Choosing the Right Dressing: A Decision Tree for the Floor Nurse

Dressing aisles are overwhelming. The good news: most dressing decisions reduce to four questions answered at the bedside.

Question 1 — How wet is the wound?

• Dry → add moisture: hydrogels, transparent films
• Light to moderate exudate → manage moisture: hydrocolloids, foams
• Heavy exudate → absorb and contain: alginates, super-absorbent foams, gelling fibers

Question 2 — Is there a bioburden concern?

• Critical colonization or local infection → antimicrobial layer (silver, iodine, PHMB) under your primary dressing
• No active infection → choose for moisture and protection only

Question 3 — What's the periwound skin doing?

• Macerated → step up absorption and add a barrier film/cream
• Fragile or denuded → silicone-bordered foams, contact layers, no aggressive adhesives

Question 4 — What's the cadence?

• Daily changes acceptable → simpler, lower-cost dressings
• Need 3–7 day wear → silicone-bordered foams, hydrocolloids, advanced layered systems

A Worked Example

A diabetic foot ulcer with moderate exudate, suspected biofilm, and intact periwound skin:

Cleanse with a surfactant cleanser → contact layer → silver foam → secondary roll gauze → change every 3 days unless strikethrough.

Key Principles

• Do no harm to the periwound. A perfect primary dressing is undone by a tape rash.
• Match the cadence to the patient's life. A dressing the family can change at home beats a perfect dressing the clinic has to do daily.
• Reassess every change. The right dressing today is the wrong one in two weeks if the wound has progressed.