The HAS published in October 2007 an assessment report of the primary and secondary dressings.
In addition to the description of the methods of investigation on the subject, this document includes useful information for health professionals: conditions of prescription, new classification of bandages indications, definition and types of dressings recommended in each case (primary bandages, placed at the direct contact of the wound, or secondary and material bandages of fixing/maintenance).
Conditions of prescription and use
According to the HAS, the choice of a primary dressing rests "on a clinical analysis of the wound. Except strictly defined conditions of delegation of power to the nurse, to guarantee the quality of the follow-up, the prescription must be left to the doctor or to a permanent nurse of an IUD in Wounds and Cicatrisation".
Secondary dressings of fixing/maintenance
For the secondary bandages, the HAS recommends "a prescription by the doctor or by the nurse, in accordance with the decree of April 13th, 2007 fixing the list of the medical procedures that the nurses are authorized to prescribe".
Preferential use of bandages
By taking into account of the limited number of existing comparative assessments on the subject, the HAS worked out these first recommendations :
- "In the chronic wounds without reference to cicatrisation phase: hydrocolloids;
- in the acute wounds without reference to cicatrisation phase: Carboxymethyl cellulose and fiber hydrocellular bandages;
- in the chronic wounds in detersion phase: alginates and alginate sequence (in detersion phase), followed by hydrocolloid (in budding phase). "
Acute wounds and chronic wounds
In view of the results of the experts' consensus on the subject, the HAS also brings back the constitution of two quotations groups:
- acute wounds : operated pilonidal sinus, cutaneaous graft and catches of grafts, burns, bites, post-surgical wounds in directed cicatrization;
- chronic wounds: diabetic feet, stumps of amputation, leg ulcers, bedsores.
The constitution of these two groups led to this second series of recommendations :
- "In the chronic wounds in detersion phase: hydrogels;
- In the chronic wounds in budding phase: interfaces and hydrocellular;
- In the chronic wounds in epidermisation phase: interfaces and hydrocolloids;
- In the acute wounds in epidermisation phase: interfaces;
- In the situations of fragile skin (Epidermolysis bullosa): interfaces;
- In the situations of hemorrhagic wound: alginates;
- In the malodorous cancerous wounds: bandages containing activated carbon. "
Categories of primary bandages
The HAS lists also the categories of primary bandages:
- Carboxymethyl cellulose fibers;
- Interface ;
- With activated carbon".
It recommends "to exclusively admit in generic descriptions bandages not incorporating pharmacologically or biologically active substances".
Consult the full assessment report of the primary and secondary bandages.
published by the HAS in October 2007.
Photographic copyright: Barbara Helgason - Fotolia.com