When to Stop Covering Open Wounds: A Wound Care Dilemma

As a wound care specialist, you know there’s no cut-and-dry answer to exactly when to stop covering an open wound. On the one hand, you don’t want to cover it too long, as that can interfere with or prolong healing. But you also want to avoid removing a wound dressing too soon, since that can lead to infection. So, how are you supposed to decide when is the right time? 

Well, there are many factors to consider, such as the type of wound and the stages of wound healing. Below, we’ll dive into the multiple factors you should keep in mind regarding when to stop covering an open wound, whether your patient is visiting you in your practice or monitoring their own care at home. 

So, without further ado, let’s get started! 

Remember Why You Cover Wounds in The First Place

When presented with an open wound dilemma, it’s best to go back to the basics and remind yourself of why wound care professionals use wound dressings at all. Remembering the factors behind why you use them can help you discern when it’s time to stop using them.

Infection Prevention 

One primary reason to cover a wound is to prevent infection. A skin opening allows bacteria to enter the body more easily and can complicate the healing process. This was one of the earliest reasons humans began dressing wounds, with many ancient people using plasters and antimicrobial honey found to cover wounds. However, once the wound forms a scab or reaches a point where infection is less likely, the dressing could be removed. 

Retain Moisture 

You might also cover a wound to provide thermal insulation and maintain moisture. Research suggests that healing in a moist environment may result in less inflammation and enhance overall recovery. With this in mind, you wouldn’t want to remove a dressing too soon on an open wound becauseairing it out could dry out the newly formed surface cells, thus causing cell death. This could slow the healing process and lead to more scarring. 

Other Reasons to Use Wound Dressings

Wound care clinicians also use dressings to: 

• Protect wounds from mechanical injury like tugging or scraping
• Maintain high humidity of wound 
• Absorb drainage
• Wound debridement 
• Hemorrhage prevention 
• Immobilize the site to prevent additional injury 

If a wound is no longer at risk of any of the above, it’s likely time to stop covering it. 

The Stages of Wound Healing

We’re preaching to the choir here, as you already know how a wound heals, but it’s a significant factor when discussing when to stop covering an open wound. If there’s a disruption to any stage of the healing process, wound care clinicians have to adjust their treatment plan. 

The typical wound-healing process involves the following. 

• Hemostasis: Blood starts to clot after injury to prevent additional blood loss. 
• Inflammation: A scab is formed, and macrophages clean and repair the injury. The right balance of blood-borne oxygen is needed for proper healing. 
• Proliferation: Oxygen-rich red blood cells start building new tissue, and collagen is created as a form of scaffolding. 
• Maturation: The wound is closed and repaired at this stage but still healing. The tissue is strengthening.  

Research suggests that this entire healing process usually takes four to six weeks. In some cases, it’s normal to expect 12 weeks. If it takes longer than that, it’s considered a chronic wound. Once you confirm it’s a chronic wound, it’s important to identify its cause so you can manage it. Hypoxia, collagen synthesis defects, and bacterial colonization are just a few examples of why healing may be impaired. 

Chronic wounds must be cleaned consistently and kept covered to remove excess fluid and prevent infection. Moist compresses may also be used to prevent the wound from drying out and to relieve itching. Wound coverage could stop once slow-healing wounds begin progressing through the healing stages and are no longer at risk of re-injury. 

The RYB Color Code

In addition to factoring in the stages of wound healing, wound care providers could also refer to the red-yellow-black (RYB) color scheme for acute and chronic wounds. This method dates back to the late 1980s. Although it does have some limitations, it can still help guide treatment. 

• Red wounds: These should be covered and protected to avoid irritation to the regenerating tissue. It’s recommended that dressings are changed as infrequently as possible. 
• Yellow wounds: Management includes removing non-viable tissue, using absorbent dressing materials to combat the accompanying slough and/or pus, and applying a topical antimicrobial. 
• Black wounds: Debridement must occur. Once the dead skin or tissue is removed, the wound is treated as yellow, then red. 

Assess The Type of Open Wound

Another factor wound care clinicians must consider is the type of open wound a patient has. This detail tells you what kind of dressing to use, the frequency of dressing changes, and potentially when to stop covering an open wound. Here are a couple example cases. 

Avulsion Wounds

Avulsion wounds, for instance, can be more challenging to treat because the tissue has been forcibly torn away, heightening the risk of infection. Treatment may involve reattaching blood vessels, consistent cleaning, and surgical debridement. 

In some scenarios, an avulsion wound dressing could be removed after three days unless drainage is present. However, the healing process ultimately depends on the size, depth, and degree of injury. 

Puncture Wounds 

Puncture wounds, where a sharp object has gone through skin and tissue, are another common type of wound. Puncture wounds should be covered with gauze or a bandage until they heal. Minor wounds usually heal within seven to 10 days. 

Incision Wounds

In 2018, 11% of all deaths in the ICU were linked to surgical site infections. Therefore, wound care specialists must carefully evaluate how the wound was closed, its location on the body, and more to maximize successful healing. While some bandages can be removed 24 to 48 hours after surgery, other dressings may need to remain for a few days or one to two weeks. 

Local Wound Factors

Wound healing may also be hindered by circumstances local to the wound. Local wound factors may include: 

• Dry Environment. Some non-healing open wounds simply lack hydration, which causes cells to dehydrate and die. 
• Maceration. If a patient’s wound is frequently in contact with water, sweat, urine, or feces, the skin can soften and break down further. This can slow wound healing and cause infection. 
• Pressure. Excessive pressure on the wound site can interrupt the capillary networks’ blood supply to the wound. Nutrients, oxygen, and immune cells are brought in through capillaries to help with the healing process, so when that is obstructed, healing is prolonged.
• Trauma. Recurring trauma can stop the wound from healing at all. 
• Edema. The excess fluid associated with swelling affects oxygen delivery and blood supply. It may also include harmful waste products that suppress cellular activity for healing. 
• Dressing choice. Sometimes, the wound dressing itself thwarts healing. For instance, gauze is a cost-effective choice but also moisture-retentive and vulnerable to bacterial contamination. 

Wound care providers trying to decide when to stop covering an open wound will have to carefully observe if any local wound factors are holding up the healing process. Correct assessment is needed to effectively treat the wound.  

Individual Patient Profile

Patient-related circumstances are among the most important factors to consider regarding when to stop covering an open wound. Some patients may progress through wound healing stages slower if their health is compromised.

Patient Age

Increased age is a significant risk factor for compromised wound healing. The inflammatory stage is prolonged in older adults, leading to the destruction of nearby cells, impaired monocyte infiltration, faulty collagen production, and more. 

There’s also an increase in the production of reaction oxygen species because of extended inflammation. This encourages DNA damage and protein breakdown, which hinders the proliferative stage of healing. 

These circumstances may mean that wound dressings have to stay on longer than usual. However, wound care experts must be careful with this, as skin is often thinner in older adults. Some wound dressings may actually cause skin tearing. 

Nutritional Status

Malnutrition also affects when you can stop covering an open wound. Consider the following nutrient deficiencies and how they can interfere with wound healing.

• Protein: Healing cells need protein for formation and activity. Lacking this nutrient could inhibit the progression from the inflammatory to the proliferative stage. 
• Carbohydrates and Fats: Both provide energy to support collagen deposition and cellular activity. Being deficient may impede the proliferative stage.  
• Vitamin A: A deficiency may impair antibody production during the inflammatory stage. It may also reduce collagen synthesis and granulation tissue development during the proliferative and remodeling phases. 
• B vitamins: Deficiencies can interfere with antibody production and white blood cell function, which may increase the risk of infection. 
• Iron: Lack of iron may lead to tissue ischemia and a reduction in wound strength.

Chronic Conditions

The wound healing process is already a complex series of steps, but having one or more chronic diseases can complicate it even further. As a wound care provider, you know your patient’s conditions may influence how you treat them and when you stop covering their open wound. 

Here are just a few of the common, but not necessarily common sense, comorbidities you’ll want to be mindful of when working with patients.

• Diabetes: This condition can affect every stage of the wound-healing process, from cell migration during the inflammatory stage to changes in collagen turnover during the maturation stage. 
• Renal Failure: Kidney disease may hinder wound healing due to chronic inflammation, issues with keratinization kinetics, tissue edema, and more. Even renal dialysis influences poor wound healing due to the loss of protein, vitamins, and minerals. 
• Obesity: Patients may experience local hypoxia, hematomas, and increased tension at the wound site. Not only are open wounds more likely to become infected, but the delivery of antibiotic treatment is also compromised. 

Patient’s Overall Lifestyle

Lifestyle factors, such as diet, physical activity, and the use of alcohol, tobacco, and other substances, also influence when you can stop using wound dressings. 

For example, a study on murine animal models illustrates that alcohol consumption affects blood vessel growth, which is critical during the proliferative stage of wound healing. Excessive alcohol use may also impact collagen production.  

Let’s now take a look at smoking, which is known to cause delayed wound healing. The nicotine in tobacco hinders the rapid production of red blood cells and macrophages, while also narrowing blood vessels. 

Interestingly, smoking can boost platelet activation in the hemostasis stage, but the clot composition is often abnormal. This results in the wound healing process starting on the wrong foot, which is why patients are encouraged to stop smoking before surgery. 

Current Medications

Although medications are meant to help patients, some may negatively affect the healing of an open wound. Consider: 

• Anticoagulants. Medications like warfarin suppress coagulation factor production, interfering with the hemostasis stage. 
• NSAIDs. These hamper inflammation and blood vessel proliferation, causing healing delays. 
• Chemotherapy drugs. Chemo may slow wound contraction and reduce collagen synthesis and fibrin deposition.  
• Immunosuppressants. These can affect T cells that help maintain skin homeostasis and regulate wound repair. 

Utilize a Wound Care EHR

The above factors heavily rely on wound care providers leaning on their own expertise, but technology also helps. For instance, wound care EHRs, those that are built specifically for wound care clinicians rather than catering to many specialties, can help you keep track of the most important information and can use predictive analytics to improve your workflow and optimize patient care.  AI-powered wound imaging platforms also help ensure diagnosis and treatment plans are as accurate as possible, comparing wound imaging with a database of thousands of other images and measurements to promote the best outcomes for patients.

When To Stop Covering an Open Wound Revealed 

Managing open wounds is no easy feat, as there are many intricacies that wound care clinicians have to keep in mind. From the type of open wound to each patient’s unique health profile, no one treatment plan works for all individuals. 

Ultimately, deciding when to stop covering an open wound will vary for each patient. However, the aforementioned factors can help you determine the best time to do so. Plus, by pairing your expertise with advanced technology, you can develop customized wound care treatment plans that maximize healing outcomes and minimize complications.