Frequently Asked Questions about ACTICOAT
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 and ions in saline have the potential to neutralise 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.
Can ACTICOAT be used alongside other topical therapy such as collagenase?
No - silver is a heavy metal and can inactivate the enzymes.
How long can ACTICOAT be used for?
International consensus documents state that a topical antimicrobial should have a positive effect within 2 weeks41. 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 cream7.
The authors concluded that the use of ACTICOAT was not associated with clinical, biochemical or haematological signs of toxicity7. Another study found no significant difference between ACTICOAT and SSD with routine blood tests, liver and renal function tests6.
Additionally, no side effects were found relating to the use of ACTICOAT6. 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 usage9.
A clinical study in chronic wounds demonstrated a faster rate of wound healing in patients treated with ACTICOAT compared to other silver dressings4.
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 stay30 and has been demonstrated to lower overall treatment costs compared to SSD in the high cost burns arena30.
ACTICOAT has also been shown to be more effective in a chronic setting compared to competitors4. In a comparative study ACTICOAT was shown to not only result in faster time to resolution of infection4 but also a decreased overall cost compared to competitors5.
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 minutes‡10,11,34,35. International consensus documents state that a topical antimicrobial should have a positive effect within 2 weeks41.
In a comparative clinical study in chronic wounds 60% of the patients treated with ACTICOAT saw a resolution of wound infection within 2 weeks compared to only 8% and 10% in competitor dressing cohorts4.
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 pathogens14,15. It is also effective (in-vitro) against Antibiotic-resistant bacteria such as Pseudomonas, Methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-Resistant Enterococcus (VRE)15,16,17 and bacteria containing NDM-1 Carbapenemases18.
How long does ACTICOAT remain active for?
ACTICOAT and ACTICOAT Flex 3 both have been shown to maintain antimicrobial barrier efficacy for 3 days (in-vitro)42, Other variants including ACTICOAT 726,27, ACTICOAT Flex 728,29, ACTICOAT Moisture Control43 and ACTICOAT Absorbent44 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 whilst 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 days36,37,38.
‡ACTICOAT, ACTICOAT 7, ACTICOAT Flex 3, ACTICOAT Flex 7
1 Daubney, L; ACTICOAT Flex 7 - Evaluation of Extensibility, report reference DS.08.123.R1
2 Smith & Nephew Data on File Report – 0403002
3 Burrell et al, ‘Efficacy of Silver-Coated Dressings as Bacterial Barriers in a Rodent Burn Sepsis Model’, WOUNDS 1999; 11(4):64-71.
4 Gago M, et al., A comparison of three silver-containing dressings in the treatment of infected, chronic wounds. Wounds 2008; 20 (10): 273-278
5 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
6 Haung 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
7 Vlachou et al., The safety of nanocrystalline silver dressings on burns: A study of systemic absorption. Burns 2007. 33(8):979-85
8 Moiemen et al., ACTICOAT dressings and major burns: Systemic silver absorption. Burns 2010. 37(1):27-35
9 Sibbald et al (2001) A screening evaluation of an ionised nanocrystalline silver dressing in chronic wound care. Ostomy Wound Management 47(10): 38-4
10 Smith & Nephew Data on file report 0810018
11 Smith & Nephew Data on file report 0810014
12 Smith & Nephew report reference DS/08/078/R2
13 Smith & Nephew report reference DS/08/062/R2
14 In-vitro study data on file: Scientific Background #0109003 and #0107010
15 Wright JB, Lam K, Hansen D, Burrell RE. Efficacy of topical silver against fungal burn wound pathogens. Am J Infect Control. 1999;27:344-350
16 DoF 0810016
17 DoF: 0810017
18 Hope R, et al., (2012) The in-vitro antibacterial activity of nanocrystalline silver dressings against bacteria withNDM-1 carbapenemase. Poster at EWMA, Austria, 2012
19 Childress et al (2007) Impact of an absorbent silver-eluting dressing system on lower extremity revascularisation wound complications. Annals of Vascular Surgery. 21(5): 598-602
20 Gravante et al (2009) Nanocrystalilne silver. A systematic review of randomised trials conducted on burned patients and an evidence-based assessment of potential advantages over old silver formulations. Annals of Plastic Surgery. 63(2):201-204
21 Muangman et al. (2006) Comparison of efficacy of 1% Silver Sulphadiazine and ACTICOAT for the treatment of partial thickness burn wounds. Journal of the Medical Association of Thailand. 89(7):953-8
22 Tredget 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
23 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
24 Silver 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
25 Peters D, Verchere C. Healing at home: Comparing Cohorts of children with medium-sized burns treated as outpatients with in-hospital applied ACTICOAT to those children treated as inpatients with silver sulfadiazine. Journal of Burn Care & Research 2006; 27(2):198-201.
26Westaim Report Ref. #001213
27Westaim Report Ref. #010322
28Data on File: 0810012
29Data on File: 0810013
30Fong 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
31Russell AD, Hugo WB. Antimicrobial activity and action of silver. Prog Med Chem 1994; 31: 351-71
32Peterson and Shanholtzer (1992) Tests for Bacteriacidal effects of antimicrobial agents: technical performance and clinical relevance. Clinical Microbiology Reviews 5(4)420-432
33Benson R Smith and Nephew Data on File 0504001v3
34A. Keene, ACTICOAT Non-Clinical Overview (Consultation Dossier). 29th January 2002
35Wright et al, ‘The Comparative Efficacy of Two Antimicrobial Barrier Dressings: In-VitroExamination of Two Controlled Release of Silver Dressings’, WOUNDS 1998; 10(6): 179-188
36Lumb, H; The Antimicrobial Activity of ACTICOAT and ACTICOAT Flex 3 while Under Negative Pressure, Data on File reference 0810010
37Bannister, N; NPWT Summary
38Carpenter, S; Investigation into wound bed pressure under ACTICOAT using an in-vitromodel, report reference DS/09/019/R1
40Smith (2005) Ref: 0503008 ACTICOAT Moisture Control Dressing – Physical testing
41International consensus. Appropriate use of silver dressings in wounds. An expert working group consensus. London: Wounds International, 2012.Available from:www.woundsinternational.com
42Westaim report #971030
43Data on File: Smith (2005) 0503006
44Data on File ref: 0403003