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Chronic wound management

TIME – a practical wound care framework

TIME is a global wound care framework used to implement appropriate care plans and promote wound healing.1 It is essential to assess the patient as a whole; wound bed preparation follows a care cycle that emphasizes treating the entire person, not just the wound itself.1

Understanding Wound Healing Through the TIME Framework

Effective wound management begins with accurate assessment. One of the most widely accepted clinical approaches is the TIME framework, a systematic method that helps healthcare professionals evaluate wounds and guide treatment decisions.1

T - Tissue Management

Wound healing is delayed when tissue is non‑viable, increasing infection/inflammation risks and hindering epithelialization. Appropriate debridement is needed to remove devitalized tissue and restore a healthy wound bed.1

I - Infection Control

All wounds are vulnerable to microbial contamination. The progression of infection is influenced by maturing bacterial biofilm. Identifying and managing bacterial burden early supports wound healing.2

M - Moisture Balance

Wounds require the appropriate wound moisture to heal and promote cell growth. Dressings should maintain proper moisture levels to prevent both maceration and drying of the wound bed.2

E - Epithelial Movement

Epithelialisation is the final healing stage, where epidermal cells migrate from the wound edge to close the surface. This requires a well‑vascularised granulation bed to support cell growth and movement.1 

Where Prontosan® Fits Into the TIME Framework
Infection and Microbial Presence - 2

Prontosan® plays a key role in wound bed preparation by addressing two major barriers to healing: devitalized tissue (T) and biofilm‑associated bioburden (I). Its combination of betaine (a surfactant that loosens and removes debris, slough, and biofilm) and polyhexamethylene biguanide (PHMB) (a guanidine based polymer with broad spectrum antibacterial activity).3,4

This dual action aligns directly with the TIME framework: improving Tissue management by facilitating removal of slough and biofilm, and strengthening Infection Control by reducing bacterial burden and preventing biofilm reformation.

Enhancing Wound Bed Preparation 

The Benefits of Prontosan Over Saline

Prontosan® Wound Irrigation Solution demonstrates significantly higher efficacy compared to saline in reducing inflammatory signs and accelerating the healing of vascular leg ulcers and pressure ulcers, supporting the revision and update of chronic wound care protocols.5

 

  • Effective wound healing: Prontosan® showed significant improvement in wound size reduction (p=0.049) and granulation tissue formation (p=0.043) in 28 days. Outcomes favored Prontosan compared with saline.
  • Reduction in inflammation: Prontosan® is more effective at controlling inflammation (p=0.03) compared to saline - improved exudate type/amount, surrounding skin color, edema, and induration.
  • Safe and well‑tolerated: No adverse events or increased pain were reported with a study of 289 patients, supporting safe regular use.
Wound improvement assessed by a reduction of average Total BWAT Scores - 1 Data from the Prontosan® Wound Irrigation Solution vs. saline compendium, derived from Bellingeri et al. 2016.
Wound improvement assessed by a reduction of average Total BWAT Scores - 2 Data derived from Dahmardehei et al. 2025

Prontosan Wound Irrigation Solution and Prontosan Gel used sequentially can accelerate burn‑wound healing while reducing pain, infection, and exudate, improving patients’ quality of life, and supporting their use as safe and effective options in clinical protocols.6

 

  • Improved clinical outcomes: Prontosan significantly reduced wound size, exudate, pain, and infection by days 14 and 21, and accelerated epithelization (p<0.01).
  • Better wound appearance & microbial control: The Prontosan group showed markedly improved wound appearance and a higher rate of negative microbial cultures compared to controls (p<0.01).
  • Effective and safe for burn wounds: The study concludes that Prontosan accelerates burn‑wound healing, reduces pain and infection, and improves quality of life; recommended as a safe option, though long‑term studies are still needed.

Clinicians can determine whether a wound is healing or chronically infected by evaluating clinical signs using the NERDS and STONES framework, which differentiates superficial critical colonization from deep or surrounding infection.7

NERDS identifies signs of superficial bacterial burden within the wound bed:

  • N – Non-healing
  • E – Exudate increasing
  • R – Red and bleeding (granulation)
  • D – Debris 
  • S – Smell 

STONES indicates deeper infection or infection spreading to surrounding tissue:

  • S – Size increasing
  • T – Temperature elevation 
  • O – Os (probing to bone)
  • N – New breakdown
  • E – Erythema or edema increasing
  • S – Smell

When several NERDS criteria are present, the wound may have critical colonization, meaning the infection remains localized to the wound surface and can be treated with topical antiseptics. The presence of STONES criteria suggests the infection involves deeper structures or surrounding tissue, often requiring systemic antimicrobials. 

Infected wounds require proper cleansing and management to reduce bioburden and support healing. Prontosan® Wound Irrigation Solution and Gel are clinically shown to improve wound healing outcomes and effectively manage biofilm, helping create an optimal environment for recovery.5

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  1. Dowsett C, Newton H. (2005). Wound bed preparation: TIME in practice. Wounds UK 1(3).
  2. Leaper DJ, Schultz G, Carville K, Fletcher J, Swanson T, Drake R. Extending the TIME concept: what have we learned in the past 10 years?(*). Int Wound J. 2012;9 Suppl 2(Suppl 2):1-19. doi:10.1111/j.1742-481X.2012.01097.x
  3. Tahir S, Parvin F, Wang M, Deva AK, Vickery K, Hu H. The efficacy of antimicrobial solutions against multispecies bacterial biofilm with or without negative pressure wound therapy in an in vitro wound model. J Antimicrob Chemother. 2024;79(12):3178-3185. doi:10.1093/jac/dkae338
  4.  Y. Xiong, L. Wang, W. Xu, L. Li, Y. Tang, C. Shi, X. Li, Y. Niu, C. Sun, C. Ren, Electrostatic induced peptide hydrogel containing PHMB for sustained antibacterial activity, J. Drug Deliv. Sci. Tec. 75 (2022) 103717
  5. Bellingeri A, Falciani F, Traspedini P. (2016). Effect of a wound cleansing solution on wound bed preparation and inflammation in chronic wounds: a single-blind RCT. J Wound Care 25(3): 160, 162–6, 168.
  6. Dahmardehei M., Dahmardehei A., Dahmardehei Z., Milanifard M., Ebrahimi M., fakhrabadi A. M. (2025). 'Evaluation of the Effects of Prontosan and Normal Saline Irrigation Solution on the Healing of Second-Degree Burn Wounds', Journal of Advanced in Medicinal, Pharmaceutical and Biomedical Research, 1(9), pp. 283-294. doi: 10.22034/jampbr.2025.541915.1038
  7. Nurses Specialized in Wound, Ostomy and Continence Canada; Harm Reduction Nurses Association; and Ontario Network of People Who Use Drugs. Canadian best practice recommendations in wound care for people who use drugs: a harm reduction approach. Ottawa (ON): Nurses Specialized in Wound, Ostomy and Continence Canada; 2025 Nov. 52 p. Available from: https://nswoc.ca/bpr