Acute Wound Care Research Articles

The incidence and prevalence of chronic wounds from a major plastic surgery service from a metropolitan city in south western Nigeria: A sixteen-year retrospective review

IntroductionChronic wound presents a burden to the patient due to the effect on their quality of life and cost of care. The exact prevalence is difficult to assess due to insufficient data, different study designs, and deferent study definitions of chronic wounds. There is limited data on the prevalence and the burden of chronic wound in our subregion. This study was therefore carried out to establish the burden of chronic wound in order to document a baseline data for monitoring progress, as well as provide information for advocacy on equitable distribution of resources for wound care. MethodThis was a retrospective review between January 2007 and December 2022. Data was analysed using SPSS. ResultA total of 866 patients with new chronic wounds were seen at an average of 54 cases per year. An average of 330 old and new chronic wounds are seen yearly. Chronic ulcers are developing at a rate of 1.2/1000 population, and the prevalence of chronic ulcer is 3.3/1000 population. Most patients were males (57.2 %), with a mean age of 41.7years ± 20.6. Post traumatic wound is the leading aetiology. Age correlates positively with aetiology, p=<0.001. Sickle cell and venous wounds are predominantly on the legs, p=<0.001. There is a correlation between increasing age and occurrence of chronic wound in the leg, p=<0.001. ConclusionPost traumatic wound is the leading cause of chronic wound in our subregion. There is a need to improve care of acute wounds to reduce the burden of chronic wounds.

Introducing PCL-Based Electrospun Nanocomposite Wound Dressings: Synergistic Effects of Curcumin and Reduced Graphene Oxide

ABSTRACT The development of effective wound dressings is critical for enhancing patient outcomes in both acute and chronic wound care scenarios. In this research, electrospun nanofibrous scaffolds were fabricated from poly(ε-caprolactone) (PCL), enhanced with curcumin and reduced graphene oxide (RGO) to optimize their biomedical applications, particularly in wound healing. The resulting scaffolds were rigorously characterized through scanning electron microscopy, contact angle measurements, water uptake capacity, and water vapor transmission rate assays. The biocompatibility of these novel nanofibers was affirmed through MTT assays. Antibacterial tests confirmed the scaffolds’ ability to inhibit both Gram-negative and Gram-positive bacteria, with inhibition zones measuring up to 9.9 mm for S. aureus and 9.2 mm for E. coli. Additionally, scaffolds containing curcumin exhibited significant antioxidant activity, achieving up to 40% radical scavenging efficiency. The study further revealed the scaffolds’ capability for sustained drug release, with an initial burst release within the first 12 hours followed by a gradual release over 168 hours. Overall, the PCL-curcumin-RGO electrospun mats demonstrated considerable potential for biomedical applications, notably in the field of wound dressings, due to their enhanced antibacterial, antioxidant, and biocompatible properties.

Accelerating diabetic wound healing by ROS-scavenging lipid nanoparticle–mRNA formulation

Current treatment options for diabetic wounds face challenges due to low efficacy, as well as potential side effects and the necessity for repetitive treatments. To address these issues, we report a formulation utilizing trisulfide-derived lipid nanoparticle (TS LNP)-mRNA therapy to accelerate diabetic wound healing by repairing and reprogramming the microenvironment of the wounds. A library of reactive oxygen species (ROS)-responsive TS LNPs was designed and developed to encapsulate interleukin-4 (IL4) mRNA. TS2-IL4 LNP-mRNA effectively scavenges excess ROS at the wound site and induces the expression of IL4 in macrophages, promoting the polarization from the proinflammatory M1 to the anti-inflammatory M2 phenotype at the wound site. In a diabetic wound model of db/db mice, treatment with this formulation significantly accelerates wound healing by enhancing the formation of an intact epidermis, angiogenesis, and myofibroblasts. Overall, this TS LNP-mRNA platform not only provides a safe, effective, and convenient therapeutic strategy for diabetic wound healing but also holds great potential for clinical translation in both acute and chronic wound care.

Avenanthramide and β-Glucan Therapeutics Accelerate Wound Healing Via Distinct and Nonoverlapping Mechanisms.

Objective: Given the significant economic, health care, and personal burden of acute and chronic wounds, we investigated the dose dependent wound healing mechanisms of two Avena sativa derived compounds: avenanthramide (AVN) and β-Glucan. Approach: We utilized a splinted excisional wound model that mimics human-like wound healing and performed subcutaneous AVN and β-Glucan injections in 15-week-old C57BL/6 mice. Histologic and immunohistochemical analysis was performed on the explanted scar tissue to assess changes in collagen architecture and cellular responses. Results: AVN and β-Glucan treatment provided therapeutic benefits at a 1% dose by weight in a phosphate-buffered saline vehicle, including accelerated healing time, beneficial cellular recruitment, and improved tissue architecture of healed scars. One percent AVN treatment promoted an extracellular matrix (ECM) architecture similar to unwounded skin, with shorter, more randomly aligned collagen fibers and reduced inflammatory cell presence in the healed tissue. One percent β-Glucan treatment promoted a tissue architecture characterized by long, thick bundles of collagen with increased blood vessel density. Innovation: AVN and β-Glucan have previously shown promise in promoting wound healing, although the therapeutic efficacies and mechanisms of these bioactive compounds remain incompletely understood. Furthermore, the healed ECM architecture of these wounds has not been characterized. Conclusions: AVN and β-Glucan accelerated wound closure compared to controls through distinct mechanisms. AVN-treated scars displayed a more regenerative tissue architecture with reduced inflammatory cell recruitment, while β-Glucan demonstrated increased angiogenesis with more highly aligned tissue architecture more indicative of fibrosis. A deeper understanding of the mechanisms driving healing in these two naturally derived therapeutics will be important for translation to human use.

Hydrogels and Wound Healing: Current and Future Prospects.

The care and rehabilitation of acute and chronic wounds have a significant social and economic impact on patients and global health. This burden is primarily due to the adverse effects of infections, prolonged recovery, and the associated treatment costs. Chronic wounds can be treated with a variety of approaches, which include surgery, negative pressure wound therapy, wound dressings, and hyperbaric oxygen therapy. However, each of these strategies has an array of limitations. The existing dry wound dressings lack functionality in promoting wound healing and exacerbating pain by adhering to the wound. Hydrogels, which are commonly polymer-based and swell in water, have been proposed as potential remedies due to their ability to provide a moist environment that facilitates wound healing. Their unique composition enables them to absorb wound exudates, exhibit shape adaptability, and be modified to incorporate active compounds such as growth factors and antibacterial compounds. This review provides an updated discussion of the leading natural and synthetic hydrogels utilized in wound healing, details the latest advancements in hydrogel technology, and explores alternate approaches in this field. Search engines Scopus, PubMed, Science Direct, and Web of Science were utilized to review the advances in hydrogel applications over the last fifteen years.

The Effectiveness of Combination of Piper betle L. ethanol Extract and Manuka Honey Spray Gel to Accelerating Acute Wound Healing

Acute wounds are injuries that occur suddenly to tissues that are prone to the risk of being infected. Therefore, acute wound care must be considered carefully. Piper betle leaf contains flavonoids that have a function in the wound healing process, Manuka honey also contains vitamins that can support the healing phase. The combination of Piper betle L. and manuka honey is made into a spray gel preparation because it has advantages over other topical preparations. The purpose of this study is to see how well a combination wound healing spray gel of Piper betle L. and Manuka honey works on an acute wound in mice. This study uses experimental research with a randomized, matched post-test-only control group design. The formulation taken was maceration extraction from Piper betle L. Simplicia powder with 70% ethanol then evaporated to acquire a concentrated concentrate. Spray gel preparations of a combination of Piper betle L extract and manuka honey were made with a concentration of 1% Piper betle L and Manuka honey, 3% Piper betle L and Manuka honey, and 5% Piper betle L and Manuka honey. Balb/c mice that had full-thickness acute wounds were divided into 7 treatment groups, namely SM1, SM2, SM3, M, KP, B, and D. Mice were treated for 14 days and the wound area ratio was calculated and analyzed by ANOVA. The test results showed a significant difference between groups SM3-M, SM5-M, M-SM3, M-SM5, KP-M, B-SM3, and BM with a significance value below 0.05 (p≤0.05) which proves that the spray gel combination of Piper betle L extract and Manuka honey, oxoferin, and base both have activity in accelerating acute wound healing.

Antimicrobial or Antiseptic Cleansers for Wounds

&#x0D; For chronic wound care, the majority of evidence suggested that antiseptic agents do not add additional clinical benefits compared with saline. No differences were observed between antiseptics and saline in the incidence of adverse events.&#x0D; For surgical wound care, irrigation with antibiotic agents is likely associated with lower rates of surgical site infections compared with saline irrigation. Depending on the type of antiseptic agent, type of surgery, and depth of infection, antiseptic irrigation may have superior or similar efficacy compared with saline in surgical site infection and wound healing rates. Indirect evidence suggested antibiotics were not superior to antiseptics for prevention of surgical site infections. No differences were observed between antiseptic irrigation and saline irrigation in the incidence of adverse events and length of hospital stay.&#x0D; For acute traumatic wound care, a limited number of studies provided mixed results on the effectiveness of povidone-iodine compared with saline for preventing infection. The effect of antiseptic agents on bacterial load was unclear. No robust conclusions could be drawn due to very low certainty of the evidence.&#x0D; The economic evaluation study showed that irrigation with hypochlorous acid preserved wound cleanser was a cost-effective strategy in the short term compared with saline for the treatment of severely complex wounds during ultrasonic debridement. However, we have little confidence in the findings due to several limitations in the methods of the study.&#x0D; We did not identify any studies that compared the clinical effectiveness and cost-effectiveness of antimicrobial or antiseptic wound cleansers with antimicrobial dressings or of different types of antimicrobial or antiseptic wound cleansers for the management of wounds.&#x0D; We did not identify any evidence-based guidelines regarding the use of antimicrobial or antiseptic wound cleansers for the management of wounds.&#x0D;

Low-value wound care: Are nurses and physicians choosing wisely? A mixed methods study.

Choosing Wisely is an international movement that stimulates conversations about unnecessary care. The campaign created five recommendations including a statement that less wound care is sometimes better. The study aims to evaluate nurses' and physicians' adherence to the Choosing Wisely recommendations for acute wound care in the Netherlands and the barriers and facilitators to improve this. This is a mixed methods study using a survey and interviews. The survey was completed by 171 nurses and 71 physicians from November 2017 to February 2018. A total of 17 nurses and 6 physicians were interviewed. Awareness of the five recommendations ranged from 62% to 89% for nurses and 46% to 85% for physicians. However, up to 15% of the nurses and 28% of physicians were aware but did not adhere to the recommendations. Barriers to adhering were a lack of knowledge, the work environment and perceptions of patients' preferences. Repeated attention, cost-consciousness and an open culture facilitated the implementation. Although most nurses and physicians were aware of the recommendations, not all adhered to them. Increasing awareness is not enough for successful implementation. A tailored approach that removes the barriers is necessary, such as increasing knowledge about wounds and changing the work environment.

Effects of Negative Pressure Wound Therapy on Graft Success In Patients with Diabetic Foot Ulcers: A Retrospective Study

Objective: One of the technological advances in wound healing is negative pressure wound therapy (NPWT). NPWT is frequently used in acute and chronic wound care. However, few studies in the literature have investigated the effects of NPWT on the graft in patients with diabetic foot ulcers. In this study, we aimed to assess the effects of applying negative pressure wound closure on grafts and its influence on the healing time in diabetic foot ulcers and thus contribute to the literature by sharing our experience. Methods: We retrospectively evaluated patients who had received treatment for diabetic foot ulcers in the chronic wound care unit of our hospital between February 2018 and October 2021 and underwent split-thickness skin grafting. The patients were categorized into two groups: those who did and did not receive NPWT to provide support for the graft. The patients were compared in terms of wound healing rates and healing times. Results: The study included 34 men (56.7%) and 26 women (43.3%) (n = 60). The mean age of the patients was 62.07 ± 11.5 years. Supportive NPWT was performed on the graft in 19 (31.7%) patients, whereas 41 (68.3%) patients were treated with grafting and conventional therapy. The treatment duration was shorter in the NPWT group (29.63 ± 19.6 days) than in the non-NPWT group (34.05 ± 17.5 days); however, this difference was not significant (p &gt; 0.05). A significant weak positive correlation (r = 0.28) was observed between the Wagner stage and treatment duration. Conclusion: The treatment of diabetic foot ulcers is affected by several factors, including the presence of infection, vascularization status, wound size, and glycemic control. In this study, we examined a general patient population with diabetic foot ulcers and identified no significant difference in terms of treatment times and healing rates between NPWT and conventional methods as graft-supporting measures. Prospective studies investigating patient populations comprising subgroups may yield varying results, which emphasizes the need for further research in this direction.

Challenges in Burn Care during the COVID-19 Pandemic-A Scoping Review.

Objective: The aim of this review is to map and summarize the experiences of various burn centers worldwide during the COVID-19 pandemic, in order to enable future strategies with regard to the most effective measures in burn care during pandemics and to detect possible gaps in knowledge. Background: The coronavirus disease 2019 (COVID-19) pandemic had a major impact on economies, social interactions, and health systems worldwide. Burn units all over the world face a new challenge in maintaining the care of acute burn wounds and follow-up treatments while dealing with constantly changing regulations. Infrastructural changes, the establishment of efficient triage systems, protective measures, personnel resources, in addition to the maintenance of efficient patient care and the guarantee of supply chains, are challenging tasks to be addressed. This review provides an overview of recent developments regarding different strategies and methods used by burn units worldwide to safely overcome the COVID-19 pandemic outbreak. Methods: A scoping review of the literature was conducted using the electronic databases PubMed and Google Scholar. Publications were screened for the following key terms: burns, burn injuries, thermal injuries, burn center, burn unit, burn ward, in combination with COVID-19, COVID-19 pandemic, SARS-CoV-2, Corona, and Coronavirus. Articles dealing with the management of burn units during the pandemic were further analyzed and included. Results: Of the 136 publications, 10 were considered relevant to the key question and were included in the present review. Results were divided into six major topics, such as infrastructural and personnel management, triaging, severe burns and emergencies, elective surgeries, patient and visitor management, and outpatient management. Conclusion: Only a few studies about managing burn units during the COVID-19 pandemic have been published. Personnel resources and equipment needed to be redistributed to cope with country-specific challenges during the COVID-19 pandemic and to maintain adequate burn care. Since all of these articles refer to the period of the initial outbreak, a lack of clinical studies exists regarding the prevention measures taken by burn units during the COVID-19 pandemic. In addition, we identified gaps in knowledge about the impact of implemented measures on burn patient outcomes in the published literature. Further studies are mandatory in order to provide generally applicable guidelines regarding COVID-19 prevention measures at a burn unit.

WOUND AND INJURY CARE TRAINING TO IMPROVE NURSE KNOWLEDGE AT THURSINA MEDICAL CENTRE

Injuries to school-age children can results in wound and tissue damage. Improper treatment of wound and injury has the potential to cause wider tissue damage. The community service program of wound and injury care training aimed to improve the knowledge and skills of nurses at Thursina Medical Centre about wound care and injury management based on the lastest evidence-based practice. The activties were conducted from September to December 2021 which comprises topics wound care, injury management, and acute wound care practice. The level of knowledge of nurses was identified through the research using a single group pretest-posttest design. The results demonstrated that the average scores of topics wound care and injury management were increased by 8.57 ± 10.59 points and 10 ± 18.52 points respectively, although statistical analysis showed that there was no significant difference in pretest and posttest scores (p&lt;0.05). The level of knowledge of nurses about wound and injury care increased after the implementation of community service program at Thursina Medical Centre.

Learning goals and content for wound care education in Finnish nursing education – A Delphi study

BackgroundCaring for patients with wounds requires diverse competences from nursing professionals. However, wound care education in undergraduate nursing education is often fragmented and lacks consistent learning goals and content. ObjectivesTo create learning goals and content for wound care education in Bachelor's level nursing education in Finland and to assess the consensus relating to these learning goals and content among wound care experts. DesignA consensus-building approach using the Delphi technique. SettingsA Delphi panel of wound care experts built on an online platform. ParticipantsThe participants of the Delphi panel were registered nurses, authorised wound care nurses, nurse educators and physicians. MethodsLearning goals and content for wound care education which had been formulated on the basis of previous focus-group interviews were presented to the Delphi panel. The data were collected in 2021 with two online Delphi rounds: 51 panellists participated in the first round and 36 in the second round. The data were analysed using statistical and qualitative analysis. ResultsLearning goals and content were divided into four competence areas: 1) Anatomy and physiology, 2) Care of chronic and acute wounds, 3) Wound management and care of a patient with a wound, 4) Values and attitudes. These competence areas comprised 26 learning goals and 29 pieces of content. The consensus between the panellists was high, at >90% in all competence areas. ConclusionsThe basis of registered nurses' wound care competence is built during their undergraduate nursing studies. The results of this study can be used to standardise wound care education by implementing consistent learning goals and content in Bachelor's level nursing education.

Responding to foot health needs of people experiencing homelessness: the role of a publicly funded community-based podiatry service

BackgroundPeople experiencing homelessness are known to suffer from poor health and can be reluctant to seek healthcare except in crisis. Foot and ankle problems are a concern; as well as causing discomfort and pain, they may escalate from a minor problem to a very serious one without timely and appropriate treatment. Little is known about the foot and ankle problems of people experiencing homelessness.This paper describes a podiatric service specifically for people experiencing homelessness, which includes a fixed site as well as outreach services. The service operates as part of the Homelessness Team program at Cohealth, a large community health service in Melbourne.MethodsThe study used routinely collected data. Every person who was seen by the podiatrist in the Cohealth Homelessness Team in 2019, whether on site or on outreach, was included in the study (n = 295). Of these, 156 were attending for the first time and 139 were returning clients. People who used the service were predominantly rough sleeping (45.2%), with 32.2% in unstable or insecure housing and 22.6% recently housed.ResultsSkin and nail pathologies (68.1%), inadequate footwear (51.9%) and biomechanical issues (44.1%) were the most common presentations. People sleeping rough were particularly likely to present with biomechanical issues (50.8%), acute wound care needs (17.4%) or traumatic injury (10.6%). Most people presented with more than one issue (mean = 2.4), and new clients (mean = 2.53) and those rough sleeping (mean = 2.69) had more issues than others.Outreach was the most effective way to reach clients in the most difficult circumstances (48.9% of those in unstable housing, 34.8% of rough sleepers). Most of the clients (81.4%) had connections with other services offered by Cohealth, such as social work or physiotherapy.ConclusionsThis study demonstrated that reaching and intervening on foot and ankle problems of people experiencing homelessness who may not seek care on their own could be achieved through a publicly funded health service, using simplified pathways to care including outreach. In addition to the long- and short- term benefits of the immediate podiatric treatment, building trust and connections through footcare may provide an entry point into accepting other health and welfare services.

Nutrition and cutaneous wound healing

Wound healing is a complex and energy-demanding process. The relationship between nutrition and wound healing has been recognized for many centuries. Several studies have indicated that nutritional deficiencies are more prevalent among patients with chronic wounds. Malnutrition may alter the inflammatory response, collagen synthesis, and wound tensile strength, all of which are crucial for wound healing. Although the specific role of nutrition and supplementation in wound care remains uncertain, it is necessary to identify and correct nutritional imbalances to avoid any potential deterioration of the healing process. It is also important to recognize the differences in pathophysiology between acute and chronic wounds. A burn, surgical, or a traumatic wound is different from a diabetic foot ulcer, which is different from a pressure ulcer. Chronic wounds are more prevalent in the aging population, and patients often have underlying comorbidities, such as diabetes mellitus, peripheral vascular disease, connective tissue disease, or other systemic illnesses that may alter energy metabolism and contribute to impaired healing. Management approaches to acute wound care may not apply universally to chronic wounds. In this review, we discuss the available data and possible roles for nutrition in wound healing.

Areas of nursing competence in acute wound care: A focus group study

BackgroundWound care is an essential part of registered nurses’ work. However, previous studies have indicated that registered nurses have limited competence in this area. Studies have also highlighted the lack of consistent and standardised areas of competence for registered nurses providing wound care. AimTo identify general areas of competence for registered nurses providing acute wound care during their transition from student to healthcare professional. MethodsFocus group interviews were used to collect the data (N = 20). Separate focus groups were held for participants representing the following professions: (i) registered nurses; (ii) authorised wound care nurses; (iii) nurse educators; and (iv) physicians. The data were analysed using two-step inductive-deductive content analysis. FindingsThe two main competence areas for registered nurses who provide care for patients with acute wounds were: (i) knowledge, skills, and performance in aetiology and care; and (ii) wound management and assessment. These competence areas were divided into more detailed subcategories. The desired values and attitudes were as follows: respect for autonomy and privacy; holistic care; professionalism and courage; and economics related to wound care. DiscussionRegistered nurses play an essential role in the care and prevention of wounds. Nursing education on acute wound care could focus on the identified competence areas to cover the core competences for providing evidence-based, best-quality care for patients with acute wounds. ConclusionsWith consistent and structured competence areas, it would be possible to develop and improve wound care education and training at the undergraduate and postgraduate level.

Service redesign: how a tissue viability specialist lead nurse developed and improved acute wound care through real-world evidence and partnership working

The importance of leadership in service redesign should not be underestimated. Increasing demand for services and cost-effective approaches makes the drive and dedication of a leader towards quality improvement crucial. The lead tissue viability nurse at the Shrewsbury and Telford Hospital NHS Trust worked in partnership with the wound care industry to redesign the trust's acute wound care service. An audit was carried out and an opportunity to reduce variations in care was identified. To achieve this, the service reduced the number of foam dressings on the formulary, listing only the ALLEVYN (Smith+Nephew, UK) family of wound dressings. As a result, the volume of dressings used reduced by 4.8%, meaning that the service produced less waste and saw a cost reduction of approximately £14 066 over a 6-month period. This article highlights the positive outcomes that can be achieved through streamlining formularies, reducing variations in care and delivering robust care pathways. It also describes the collaborative working approach taken by this service, spearheaded by the lead tissue viability nurse, as an example of innovative practice for other NHS trusts.

Interpretation of Near-Infrared Imaging in Acute and Chronic Wound Care.

Vascular assessment is a critical component of wound care. Current routine noninvasive vascular studies have limitations which can give a false sense of security of the presence of adequate perfusion for healing. Near-infrared imaging modalities can serve as an additional diagnostic assessment of wounds in which adequate perfusion is a concern. Correct interpretation of near-infrared images obtained is critical as subtleties that exist in the acute and chronic wound population goes beyond the interpretation that increased signal is consistent with adequate perfusion for healing. The objective of this paper is to educate providers on the correct interpretation of this point-of-care imaging modality in day-to-day wound-care practice to guide clinical decision-making for rapid wound resolution.

A review of epigenetic regulation in wound healing: Implications for the future of wound care.

Epigenetic regulatory mechanisms are essential for maintaining skin homeostasis and aid in the processes of wound healing. The nucleus co-ordinates gene expression using epigenetic regulatory mechanisms based on distinct chromatin structural states and their remodeling. These include DNA methylation and hydroxymethylation, post-translational histone modifications, ATP-dependent chromatin remodeling and higher-order chromatin structure and 3D genome organization. Epigenetic pathways play a key role in co-ordinating the behavior and activity of the multitude of cell types seen during skin repair, and research is now focusing on how wound healing can be modulated by altering the activity of certain reparative genes. Herein, we aim to highlight recent advances in understanding epigenetic regulatory mechanisms, with particular reference to those involved in keratinocyte and fibroblast biology. We also propose future directions for exploration of epigenetic mechanisms, and their potential clinical applications in acute wound care.

COVID-19 and wound care: A Canadian perspective

To the Editor: Delivering acute and chronic wound care with physical distancing measures has been a major challenge during the coronavirus disease 2019 pandemic. The average age of patients with chronic wounds is older than 70 years, putting this population at increased risk.1 Health care providers should continue to focus on reducing exposure risk in this subgroup of patients while adapting to the new normal. We recommend a multifaceted approach including virtual wound care, patient education, and interprofessional collaboration to optimize care (Fig 1).

Does the Use of Clean or Sterile Dressing Technique Affect the Incidence of Wound Infection?

The purpose of this article is to examine the evidence and provide recommendations for the use of clean or sterile dressing technique with dressing application to prevent wound infection. In all persons with acute or chronic wounds, does the use of clean or sterile dressing technique affect incidence of wound infection? A search of the literature was performed by a trained university librarian, which resulted in 473 articles that examined any age group that dealt with application of a wound dressing using either sterile or nonsterile technique. A systematic approach was used to review titles, abstracts, and text, yielding 4 studies that met inclusion criteria. Strength of the evidence was rated using rating methodology from Essential Evidence Plus: Levels of Evidence and Oxford Center for Evidence-Based Medicine, adapted by Gray and colleagues. Johns Hopkins Nursing Evidence-Based Practice Nursing Research Appraisal Tool was used to rate the quality of the evidence. All 4 studies reported no significant difference in the rate of wound infection when using either clean or sterile technique with dressing application. The strength of the evidence for the identified studies was identified as level 2 (1 level A, 3 level B). The study sizes were variable, and the wounds included do not represent the continuum of wounds clinically encountered across the board. Evidence indicates that the use of clean technique for acute wound care is a clinically effective intervention that does not affect the incidence of infection. There is no recommendation that can be made regarding type of dressing technique for a chronic wound due to the lack of evidence in the literature.