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ACTICOAT

Silver-Coated Antimicrobial Barrier Dressing

Overview

Description 

An antimicrobial dressing utilizing advanced silver technology to help create an optimal wound environment.

Features 

  • Rayon/polyester inner core helps manage moisture level.
  • Silver-coated high-density polyethylene mesh facilitates the passage of silver through the dressing.
  • The nanocrystalline coating of pure silver delivers antimicrobial barrier activity within 30 minutes - faster than other forms of silver.
  • ACTICOATs antimicrobial technology is able to produce silver-coated polyethylene films that can release an effective concentration of silver over several days. Thus, as silver ions are consumed, additional silver is released from the dressing to provide an effective antimicrobial barrier. This patented silver-based antimicrobial technology can be applied to a wide range of medical devices including wound dressings.

Benefits 

  • Delivers fast-acting, long-lasting antimicrobial barrier control.
  • Effective barrier which may assist in preventing contamination of the wound.
  • Laboratory studies show that ACTICOAT dressing kills micro-organisms faster than conventional products such as silver sulfadiazine (1 percent cream) or silver nitrate (0.5%) solution. It has also been shown in-vitro to provide protection against more than 150 pathogens. The pathogens tested in the lab include resistant strains of bacteria such as antibiotic-resistant strains of Pseudomonas, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus and fungi. These pathogens have been known to infect many patients with already weakened immune systems. Infections contracted during hospitalization caused by these so-called superbugs and other organisms cost North American taxpayers an estimated $18 billion a year in additional hospital care.
  • ACTICOAT is versatile. The dressings can be cut to the desired shape and size to wrap around all body parts.
  • The sustained release of silver also means fewer dressing changes, resulting in less exposure of the wound bed to the environment. This reduces the risk of infection, which lowers costs to hospitals.
  • ACTICOAT is cost-effective because it can be left on wounds for up to 3 days.

Indications

ACTICOAT Dressings are an effective barrier to bacterial penetration. The barrier function of the dressing may help reduce infection in partial and full-thickness wounds including pressure ulcers, venous ulcers, diabetic ulcers, surgical wounds, first and second degree burns and graft and dermal substitutes recipient sites. ACTICOAT dressings may be used over debrided and grafted partial thickness wounds.

Contraindications / Precautions

  • For external use only.
  • Should not be used on patients with a known sensitivity to silver.
  • May cause transient discoloration.
  • Not compatible with oil-based products, such as petrolatum.
  • Not compatible with MRI (Magnetic Resonance Imaging) procedures.
  • Should not come in contact with electrodes or conductive gels during electronic measurements.
  • If reddening or sensitization occurs, dicontinue use.

Ordering Codes 

Product #  Sizes Pcs/Pkg
20601 5cm x 5cm 1 bx/5 dressings
20101 10cm x 10cm 1 bx/12 dressings
20201 10cm x 20cm 1 bx/12 dressings
20301 20cm x 40cm 1 bx/6 dressings
20401 40cm x 40cm 1 bx/6 dressings
20501 10cm x 120cm 1 bx/6 dressings

How to Use

Cleanse wound according to local clinical protocol.

Step 1
Remove ACTICOAT from the package using a clean technique.

Step 2
Moisten the dressing according to local clinical protocol (DO NOT use saline). Remove excess water prior to application e.g. leave to drain on a sterile field for approximately 2 minutes. Where there is a moderate to high level of exudate, there is no need to pre-moisten.

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

Step 3
ACTICOAT How to use Step 3
Cut the dressing to shape as necessary. Leave at least one tab intact to prevent the layers of the dressing from separating. 

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.

Step 4
ACTICOAT and 7 how to use Step 4
Apply the dressing to the wound surface.

Step 5
ACTICOAT and 7 how to use 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 wet 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.

FAQ

Frequently asked questions about ACTICOAT and ACTICOAT 7

ACTICOAT and ACTICOAT 7 have a blue side and a silver side, which side should be in contact with the wound bed?

Either side can be placed in contact with the wound bed, there is no difference in efficacy.

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