Global

‡ In these countries please contact our distributor

ACTICOAT Flex 3 & 7

Silver-Coated Antimicrobial Barrier Dressing

Overview

Description

ACTICOAT Flex 3 & 7 are effective antimicrobial barrier dressings. The Nanocrystalline silver coating rapidly kills a broad spectrum of bacteria in as little as 30mins. ACTICOAT Flex 3 & 7 consist of a single layer of knitted polyester to ensure ultimate flexibility and comfort during wear time for the patient.  


Features & Benefits

  • Sustained (3 or 7 day) antimicrobial activity against a broad spectrum of wound pathogens including MRSA & Pseudomonas aeruginosa
    Helps remove some barriers, allowing the patient to regain control and progress the wound to closure.
  • Rapidly kills bacteria in as little as thirty minutes.
    Antibacterial action helps provide rapid protection from bacterial colonization.
  • Soft and highly flexible with stretch properties
    Moves with the patient when they need to move the affected body part with minimum local trauma.
    Minimizes discomfort for the patient.
  • Allows exudate transport through the dressing
    This helps reduce the risk of maceration for faster closure with less potential for leakage and odor.
    ACTICOAT Flex 3 & 7 have been shown to be compatible with negative pressure wound therapy (NPWT).
  • Easy to use range of dressing sizes and formats with a 3 and 7 day wear time.
    The product is easy to apply, can be removed in one piece to minimize trauma and is designed in sizes appropriate for various wound types to reduce the time taken for dressing changes.
  • Low adherent wound contact layer
    Helps prevent trauma on removal to optimize closure times


Indications

ACTICOAT Flex 3 & 7 are indicated for use on partial and full thickness wounds. This includes:

  • First and second degree burns
  • Covering of grafts
  • Surgical sites
  • Venous ulcers
  • Pressure ulcers
  • Diabetic ulcers


Contraindications

  • Do not use on patients with a known sensitivity to silver
  • Do not use on a patient undergoing MRI (Magnetic Resonance Imaging) examination
  • Prior to administering radiation therapy, remove ACTICOAT Flex 3 & 7. A new dressing can be applied following treatment.


Precautions

  • ACTICOAT Flex 3 & 7 are not compatible with oil-based products, such as petrolatum.
  • Avoid contact with electrodes or conductive gels during electronic measurements e.g. EEG and ECG.
  • For external use only, for example do not apply the dressing to exposed organs.
  • This device is not intended for use on 3rd degree burns.
  • ACTICOAT Flex 3 & 7 should only be used on premature infants (less than 37 weeks gestation) when the clinical benefit outweighs the potential risks.
  • ACTICOAT Flex 3 & 7 are not intended to provide sole treatment for infected wounds. ACTICOAT Flex 3 & 7 may be used on infected wounds which are being managed per local clinical protocol.
  • There may be transient pain (or stinging) experienced on application of ACTICOAT Flex 3 & 7. This can be minimized be carefully following the application instructions. Should continuous pain be experienced after application, remove the dressing and discontinue use.
  • The color of the dressing may vary. This does not affect the performance of the dressing.


Ordering Information

Catalog# Size Unit
ACTICOAT Flex 3    
66800396 5cm X 5cm 1 bx/5 dressings
66800399 10cm X 10cm 1 bx/12 dressings
66800409 10cm X 20cm 1 bx/12 dressings
66800419 20cm X 40cm 1 bx/6 dressings
66800432 40cm X 40cm 1 bx/6 dressings
66800435 10cm X 120cm 1 bx/6 dressings
ACTICOAT Flex 7    
66800395 5cm X 5cm 1 bx/5 dressings
66800397 10cm X 12.5cm 1 bx/5 dressings
66800420 15cm X 15cm 1 bx/5 dressings
66800545 2.5cm x 60cm 1 bx/5 dressings

How to Use

Cleanse wound according to local clinical protocol.

Step 1
Remove ACTICOAT Flex 3 or Flex 7 from the package using a clean technique.

Step 2
ACTICOAT Flex 3 and 7 - Step 2
Cut the dressing to shape as necessary. When used with compression therapy the dressing must be cut to the size of the wound.

Step 3
Moisten the dressing according to local clinical protocol, fully submerging the dressing then squeezing gently (DO NOT use saline). Allow excess water to drain prior to application.

Alternatively a thin layer of a hydrogel product e.g. INTRASITE Gel can be applied directly to the wound and/or the dressing or INTRASITE conformable on top of the dressing.

Step 4
ACTICOAT Flex 3 and 7 - Step 4 a    ACTICOAT Flex 3 and 7 - Step 4-b
Without stretching the dressing, apply to the wound, either way up, to the wound surface ensuring there are no creases. The dressing should be applied with the direction of stretch running along the limb to allow movement.

ACTICOAT  Flex 7 ribbon may be used to pack wounds.

Step 5
ACTICOAT Flex 3 and 7 - Step 5
Secure the dressing in place with an appropriate secondary dressing that will maintain a moist wound environment.

In the case of highly exuding wounds an absorbent secondary dressing is appropriate. Keep the dressing moist but not so we that tissue maceration occurs.
            
Change the dressing depending on the amount of exudate present and the condition of the wound. Dressing should be changed every 3 to 7 days depending on wear time.


FAQs

Frequently asked questions about ACTICOAT Flex 3 and ACTICOAT Flex 7

Why should ACTICOAT be moistened with water and not saline?

The chloride ions in saline have the potential to neutralize released Ag + ions so to prevent this, water is the best wetting agent.

What is the minimum age a patient should be for ACTICOAT application?

ACTICOAT should only be used in premature infants (<37 weeks gestation) when clinical benefits outweigh any potential patient risks. No clinical data is available in this age group and only limited data is available for use in neonates.

How long can ACTICOAT be used for?

ACTICOAT should not be required for more than 4-6 weeks on wounds showing signs and symptoms of infection. Progress should be assessed every 2 weeks to help dictate forward strategies in terms of therapeutic options. In certain "at risk" wound types (including surgical incisions) ACTICOAT use can be part of a preventative strategy even though the signs and symptoms of infection are absent. Use over extended time periods should be based on a clinical and microbiological justification.

Is silver toxic?

A study of silver levels in patients dressed with ACTICOAT for skin grafts, and residual burn sites showed that the levels of serum silver for ACTICOAT were less than the maximal level reported in the literature for patients treated with SSD cream1. The authors concluded that the use of ACTICOAT was not associated with clinical, biochemical or haematological signs of toxicity 1. Another study found no significant difference between ACTICOAT and SSD with routine blood tests, liver and renal function tests. Additionally, no side effects were found relating to the use of ACTICOAT2. In relation to chronic wounds, blood testing of a cohort of venous leg ulcer patients showed no clinically relevant changes in serum silver concentrations, haematology or biochemistry results following ACTICOAT usage3.

ACTICOAT contains nanocrystalline silver, aren't nanoparticles dangerous?

A nanoparticle and the nanocrystalline structure of ACTICOAT are very different. ACTICOAT does not contain nanoparticles. The word nanocrystalline refers to the structure of the silver and its ability to have a high surface area in contact with the wound bed and wound fluid. The silver released into the wound is Ag + ions, which is the same antimicrobial agent that is released from other silver containing dressings. Silver release from ACTICOAT does not involve the release of free nanoparticles.

Why are the levels of silver release higher with ACTICOAT compared to some other silver dressings?

The level of silver released from ACTICOAT has been demonstrated to have bacteriocidal effects ( in-vitro) against a broad spectrum of over 150 Gram positive and Gram negative bacteria and fungal wound pathogens14,22,4. It is also effective ( in-vitro) against Antibiotic- resistant bacteria such as Pseudomonas, Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE)21.  In the clinical setting ACTICOAT has been demonstrated to be more effective than competitor silver dressings including faster resolution of the signs of infection and faster healing5.

How are the high levels of silver release maintained compared to some other silver dressings?

The higher levels of silver at the wound when ACTICOAT is applied occur due to its efficient and prolonged release of silver ions. This is due to its nanocrystalline structure formed from column-shaped crystals which are deposited on the dressing surface by a physical vapour deposition process. This process creates a surface topography with features on the nano-scale. This specialist structure presents a larger surface compared to other silver presentations.  The SILCRYST nanocrystalline structure consists of small clusters of water soluble crystals; when moistened these atomic clusters, which are very porous, rapidly release and replenish concentrations of silver ions at sufficient levels ( in-vitro)6

What about silver resistance?

Unlike antibiotics, which tend to act on a single target within the bacteria, silver acts on multiple targets. These include the respiratory action in cytochromes, components of the microbial electron transport system and DNA replication7.  Chopra (2007) describes how faster acting antimicrobial dressings will present less risk of resistance developing as organisms are more likely to be killed, removing the chance of a build-up of the resistant population8. The author also states that the multi-faceted mode of action of silver means that resistance is unlikely. SILCRYST Silver provides a sustained release of silver with a rapid action due to its nanocrystalline structure.

Why is speed of kill so important?

Bacteria reproduce very rapidly. For example, E.coli reproduces about every ~20 minutes (depending on the strain)9 and with each new generation, mutations are possible. The longer a given microbe is allowed to live and multiply in the presence of an antimicrobial agent, the greater the chances for selection of resistance to that agent. Guarding against resistance is a huge benefit of a rapid kill rate (for any antimicrobial agent).  In addition, preventing biofilm formation (under appropriate conditions, biofilms can begin to form rapidly)10 is another potential advantage of a quick acting agent.

What makes SILCRYST nanocrystalline silver different from other silvers?

The SILCRYST nanocrystalline silver utilized in the ACTICOAT range is unique in that it is formed from column-shaped crystals which are deposited on the dressing surface by a physical vapour deposition process. This process creates a surface topography with features on the nano-scale. This specialist structure presents a larger surface area to volume ratio compared to other silver presentations.  This structure enables the rapidly release and replenish concentrations of silver ions at sufficient levels ( in-vitro)11 ACTICOAT is proven ( in-vitro), to begin working within 30 minutes‡.11,12,13,14,15,22. This rapid action gives the bacteria very little time to multiply.

Isn't silver expensive?

The unit cost for an ACTICOAT dressing may be greater than a non-antimicrobial but the benefits to both the patient and the overall care budget outweigh this difference.  ACTICOAT has been shown to decrease the length of inpatient stay and has been demonstrated to lower overall treatment costs compared to SSD in the high cost burns arena16.  ACTICOAT has also been shown to be more effective in a chronic setting by promoting faster wound healing compared to competitors5. In a comparative study ACTICOAT was shown to not only result in faster time to resolution of infection17 but also a decreased overall cost compared to competitors.  In terms of the total cost of wound care it is the complications such as infection that drive up costs. For example infection may cause an increase in bed days, increased antibiotic use and increased clinician time. So an interventional, fast acting product with improved outcomes can easily justify a higher price.

How long does it take ACTICOAT to have an effect?

ACTICOAT has been shown ( in-vitro) to kill bacteria in as little as 30 minutes13,14,15,16,17,18,‡.

What microbes is ACTICOAT effective against?

ACTICOAT is effective ( in-vitro) against a broad spectrum of over 150 Gram positive and Gram negative bacteria and fungal wound pathogens. 14,21,22  It is also effective ( in-vitro) against Antibiotic- resistant bacteria such as Pseudomonas, Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-Resistant Enterococcus (VRE)6. ACTICOAT has been shown, in a 2010 study, to reduce MRSA bacteraemias.19

How long does ACTICOAT remain active for?

ACTICOAT and ACTICOAT Flex 3 both have a sustained release of silver (in-vitro) for up to 3 days 20 and have been shown to maintain antimicrobial barrier efficacy for 3 days ( in-vitro) 25. Other variants including ACTICOAT 721,22, ACTICOAT Flex 7 3,24,25, ACTICOAT Moisture Control26 and ACTICOAT Absorbent27 maintain antimicrobial barrier efficacy for up to 7 days.

When should ACTICOAT dressings be changed?

ACTICOAT dressings have recommended wear times of between 3 and 7 days depending on the variant (please refer to dressing specific insert leaflet), appropriate clinical protocols and judgement should always be used when deciding on dressing change timings.

Can I use ACTICOAT under NPWT?

ACTICOAT and ACTICOAT Flex are both indicated for use under negative pressure devices. ACTICOAT requires fenestration before application while the mesh structure of ACTICOAT Flex gives fluid transfer properties for use as an antimicrobial layer under NPWT28,29,30 and can be used for up to 3 days.

Why should I use ACTICOAT compared to other silver dressings?

When compared to other silver dressings or traditional dressing protocols studies have shown ACTICOAT to provide a) faster healing2,1,31 , b) faster time to resolution of infection 20 , c) a decrease in odour causing bacteria23,32, d) decreased pain (compared to SSD)33,34, e) a reduced number of dressing changes35,36, f) decreased in-patient stay37 and g) decreased antibiotic usage42

‡ACTICOAT, ACTICOAT 7, ACTICOAT Flex 3, ACTICOAT Flex 7

References
1. Vlachou E, et al. The safety of nanocrystalline silver dressings on burns: A study of systemic absorption. Burns 2007. 33(8):979-85 2. Haung Y, et al. A randomised comparative trial between ACTICOAT and SD-Ag in the treatment of residual burn wounds, including safety analysis. Burns 2007. 33(2):161-166 3. 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 4. Westaim (Sherritt) Report Ref: 93/001 'Broad Spectrum Efficacy' (in-vitro) 5. Gago M, et al. A comparison of three silver-containing dressings in the treatment of infected chronic wounds.Wounds. 2008. 20(10) 273-278 6. Smith & Nephew report reference DS/08/062/R2 (in-vitro) 7. Warriner R. Infection and the chronic wound: A focus on silver. Advances in Skin and Wound Care. 2005 (18) Supp. 1 8. 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 9. Caddow P. Microorganisms and their properties. In: Applied Microbiology. 1st ed. London, England: Scutari Press, 1989:17-42. 10. Harrison-Balestra C, Cazzaniga AL, Davis SC, et al. A Wound-Isolated Pseudomonas aeruginosa Grows a Biofilm in Vitro Within 10 Hours and Is Visualized by Light Microscopy. Dermatologic Surgery, 2003; 29(6): 631. 11. Smith & Nephew Data on file report 0810018 (in-vitro) 12. Smith & Nephew Data on file report 0810014 (in-vitro) 13. 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 14. Yin HQ, et al. 'Comparative evaluation of the antimicrobial activity of ACTICOAT Antimicrobial barrier dressing.Journal of Burn care and rehabilitation. 1999; 20(3): 195-200 15. Wright JB, et al. 'The Comparative Efficacy of Two Antimicrobial Barrier Dressings: In-Vitro Examination of Two Controlled Release of Silver Dressings', WOUNDS 1998; 10(6): 179-188 16. Fong J, Wood F, Fowler B. A silver coated dressing reduces the incidence of early burn wound cellulitis and associated costs of inpatient treatment: Comparative patient care audits. Burns 31 (2005)562-567. Burn Care Res 2006;27:198-201 17. Searle R and Bielby A. (2010) Dressing strategies for the management of infected wounds in community wound care: impacts and implications. Poster at Wounds UK, Harrogate Nov 2010 18. Wright JB, et al. 'Efficacy of topical silver against fungal burn wound pathogens', American Journal of Infection Control 1999; 27(4): 344-350. 19. Newton H. 2010; Reducing MRSA bacteraemias associated with wounds. Wounds UK (6) 1 20. Westaim Report Ref: #971030 'The Antimicrobial Activity of Westaim's ACTICOAT Silver Coated Dressing Against Clinically Relevant Organisms Over An Extended Period of Time' (in-vitro) 21. Westaim Report Ref. #001213 'Long Term Comparative Evaluation of SilverlonTM and ACTICOAT 7 Dressings' Activities Against MRSA' (in-vitro) 22. Westaim Report Ref. #010322 'Seven Day Efficacy of ACTICOAT 7 Dressings Against Multiple Organisms' (in-vitro) 23. Antimicrobial Activity of ACTICOAT Flex 7 against a Broad Spectrum of Wound Pathogens, Data on File reference 0810012 (in-vitro) 24. Antimicrobial Activity of ACTICOAT Flex 7 dressings in a 7 day Repeat Challenge Test, Data on File reference 0810013 (in-vitro) 25. Antimicrobial activity testing of ACTICOAT Flex 7 dressings against a broad spectrum of wound pathogens using log reduction, report reference WRP-TW141-022 (in-vitro) 26. Ref: 0503006 ACTICOAT™ Moisture Control Dressing - Corrected Zone of Inhibition Testing (in-vitro) 27. Data on File Report - 0403003.Acticoat Absorbent Dressing Corrected Zone of Inhibition (in-vitro) 28. Lumb, H; The Antimicrobial Activity of Acticoat and Acticoat Flex 3 while Under Negative Pressure, Data on File reference 0810010 29. Bannister N. (2009) Smith & Nephew ACTICOAT and NPWT Summary 30. Carpenter, S; Investigation into wound bed pressure under ACTICOAT using an in-vitro model, report reference DS/09/019/R1 31. Moiemen NS, et al. ACTICOAT dressings and major burns: Systemic silver absorption. Burns 2010. 37(1):27-35 32. Thomas S, Treating malodorous wounds. Community Outlook, October 1989 27-30 33. Muangman P, et al. (2006) Comparison of efficacy of 1% Silver Sulphadiazine and ACTICOAT for eth treatment of partial thickness burn wounds.Journal of the Medical Association of Thailand. 89(7):953-8 34. Tredget EE, et al. 'A Matched-Pair, Randomized Study Evaluating the Efficacy and Safety of Acticoat Silver-Coated Dressing for the Treatment of Burn Wounds', Journal of Burn Care & Rehabilitation 1998; 19(6): 531-537 35. Cuttle L. Naidu S. Mill J. Hoskins W. Das K. and Kimble R. (2007) a retrospective cohort study of ACTICOAT versus Silvazine in a paediatric population. Burns. 33 (6): 701-7 36. Silver S, et al. (2007) A silver-coated antimicrobial barrier dressing used postoperatively on meshed autografts: A dressing comparison study. Journal of Burn Care and Research. 28(5):715-719 37. Tonkin C and Wood F (2006). Nanocrystalline silver reduces the need for antibiotic therapy in burn wounds. Primary Intention. 13(4): 163-168