Dressings — MSF Clinical guidelines — Médecins Sans Frontières 2026

MSFClinical guideline (chapter)Current edition

From Clinical guidelines — Diagnosis and treatment manual › Chapter 10: Medical and minor surgical procedures · Médecins Sans Frontières, Current online edition, 2026

Practical guidance on wound dressing technique, equipment and organisation for clinicians in resource-limited settings.

In one sentenceClean wounds with sterile saline; infected/necrotic wounds with diluted povidone iodine (1:4); change clean wound dressings after 5 days, infected daily, granulating every 2–3 days.

Issuer: Médecins Sans Frontières
Edition: Current online edition, 2026
Audience: Clinicians, nurses and healthcare workers performing wound care
Evidence: Expert consensus based on MSF field experience
Reviewed: 21 Oct 2026 · GMJ

Read the original on MSF Whole guideline (PDF)

Summary by GMJ Guidelines Desk•Reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD•Record updated 21 Oct 2026•Next check Apr 2027

What this guideline says

GMJ summary

This MSF clinical guideline provides detailed procedural guidance on wound dressings to promote healing whilst maintaining aseptic technique. It covers equipment preparation, care organisation, cleaning and dressing techniques for different wound types (clean sutured, infected, necrotic, and granulating wounds).

The guideline emphasises infection prevention through proper workflow (clean to dirty), appropriate use of sterile instruments or gloves, and selection of cleaning solutions based on wound condition. It specifies povidone iodine solutions for infected or necrotic wounds and sterile saline for clean wounds, with frequency of dressing changes tailored to wound status.

The document includes guidance on wound assessment, recognition of infection signs, and subsequent dressing schedules, designed for settings where resources may be limited but sterile technique must be maintained.

Key points

For clinicians — doses and thresholds as stated in the guideline

For necrotic or infected open wounds: clean with povidone iodine 7.5% scrub solution diluted 1 part solution + 4 parts sterile 0.9% sodium chloride or sterile water, or apply 10% povidone iodine dermal solution
For clean sutured wounds or clean open wounds with red granulation: clean with 0.9% sodium chloride or sterile water only
Clean sutured wounds: remove initial dressing after 5 days if wound remains painless, odourless and dressing remains clean
Open granulating wounds: change dressing every 2 to 3 days, except for hypertrophic granulation (apply local corticosteroids)
Infected sutured wounds: remove one or more sutures to evacuate pus and change dressing at least once daily
Always proceed from clean to dirty: start with patients with uninfected wounds; if multiple dressings for one patient, start with cleanest wound
Instruments or sterile gloves must be changed between patients to prevent cross-contamination
Open dirty wounds require daily cleaning and dressing change until clean

Wound appearance and healing stage

Table extracted from the guideline

Colour/appearance	Clinical significance
Black area	Necrosis, wet or dry infected eschar
Yellow or greenish area	Infected tissue and presence of pus
Red area	Granulation, usually a sign of healing (unless hypertrophic); red edges indicate inflammation or infection
Pink area	Process of epithelisation, the final stage of healing that begins at wound edges

Source: Médecins Sans Frontières, Dressings — MSF Clinical guidelines. Reproduced in summary form.

From the guideline

Verbatim

“Always proceed from clean to dirty: start with patients with uninfected wounds.”

— Médecins Sans Frontières, Dressings — MSF Clinical guidelines, Organisation of care (2026)

Editor’s perspective

Why this matters for Georgia and the region

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration

As Editor-in-Chief of the Georgian Medical Journal and Chair of the Public Health Institute, I recognise that standardised wound dressing protocols remain essential across Georgia's healthcare system, from Tbilisi tertiary centres to rural ambulatories in Kakheti and Samtskhe-Javakheti. The guideline's emphasis on infection prevention through clean-to-dirty workflow and appropriate antiseptic selection aligns with Georgia's ongoing efforts to strengthen hospital infection control, which has gained momentum since our UHC reforms in 2013. I would particularly stress to Georgian colleagues the practical guidance on recognising wound infection stages by colour and the specific povidone iodine dilution ratios (1:4 for scrub solution), as anecdotal evidence suggests considerable variation in current practice. The main implementation challenge in Georgia will be ensuring consistent availability of sterile supplies and functioning sterilisation equipment in smaller facilities, particularly in mountainous regions where supply chains remain vulnerable, though this guideline's provision for using sterile gloves when instruments are unavailable offers pragmatic flexibility.

ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 21 Oct 2026

Applicability

Georgia and the South Caucasus

This guideline is directly applicable to clinical practice in Georgia and the South Caucasus, particularly in primary care facilities, rural hospitals, and humanitarian settings where resource-efficient wound care protocols are essential. Georgian healthcare facilities implementing infection prevention and control programmes would benefit from standardising wound dressing procedures according to these principles. National adaptation should consider local availability of povidone iodine solutions, sterile supplies and sterilisation equipment, as well as integration with existing infection control protocols in Georgian healthcare standards.

Questions this guideline answers

Quick answers

What dilution of povidone iodine scrub solution should be used for infected wounds?

Use 7.5% povidone iodine scrub solution diluted 1 part solution to 4 parts sterile 0.9% sodium chloride or sterile water. Rinse thoroughly then dab dry, or alternatively use sterile saline followed by 10% povidone iodine dermal solution.

How often should dressings be changed for different wound types?

Clean sutured wounds: remove initial dressing after 5 days if no signs of infection. Infected sutured wounds: at least once daily. Open dirty wounds: daily. Open granulating wounds: every 2 to 3 days (unless hypertrophic granulation).

When can sterile gloves be used instead of sterile instruments?

If there are no sterile instruments available, a dressing can be done using sterile gloves. The principles of the procedure remain the same whether using instruments or sterile gloves.

What are the signs that a sutured wound is infected and requires suture removal?

Red, indurated and painful edges; drainage of pus between sutures (spontaneously or with pressure); lymphangitis; or subcutaneous crepitations around the wound. Remove one or more sutures to evacuate pus and change dressing at least daily.

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Dressings — MSF Clinical guidelines

What this guideline says

Key points

Wound appearance and healing stage

From the guideline