern observed suggests that antimicrobial dressing usage generally is based on patient and wound assessment variables but prospective studies are needed to develop optimal guidelines of care.