Why use silver dressings?

Silver is an antimicrobial that has stood the test of time.

The increasing problem of antibiotic resistance, along with concerns about the safety and toxicity of topical antiseptics, has resulted in the need for an agent that can be used to treat colonised and infected wounds effectively.

Silver is a powerful broad spectrum antimicrobial when it is delivered at the right concentration over an appropriate time period1,2.

Silver exerts an antimicrobial action in its ionic form (Ag+)3,4

Ag+ works by via multi-model action, affecting several areas of the cell3,4

ACTICOAT Silver Dressing

This multi-way action is one of the reasons that resistance to silver is not a cause for concern in the way that antibiotic resistance is5.

Clinical studies investigating the safety and toxicology of silver in severely immunocompromised burn patients have concluded that the use of ACTICOAT was not associated with clinical, biochemical or haematological signs of toxicity6.

In the chronic arena blood testing of a cohort of venous leg ulcer patients showed no clinically relevant changes in serum silver concentrations or haematology or biochemistry results following ACTICOAT usage7.

 

 

Wound Infection Best Practice

Wound infection can have a massive effect on the wellbeing of the patient. The classic signs and symptoms of infection such as odour, swelling, exudate and pain can cause both physical and emotional stress for the patient.

By identifying an infected wound and treating it quickly and appropriately with an effective solution you can have a direct impact on your patient’s wellbeing.

Signs and symptoms of localised, spreading and systemic infection in wounds15,16

CHRONIC WOUNDS
e.g. diabetic foot ulcers, venous leg ulcers, arterial leg/foot ulcers, pressure ulcers
Localised infectionSpreading infection

New, increased or altered pain:

  • Delayed (or stalled) healing
  • Periwound oedema
  • Bleeding or friable granulation tissue
  • Distinctive malodour or change in odour
  • Wound bed discolouration
  • Increased, altered or purulent exudate
  • Induration
  • Pocketing or bridging

As for localised chronic infection, plus:

  • Wound breakdown
  • Erythema extending from the wound edge
  • Crepitus, warmth, induration or discolouration spreading into periwound area
  • Lymphangitis
  • Malaise or non-specific deterioration in the patient’s general condition
SYSTEMIC INFECTION†
Sepsis:
documented infection with pyrexia or hypothermia, tachycardia, tachypnoea, raised or depressed white blood cell count
Severe sepsis:
sepsis and multiple organ dysfunction

Guidelines

Recent best practice statements and consensus documents have highlighted the need to use antimicrobial dressings appropriately to help manage wound infections15,16.

In the recently published International consensus document titled ‘Appropriate use of silver dressings in wounds’ an expert working group suggested that a two week period can be used to assess the efficacy of silver dressings16.

The group concluded that if after two weeks:

  • There is improvement in the wound, but continuing signs of infection – it may be clinically justifiable to continue the silver dressing with further regular reviews
  • The wound has improved and the signs and symptoms of wound infection are no longer present – the silver dressing should be discontinued
  • There is no improvement – the silver dressing should be discontinued and consideration given to changing the dressing to one that contains a different antimicrobial agent and if the patient is unwell using a systemic antibiotic and re-evaluating possibly untreated comorbidities

The group referred to this initial period as the two week ‘challenge’16

Change the outcome, take the ACTICOAT 2 WEEK CHALLENGE.

Apply to receive a 2 week's supply of ACTICOAT Flex* samples for appropriate use on an infected wound.

*Where possible samples will be ACTICOAT Flex, in areas where ACTICOAT Flex is not registered an alternative ACTICOAT variant may be offered.

†Use of an antimicrobial dressing (e.g. ACTICOAT) does not replace the need forconcurrent antibiotic therapy when required as per local clinical protocol.

References

  1. Kelly J. Addressing the problem of increased antibiotic resistance. Prof Nurs 2001; 17(1): 56-9
  2. Hamilton-Miller JMT, Shah S, Smith C. Silver sulphadiazine: a comprehensive in-vitro reassessment. Chemotherapy 1993; 39: 405-9
  3. Maillard J-Y and Denyer SP. 2006. Focus on Silver. EWMA JournalV6(1)
  4. Warriner R and Burrell R. Infection and the chronic wound - a focus on silver. Advances in Skin and Wound Care Vol 18 (Supp. 1) Oct 2005
  5. Chopra I. (2007) The increasing use of silver based products as antimicrobial agents: a useful development or a cause of concern. Journal of Antimicrobial Chemotherapy 59, 587-590
  6. Vlachou E, et al. The safety of nanocrystalline silver dressings on burns: A study of systemic absorption. Burns 2007. 33(8):979-85
  7. Sibbald R G, Browne A C, Coutts P, Queen D, 'A Screening Evaluation of an Ionized Nanocrystalline Silver Dressing in Chronic Wound Care'. Ostomy Wound Management 2001; 47(10): 38-4
  8. Gago M, et al., A comparison of three silver-containing dressings in the treatment of infected, chronic wounds. Wounds 2008; 20 (10): 273-278
  9. Wright JB, et al. 'Wound Management in an era of increasing bacterial antibiotic resistance: A role for topical silver treatment', American Journal of Infection Control 1998; 26(6): 572-577 
  10. Smith & Nephew Data on File; 0810016 
  11. Smith & Nephew Data on File; 0810017 
  12. Hope R, et al., (2012) The in-vitro antibacterial activity of nanocrystalline silver dressings against bacteria withNDM-1 carbapenemase. Poster at EWMA, Austria, 2012. 
  13. Smith & Nephew Data on File WRP-TW141-022 
  14. Westain Report Ref: #971030
  15. World Union of Wound Healing Societies (WUWHS). Principles of best practice: Wound infection in clinical practice. An international consensus. London: MEP Ltd, 2008. Available from www.woundsinternational.com  
  16. International consensus. Appropriate use of silver dressings in wounds. An expert working group consensus. London: Wounds International, 2012.Available from:www.woundsinternational.com 
  17. Searle and Bielby (2010) Dressing strategies for the management of infected wounds in community wound care: impacts and implications. Poster at Wounds UK, Harrogate Nov 2010.
  18. Murray, S and Pardoe, A (2010) Making an Impact: Improving the patient experience using ACTICOAT Flex. Case Study Booklet 
  19. Tongue G., Prytherch J., Harvey A. The Silver Revolution. Exeter Primary Care Trust. Poster Presentation. Wounds UK. Harrogate 2004 
  20. Bowering K. “ACTICOAT Moisture Control. A New Clinical Option” Case study presentation. Satellite Symposium at Stuttgart (a joint meeting for ETRS, EWMA and DGfW) 2005

Infected Wounds

Change
the outcome