Frequently Asked Questions about ACTICOAT
Is the ACTICOAT Antimicrobial Barrier active against resistant micro organisms such as Methicillin Resistant Staphylococcus aureus (MRSA) or Vancomycin Resistant Enterococci (VRE)?
ACTICOAT with SILCRYST◊ nanocrystals has been demonstrated in vitro to be effective against 150 micro organisms including resistant micro organisms such as MSRA and VRE. Staphylococcus aureus (Methicillin Resistant Staphylococcus aureus or MRSA)
Enterococcus faecium (Vancomycin Resistant Enterococcus or VRE)
Is the ACTICOAT Antimicrobial Barrier compatible with various cleansing agents?
Many agents or solutions have been traditionally used to cleanse burn wounds. If these agents do not contain an oil base or leave a residue they may be used to cleanse the wound.
What do you do if a patient is admitted with other antimicrobials or dressings already applied?
It is recommended to remove all agents unless compatibility has been demonstrated.
Can you overlap the ACTICOAT Antimicrobial Barrier?
Yes, the ACTICOAT Antimicrobial Barrier may be overlapped without any concern.
Can the ACTICOAT Antimicrobial Barrier be used with patients who will undergo MRI?
In patients undergoing MRI (Magnetic Resonance Imaging) ACTICOAT must be removed from the area within the anatomical field being imaged. If ACTICOAT is being used on any area not within the image field, it may remain in place during the MRI.
Why can't saline be used to moisten ACTICOAT?
Saline contains chloride. If chloride ions are added to silver, a white solid called Silver Chloride is formed.
Ag+ + Cl- = AgCl
This Silver Chloride solid will greatly reduced the efficacy of the sustained silver release of the ACTICOAT dressing. Although there will be trace amounts of sodium chloride-salt in the wound bed already there will not be sufficient quantities of chloride ions to inactivate all silver ions.
What does Nanocrystalline mean and why does size matter?
Nanocrystalline †, as in ACTICOAT Nanocrystalline silver, is a reference to size. Nano means small…very, very small. When silver is deposited onto the ACTICOAT dressing during the manufacturing process, it is done via a patented process which deposits very, very small “clumps” of silver onto the dressing. These small “clumps” are extremely porous and greatly enhance the surface area from which ionisation and the dissolution of silver ions can occur.
Why is more parts per million (PPM) important?
PPM is "parts per million" and is a measure of concentration (PPM is also the same thing as milligrams per liter). For an agent that kills microbes, such as ionic silver, PPM is important because in order to kill the microbes, the silver must be present in adequate concentrations. In complex biological fluids such as wound exudate, ionic silver must be present in concentrations of roughly 20 PPM or greater to have bactericidal activity. Products that release higher than 20 PPM of ionic silver are highly effective antimicrobial agents. The concentration of ionic silver released from ACTICOAT is 70-100 PPM1.
How can bacteriostatic silver products lead to resistance?
There has not been a documented clinical case regarding resistance to silver in either form (bacteriostatic or bactericidal agent), however, silver-resistant organisms have been developed in the lab (Li et al, 1997). Regarding other non-silver antimicrobial agents, if you don't kill the bugs, you give them a chance to mutate and potentially develop resistance as they have an opportunity to respond to the challenge by mutating to resistant forms. One of the key benefits of ACTICOAT is that the quick kill or bactericidal effect is so fast and immediate (within 30 minutes of dressing application), that building any type of resistance is virtually impossible.
What is the difference between log reduction and % reduction?
Logarithms are a unit of measure typically used by microbiologists in testing scenarios. Smith & Nephew uses logarithms as a way to measure the reduction of colony forming units (CFU) on a wound. You can see this label used on the Y-Axis (up and down or left side) of graphs displayed in the ACTICOAT product brochures, while time is displayed on the X-Axis (left to right or the bottom of the graphs). For instance, let's say that a wound has an initial bug concentration of log 7 CFU's, which equals 10 to the 7th power, or 10,000,000 (1 with 7 zeros). ACTICOAT will kill pathogens in as little as 30 minutes after application. We can see this graphically as the Log CFU/ml reduces from the initial log 7 CFU's to Log 0 CFU's within .5 of an hour. Other silver dressings typically uses % reduction, not log reduction, in defining the strength of their dressing. They will say that the use of the dressing will decrease the CFU concentration by 90%. 90% reduction in CFU concentration only equals 1 log. This means that the CFU concentration decreases from 10 to the 7th power, to 10 to the 6th power. That is to say, it decreased from 10,000,000 to 1,000,000. Very few bugs are killed and there are still 1,000,000 CFU's left.
Can ACTICOAT 7 be used under PROFORE◊, regardless if the wound is infected?
If the wound shows clinical signs of infection (advancing erythema in the surrounding tissue, warmth, tenderness, oedema/induration, fever), the use of ACTICOAT or PROFORE are not recommended. It is generally accepted that the infection must be treated first and since the signs and symptoms are extending beyond the wound into the surrounding tissue, then systemic antibiotics are indicated. However, venous ulcers are prone to bacterial burden and the signs and symptoms are generally contained within the wound margins, for example, increased serous drainage, friable granulation tissue, impaired healing, and the absence of normal granulation tissue. In this case, ACTICOAT may be used with Profore and the wound should be assessed and monitored at regular intervals.
Why does a “slimy” film sometimes appear on the wound bed after application of ACTICOAT?
Sometimes a “slimy” film will appear on the wound bed (typically around day 3) after the application of ACTICOAT. This film is referred to as a “benign coagulum” and is considered normal. Clinically, it does no harm and seems to be re-absorbed by the wound or absorbed by the dressing around day 4-5, if the wound and dressing are kept moist. This “benign coagulum” may also persist under dry conditions. In general, the film does not need to be washed off or removed with each dressing change. It is believed that the “benign coagulum” is a mixture of fibrin and denatured proteins. This film is most often seen on partial thickness wounds, such as donor sites.
Why does ACTICOAT promote some staining or discoloration in the wound?
Staining, discoloration, or silver specks may appear in the wound bed after the application of ACTICOAT because when silver oxidizes, it turns black. The discoloration or presence of silver specks is temporary and will dissipate over a 2-14 day period. This causes no harm to the patient. Also, the healthy skin surrounding the wound may have a light brown, yellow or black staining where the ACTICOAT has overlapped the healthy skin. Again, this is normal and should not be a concern to the clinician or patient. The note, “may cause transient discoloration” is referred to in the Instructions for Use package insert.
Why does the application of ACTICOAT cause a stinging sensation with some patients?
Stinging upon the application of ACTICOAT has been reported in some patients. The stinging can be uncomfortable, but is usually transient and will typically disappear in 10 - 20 minutes (it appears that stinging is mostly observed with any treatment that involves a partial-thickness burn injury). Stinging can be reduced in many cases by placing the moistened ACTICOAT on sterile gauze for 2-3 minutes to drain excess water prior to application. If the patient continues to feel a stinging sensation, a silver sensitivity may be involved and the use of ACTICOAT should be discontinued.
Can ACTICOAT be used simultaneously with electrical stimulation?
The silver in ACTICOAT could interfere or intensify the electrical current since Ag+ is a good conductor of electricity. Our recommendation is to remove the ACTICOAT dressing and irrigate the wound with sterile water prior to the patient undergoing electrical stimulation therapy.
Can ACTICOAT be used post-operatively on a non-chronic wound, like a sternal incision?
ACTICOAT can and does play a large role in preventing infection on post-operative wounds in acute settings. It has been used as a prophylactic to prevent post-operative infection in high-risk patients, who may get exposed to bacterial or infection causing organisms during their surgery. For these types of patients, the prevention of infection is a key requirement for the wound healing process. Additionally, it is recognized that open wounds that are not clinically infected can be heavily colonized, thus impairing wound healing. ACTICOAT is promoted as a barrier for bacterial penetration and for the management of more heavily colonized non-infected chronic wounds.