PRODUCT FOCUS

Use of Hydrofilm and Hydrofilm

Plus in the community: an assessment
Simon Palfreyman and Jane Stevens

Simon Palfreyman is Research Nurse/Honorary Lecturer, School of Health and Related Research, University of Sheffield, and
Jane Stevens is Clinical Nurse Specialist, Tissue Viability, Team Leader (Havering Area), Outer North East London Community
Services (ONEL CS)
Email: s.palfreyman@sheffield.ac.uk, jane.stevens@haveringpct.nhs.uk

he process by which wounds heal and the need

for the holistic management of the patient and
the role of moisture in wound healing has only
recently become more clearly understood. This was a
consequence of two landmark studies conducted in the
1940s and 1960s. The first study by Gilje in 1948 found
that leg ulcers healed faster when covered with occlusive
tape rather than when covered with gauze (Gilje, 1948).
It was the study by Winter on wounds in pigs (Winter,
1962) that really gave impetus to the whole movement
to promote moist wound healing. Winter demonstrated
that re-epithelialization of wounds in pigs occurred more
rapidly under an occlusive covering rather than under the
dry scab tissue and that if the formation of the scab was
prevented, quicker healing occurred. Hinman and Maibach
(1963) conducted a study that seemed to confirm the
benefits of moist wound healing by comparing superficial
wounds in humans. They found that covered wounds had
an increased rate of epidermal regeneration compared to
those exposed to the air. We now know that the reason for
this is that a moist wound surface provides the most suitable
environment for wound healing as it allows the bodys
natural healing process to take place (Hanna and Giacopelli,
1997). If the wound surface dries out epithelial cells have
to burrow beneath the scab and it impedes their ability to
migrate across the wound surface and adversely affects the
delivery of nutrients and immune defences to the wound
surface (Benbow, 2008).

Moist wound healing

The normal healing process follows a similar set of stages
irrespective of whether a wound is acute or chronic
but the amount of time that a wound takes to heal will
depend on the cause of the wound, amount of tissue
damage, patient co-morbidities and the management of
the wound (Benbow, 2008). The stages of wound healing
are facilitated by the moist environment under modern
dressings and this aids the bodys normal healing processes
to take place (Vowden, 1999). Patients with chronic and
acute wounds have different requirements in terms of what
will be necessary for wound healing to occur. Where a
patient has a chronic wound research has shown that the
underlying cause of the wound needs to be investigated,
and if possible, ameliorated or wound healing may only
occur after a protracted time no matter what type of

dressing is in place (OMeara et al, 2001; Chambers et al,

2007; Palfreyman et al, 2007).
In a normal healthy individual with an acute superficial
wound it can actually be very difficult to prevent the
wound from healing and the wound will progress through a
series of stages until it heals (Kerstein, 1997). The first stage
(1-4 days post injury) is inflammation with macrophages
and leucocytes removing debris and bacteria. The second
stage is proliferation (4-20 days) where connective tissue
is deposited, a collagen matrix is established, new blood
vessels extend into the wound and epithelial cells migrate
across the wound surface (Benbow, 2008). The final
stage is maturation (21 days-2 years) where collagen fibres
strengthen and contract to produce scar tissue.
The manufacturers of wound dressings have embraced
and promoted the concept of moist wound healing (Hanna
and Giacopelli, 1997) and there are currently a large number
of different types of dressings. Today, over 50 manufacturers
worldwide produce more than 350 brands of moistureretentive or semi-occlusive wound dressings (Ovington,
2002) with over 200 different types being listed in the UK
National Formulary (BMJ Group, 2010). These include
polyurethane films, foams, hydrogels, hydrocolloids, calcium
alginates, collagens and other materials.

Modern dressings
Modern dressings that promote wound healing have been
shown to have advantages over gauze dressings in that they
are less painful and more convenient for patients (Singer
and Dagum, 2008). They may also speed healing, although
the comparative evidence for the recommendation of a
particular occlusive dressing for these types of wounds is
equivocal and they are more expensive than gauze dressings
(National Prescribing Centre, 2008; Szycher and Lee,

Abstract

The aim of this article was to critically examine the case for using film
dressings with a particular emphasis on two dressing manufactured by Paul
Hartmann Ltd: Hydrofilm and Hydrofilm Plus. The authors undertook
a review of the current published evidence and present four case studies
where Hydrofilm and Hydrofilm Plus were used in the community setting.

KEY WORDS
w Healing w Dressings w Preference w Tolerance w Cost

This article is reprinted from the British Journal of Community Nursing, Vol 15, No 3 Wound Care March 2010

PRODUCT FOCUS

Case Study 1. Mr T
Mr T is a 45 year old gentleman who has lung cancer with bone metastases.
Mr T required a syringe driver to administer his medication through a subcutaneous infusion. Film dressings are regularly used in the community for this
purpose. They allow continuous inspection of the needle entry site and those
with high MVTR prevent moisture build up.
Hydrofilm was used to secure Mr Ts infusion (Figure 1). The district nursing
team were asked to evaluate the dressings performance against the criteria
in Box 1 and their experience of using the film dressings currently available in
the local formulary.
Hydrofilm performed favourably in both areas. The district nurses (DNs) said
they really benefited from the easy application process. As DNs work alone
they had previously encountered difficulty holding the subcutaneous infusion
set in place while securing with the dressing.

1992). Modern dressings have become so pervasive and

widely used that it seems almost counter-intuitive that the
evidence for their use can seem to be missing.
It has been reported that there is a lack of high-quality
evidence, from large randomized controlled trials (RCTs),
on the efficacy of modern wound dressings in promoting
chronic and acute wound healing (National Prescribing
Centre, 2008; Palfreyman et al, 2007). A large number of
the published studies had a small sample size and showed
inconsistencies in their design, inclusion criteria and choice
of outcomes (Chaby et al, 2007)
The British National Formulary (BNF) (BMJ Group
2010) also reports that there have been few clinical trials
conducted in order to establish the clear advantage for any
particular product or type of wound dressing. In spite of
the sometimes contradictory and poor quality evidence,
modern dressings do seem to have advantages in terms
of comfort and convenience over merely applying a dry
dressing. Indeed, the BNF recommends that dressing
choice should not only be based on the wound type, site,
and stage of healing: but also patient preference or tolerance
and cost.

Film dressings

Figure 1. - Subcutaneous infusion via syringe driver secured

with Hydrofilm

Box 1. Dressing criteria

Acceptability to patients
Ease of application
Ease of removal
Conformable
Extensible
Hypoallergenic observation of skin
Adaptability (whether it can be cut into strips for awkward areas)
Durability
Moisture build up (MVTR)
Range of size.

Table 1. Indications of film dressings

Wound

Other

Minor burns

Secondary dressing

Pressure areas

Protective skin cover

Donor sites
Post-operative wounds

Film dressings were one of the earliest types of occlusive

dressings to be introduced and become widely used. They
were first introduced in the 1970s but were originally
designed as a preoperative cover in order to prevent
contamination of the surgical incision by the patients own
skin flora and not as a wound dressing.They were then used
as wound covering in order to try and prevent the leakage
of wound exudate but also seemed to accelerate healing
and reduce pain (Aindow and Butcher, 2005).
These dressings consist of a thin layer of transparent
polyurethane film, with an adhesive, which are permeable
to water vapour and oxygen but impermeable to liquid and
bacteria (Thomas, 1996). As the films are non-absorbent they
are not suitable for wounds with excessive exudates, although
island dressings with a central non-stick pad are available
and can absorb slightly more exudate than the simple films.
Films can also be used as secondary dressings to waterproof
a primary dressing such as foam. Incorrect removal of film
dressings may cause trauma to surrounding skin.
Film dressings work by simply adhering to the surrounding
skin and maintaining a moist environment, by preventing the
loss of moisture from the wound, but care needs to be taken
in the assessment of the patient as there is the potential to
cause skin tears when the dressing is removed (Queen et al,
2004). Another problem can be maceration, as these types of
dressings are non-absorptive and fluids tend to accumulate
beneath the dressings (Marshall et al, 1990). It has also been
found that there can be an increase in bacteria beneath film
dressings especially in the patients own skin flora - but
this is not thought to adversely affect the wound healing
(Aindow and Butcher, 2005). As a result of these problems
one precaution that has been recommended when using
film dressings is that they are not be used in wounds which

This article is reprinted from the British Journal of Community Nursing, Vol 15, No 3 Wound Care March 2010

PRODUCT FOCUS

Case Study 2. Mrs W

Mrs W was discharged from hospital with a pressure ulcer overlying the
lateral aspect of her left heel (Figure 2) into the care of the DN service. The
wound bed was covered with 100% sloughy tissue which made accurate
grading difficult. However, it was evident that the ulcer was at least a grade 3
and measured 3cm x 3.5cm. There were no signs of clinical infection. The aim
was to deslough the wound using products that aided autolysis while protecting the surrounding skin. The wound was treated with a hydrogel, the skin
protected with a barrier film and covered with Hydrofilm.
Following 10 days of treatment the wound bed had significantly improved with
60% healthy granulating tissue (Figure 3). The patient experienced no pain
during the treatment and the DNs reported back positively when evaluating
the product using the criteria previously mentioned.

Figure 2. Heel pressure ulcer with 100% slough

moisture to escape from the wound (Aindow and Butcher,

2005). The key mechanism of action for these dressings is
to provide the best environment to facilitate healing in the
inflammation and proliferation phase (Thomas, 1996).

Moisture vapour transmission rate

One way of distinguishing between film and other occlusive
dressings is through the MVTR which is a measure of a
materials breathability (Seaman, 2002). This is measured
as the steady flow (g) of water vapour per unit (m2) area
of surface in unit (h) time induced by the vapour pressure
difference (g/m2/hr) (Jonkman et al, 1988). It is used by
manufacturers of dressings to assess how much gaseous
exchange the material allows from the wound surface to
the outside environment but can also be used to examine
other types of material, for example, outdoor clothes and
damp-proof membranes.
One important consideration is that the conditions
under which measurements are made can influence the
results and both the temperature of and humidity gradient
across the sample should be reported with the result
(Gretton et al, 1998). An MVTR result without specifying
these conditions can be almost meaningless. The most
common international unit for the MVTR is g/m/day.
In the USA, g/100in/day is also in use, which is 1/15 of
the value of g/m/day units. There is thought to be some
correlation of the ability of the dressing to retain moisture
and earlier healing when compared to those dressing with
less moisture-retentive properties (Bolton et al, 2000).
However, a balance is necessary. If the MVTR is too low,
the skin underneath can become too wet and macerated
and can be uncomfortable for the patient (Cuzzell, 1997).
Different types of occlusive dressings have different
MVTRs. Most film dressings are designed to have a
high MVTR but this can vary between manufacturers
(Aindow and Butcher, 2005). SMTL data has shown that
Hydrofilm has a mean MVTR in contact with vapour of
1327.6 g/m/24 hours (SMTL Report no. 08/2883/01).

Evidence for film dressings

Figure 3. Heel pressure ulcer with 60% slough 10 days post
treatment

have excessive exudate or those that show signs of infection

(Vaneau et al, 2007).
Film dressings are indicated for acute rather than chronic
wounds and can be used on a number of different wound
types (see Table 1) (Vaneau et al, 2007). They are generally
suitable for most superficial wounds, but are not suitable
for deep or exudating wounds because of their inability
to absorb exudate (Aindow and Butcher, 2005). There are
currently over 16 different types of film dressing made by
14 different manufactures with their unit costs ranging
from 1141 pence (for a 6x7 film) (BMJ Group, 2008).
Film dressings are designed to have a high moisture
vapour transmission rate (MVTR) in order to allow

The evidence for film dressings from large RCTs or

systematic reviews mirrors that of other occlusive dressings.
However, although there is little comparative evidence,
some studies have shown that there can be advantages for
the patient when using film dressings. A small randomized
study by Briggs (1996) compared the pain in 30 patients
who had undergone abdominal hysterectomy, half of which
had a film dressing and half a standard dry dressing. The
pain of their surgical incision was assessed using the McGill
Pain Questionnaire (Melzack, 1975) for the first four days
post-op. There was no difference in scores for the first two
days but those who had the film dressing applied seemed
to experience less pain on day three compared to the dry
dressing group.
A systematic review by Gilles et al (2003) of film dressings
for central venous catheters compared to standard dry
dressings found 23 studies but had to exclude 15.They found

This article is reprinted from the British Journal of Community Nursing, Vol 15, No 3 Wound Care March 2010

PRODUCT FOCUS

Table 2. Comparison of film dressing unit costs

(based on prices in the NHS Drug Tariff Feb 2010)
HydroFilm

.pp

Active
heal

.pp

Tegaderm

.pp

C-View

.pp

Mepore
Film

.pp

Opsite
Flexigrid

.pp

6x7

21

6x7

31

6 x7

38

6x7

38

6x7

44

6x7

37

10 x 12.5

39

10 x
12.7

74

12 x 12

108

10 x 12

102

10 x 12

117

12 x 12

106

15 x 20

90

15 x
17.8

179

15 x 20

234

15 x 20

232

10 x 25

228

15 x 20

267

10 x 15

49

12 x 12

107

15 x 20

289

Table 3. Comparison of film dressings which incorporate absorbent pad

HydroFilm
Plus

.pp

Mepore Ultra

.pp

Tegaderm and Pad

.pp

Opsite Post Op

.pp

5 x 7.2

15

7x8

38

5x7

25

8.5 x 9.5

81

9 x 10

20

10 x 11

75

9 x 10

62

8.5 x 15.5

112

9 x 15

22

9 x 25

157

9 x 15

92

10 x 12

110

10 x 20

34

9 x 20

142

9 x 20

134

10 x 20

185

10 x 25

36

11 x 15

111

9 x 25

151

10 x 25

233

10 x 30

53

9 x 30

250

10 x 30

276

that the evidence of effectiveness was poor and that there was
no evidence of any difference in the incidence of infectious
complications between any of the dressing types.
A review by Rakel et al (1998) of film dressings for split
skin graft donor sites found 33 studies and concluded that
film dressings were associated with faster healing rates and
low pain and were cost effective.
A Cochrane review of dressings and topical agents
for surgical wounds healing by secondary intention
(Vermeulen et al, 2004) were unable to identify any large,
high quality RCTs in this area and found 13 poor quality
trials. However, they did, with reservations, recommend
that gauze should not be used as it may be associated with
greater pain or discomfort for the patient.
No systematic reviews of the care of acute superficial
wounds currently exists but it is likely that the evidence
for the effectiveness of modern dressings compared to
gauze or dry dressings will exhibit the same deficiencies
as for surgical wounds and graft sites. However, it is also
likely that in uncomplicated, non-infected wounds, film
dressings would result in less pain, compared to the use of
dry gauze dressings.

Case Study 3. Mr K
Mr K is a 67 year old gentleman discharged from hospital to the community
post-op clinic for management of his surgical wound. Mr K had an excision and removal of a lump from his neck which was closed with clips
(Figure 4). At the time of this case study Mr K was waiting for the histology
results from the tissue removed.
The wound was located in an awkward area to dress and Mr K asked if
he could wash his hair. Hydrofilm Plus was used to dress the wound.
The dressing conformed well to the awkward area demonstrating good
extensible properties. It performed well as a waterproof dressing with no
evidence of water infiltration following Mr K washing his hair. Mr K said he
found the dressing comfortable to wear and less bulky than the pad and
tape used previously.

Hydrofilm film dressing

Hydrofilm is made from a semi-permeable, transparent
polyurethane film coated with a hypoallergenic acrylic
adhesive. Hydrofilm Plus differs from Hydrofilm in that
it has an absorbent pad with a soft polyethylene surface to
prevent adherence. It is a waterproof transparent adhesive
wound dressing that enables the exchange of water vapour

Figure 4. - Post surgery neck wound closed with clips

This article is reprinted from the British Journal of Community Nursing, Vol 15, No 3 Wound Care March 2010

PRODUCT FOCUS

Case Study 4. Mr B
Mr B is a 64 year old gentleman discharged into the community following
surgery for a triple coronary artery bypass. Prior to discharge clips were
removed from the chest incision which subsequently dehisced at the bottom
of the incision line. The dehisced area measured 1.5cm x 1cm with minimal
exudates (Figure 5).
Mr B expressed his great desire to shower as he had not been able to do this
for the 4 weeks he spent in hospital. Hydrofilm Plus was used to dress the
wound on alternate days. Mr B showered each day and the DNs reported
that the dressing offered an effective waterproof barrier. General feedback
from the DNs was extremely positive in relation to the criteria previously mentioned. Mr B was delighted with the dressing in that it allowed him to shower
every day, caused no pain on removal and did not leak onto his clothes. The
wound closed completely after 2 weeks.

It should be applied using an aseptic or no-touch

technique using a four-stage application process which is
shown by the numbers on the dressing liner.This technique
ensures that the film does not wrinkle. It is removed by the
support and pull method which reduces the chance of
wound trauma.
Hydrofilm and Hydrofilm Plus are competitively
priced as can be seen from Table 2 and Table 3. The
dressings are between 32-52% cheaper than the majority of
alternative dressings in the same group. For some sizes of
dressings Hydrofilm Plus was up to 80% cheaper.

Case studies
The aim of conducting these case studies was to examine
whether Hydrofilm and Hyrdrofilm Plus offered a
clinically and cost-effective alternative to the equivalent
products on the current formulary (Tegaderm, Activeheal
Film, Tegaderm + Pad and Mepore Ultra).
The dressings were evaluated against the criteria in Box 1,
and by drawing comparisons with the equivalent products
currently used.
All the case studies produced favourable evaluations
from both patients and clinicians for both Hydrofilm and
Hydrofilm Plus. In addition to meeting the criteria in Box 1,
both products were also competitively priced compared to
other film dressings previously used by the clinicians (See
Table 2). The Trust has realized substantial savings of between
38-75%, depending on the size of dressing by replacing
products previously used with the Hydrofilm range

Discussion
Figure 5. Dehisced post-op chest wound

and other gases between the wound and the outside

environment, therefore helping excess moisture to escape
and so prevent wound maceration. It is impermeable to
micro-organisms and is transparent so that the wound can
be inspected without having to remove the dressing. It also
protects the wound against dirt, trauma and supports the
natural moist wound healing process. It is available in a
wide range of sizes. Like other film dressings it is indicted
for use on wounds where there is little or no exudate.
Hydrofilm can be used on a range of different wounds
and circumstances:
w Post-operative wounds where there is likely to be no
excessive exudate
w Wound covering for surgical procedures
w As a sterile dressing for superficial wounds such as cuts
and abrasions
w Superficial pressure ulcers
w As a secondary dressing over alginates and hydrogels
w For fixation of catheters or cannulae
w As a prophylactic measure to reduce skin shear and
friction.
The manufacturers recommend that it should not be used
in clinically-infected, bleeding or highly-secreting wounds.

In this article the authors sought to undertake a balanced

assessment of two dressings: Hydrofilm and Hydrofilm
Plus.The available literature was critically examined in order
to obtain an overview of the dressings. This highlighted
that there was a lack of high quality comparative studies
and that the evidence of benefit was not always clear.
However, film dressings are used widely within the health
setting and both patients and clinicians can have positive
experiences of using these types of dressings (Thomas,
1996; Aindow and Butcher, 2005). There does seem to be
a lack of published studies that conform to the standard
of what is usually considered high quality evidence, i.e.
cost effectiveness studies alongside large RCTs. However,
Carter et al (2009) criticized wound care RCTs for not
reflecting the true population in the clinical setting with
wounds and only including a selected subset of the overall
population. In the absence of Level 1 evidence or where
there is a clear cost difference between dressings, it may
be that other considerations such as patient/clinician
preferences and subjective outcomes could also be included
in any evaluation of a dressings effectiveness.
A series of subjective outcomes were assessed within the
presented case studies (see Box 1) and these highlighted that
Hydrofilm and Hydrofilm Plus exhibited a number of
benefits. Clinicians appreciated that the dressings could be
easily applied and removed, managed exudate reasonably

This article is reprinted from the British Journal of Community Nursing, Vol 15, No 3 Wound Care March 2010

PRODUCT FOCUS

well and conformed to wounds in difficult areas. Patients

reported that they experienced a reduction in pain and
appreciated that the dressings were waterproof and so
allowed them to shower.
A final consideration was that both Hydrofilm
and Hydrofilm Plus were competitively priced when
compared to comparative dressings available on the NHS
drug tariff (see Table 2 and Table 3).

Conclusion
Clinicians should base their choice of dressing on a thorough
assessment of the patient, wound and local guidelines.
These case studies provide some preliminary evidence that
Hydrofilm and Hydrofilm Plus dressings are acceptable
alternatives to some of the more established film dressings.

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This article is reprinted from the British Journal of Community Nursing, Vol 15, No 3 Wound Care March 2010