Infection management

Choose the right product, at the right time, for the right patient

Chronic wounds such as diabetic foot ulcers, venous leg ulcers and pressure ulcers can be costly and hard to treat. The presence of infection and biofilm can delay healing, cause wider complications such as amputation or systemic infection, and increase costs^1,3,4,18. Treating an infected VLU with antimicrobials can cost an average £10,777².

Optimal management of infection and biofilms, with informed antimicrobial stewardship and the appropriate use of antibiotics, can improve patient outcomes¹⁹.

Find the right treatment pathway to help improve outcomes

Average treatment costs can be three times higher if wounds get infected^1,18, with incorrect antimicrobial use reported in 51.4% of cases⁵. Our solutions aim to facilitate effective management and treatment:

• When biofilms are identified.
• For stalled chronic wounds.
• When there are obvious signs of clinical (acute) infection.
• When precise debridement is required.
• To inform wound assessment and treatment choice.

With an effective treatment pathway:

	Minimise wound healing time and, through early intervention, potentially minimise the progression of local wound infection to something more severe20
	Reduce usage of antimicrobial dressings, antibiotics and super-absorbers, and improve antimicrobial stewardship21-22
	Reduce treatment failures and recurrent infections, enhancing patient care3,21
	Chronic wound management best practice may differ in the presence of infection or biofilm.

When symptoms of biofilm are identified, or for stalled chronic wounds

	IODOSORB◊ 0.9% Cadexomer Iodine Ointment Shown to physically disrupt mature biofilm by absorbing it into a dressing, helping to reduce the biofilm’s bacterial load7,9,10,11,23 Sustained antimicrobial activity over 3 days (in vitro)24-26
	Study: Statistically significant reductions in wound biofilms  compared to a carboxymethyl cellulose (CMC) silver dressing11
	IODOFLEX◊ 0.9% Cadexomer Iodine Dressing - Highly absorptive deslougher, disrupts mature biofilms*23.  - Slow-release27, broad-spectrum antimicrobial activity28 for up to 3 days29.

Silver and systemic antibiotics have been shown to be ineffective against mature biofilms^3,8,30,31.

For obvious signs of clinical (acute) infection

ACTICOAT◊ Antimicrobial Barrier Dressings with nanocrystalline silver - Nanocrystalline structure15 for quick release of bactericidal silver at  effective concentration16,17, capable of preventing biofilm reformation32. - Shown to eliminate infection in 60% of wounds within 2 weeks21, with 33% fewer treatment dressings and a potential 50% cost reduction per healed wound, compared to AquacelTMAg21,33. Try ACTICOAT Dressings for 2 weeks >

Study: Use of nanocrystalline silver to support infection control protocols and antimicrobial stewardship22

To inform debridement, wound assessment and treatment choice

	MolecuLightTM i:X Imaging Device - Instant visualisation of bacterial fluorescence for a range of pathogens, facilitating debridement precision12-14. - Optimise therapy preparation, guide sampling and assess bacterial status to help track treatment progress12.
	Study: Using the MolecuLight i:X Imaging Device to help inform clinical practice and facilitate antimicrobial stewardship34

T.I.M.E. clinical decision support tool

Consistent, holistic and multidisciplinary clinical practice^35,36

The new T.I.M.E. clinical decision support tool (CDST) has been developed with expert practitioners to promote consistency in daily clinical practice through a patient-centric, holistic and multidisciplinary framework25,36.

Download T.I.M.E. CDST >

Helping you get CLOSER TO ZERO^◊ wound infection.

*demonstrated in a mouse study

References
1) Guest, J. et al Costs and consequences of managing infection associated with venous leg ulcers in the UK. Presented at: CATALYST Health Economics Consultants Ltd; UK. 2017.
2) Guest, J. F., Fuller, G. W. & Vowden, P. Venous leg ulcer management in clinical practice in the UK: costs and outcomes. Int. Wound J. 15, 29–37 (2018).
3) Schultz, G. et al. Consensus guidelines for the identification and treatment of biofilms in chronic nonhealing wounds. Wound Repair Regen. 25, 744–757 (2017). 5
4) Malone, M. et al. The prevalence of biofilms in chronic wounds: a systematic review and meta-analysis of published data. J. Wound Care 26, 20–25 (2017).
5) UK, Ireland & Nordics audit data. Collated 2017-2019.
6) H, Oono T, Saito M, Iwatsuki K. Assessment of Cadexomer Iodine Against Staphylococcus Aureus Biofilm In Vivo and In Vitro Using Confocal Laset Scanning Microscopy. The Journal of Dermatology. 2004;31: 529-534.
7) Fitzgerald DJ, Renick PJ, Forrest EC, et al. Cadexomer iodine provides superior efficacy against bacterial wound biofilms in vitro and in vivo. Wound Repair Regen. 2017; 25(1):13-24.
8) Phillips PL, Yang Q, Davis S, et al. Antimicrobial dressing efficacy against mature Pseudomonas aeruginosa biofilm on porcine skin explants. Int Wound J. 2015; 12(4):469-48 3.
9) Oates JL, Phillips CD, Wolcott R, Woodmansey E. Effect of a Cadexomer Iodine Wound Dressing on a Chronic Wound Multi-Species Biofilm Model with Comparison to a Silver Hydrofiber Antibiofilm Dressing. 2016.
10)Hill KE, Malic S, Mckee R, et al. An in vitro model of chronic wound biofilms to test wound dressings and assess antimicrobial susceptibilities. J Antimicrob Chemother. 2010;65(6):1195-1206.
11)Roche ED, Woodmansey EJ, Yang Q, et al. Cadexomer iodine effectively reduces bacterial biofilm in porcine wounds ex vivo and in vivo. Int Wound J. 2019; 1-10 [in press].
12)DaCosta RS, Kulbatski I, Lindvere-Teene L et al. Point-of-care autofluorescence imaging for real-time sampling and treatment guidance of bioburden in chronic wounds: first-in-human results. PLoS One. 2015 Mar 19; 10(3).
13)Ottolino-Perry K, Chamma E, Blackmore KM, et al. Improved detection of clinically relevant wound bacteria using autofluorescence image-guided sampling in diabetic foot ulcers. Int Wound J. 2017; doi: 10.1111/iwj.12717.
14)Rennie M.Y, Lindvere-Teene L, Tapang K, Linden R. Point-of-care fluorescence imaging predicts the presence of pathogenic bacteria in wounds: a clinical study. Journal of Wound Care. 2017; 26(8).
15)West, P. & Gunning, P. Visualization of silver levels in 2 silver dressings using scanning electron microscopy and energy dispersive X-ray microanalysis. in SAWC Tampa FL (2006).
16)Wright, J. B., Lam, K., Hansen, D. & Burrell, R. E. Efficacy of topical silver against fungal burn wound pathogens. Am. J. Infect. Control 27, 344–50 (1999).
17)Woodmansey, E., West, P., Benson, R. & McCulloch, D. A visual demonstration of the antimicrobial efficacy of silver-based dressings against key pathogenic bacteria using confocal laser scanning microscopy. Poster presentation SAWC. in SAWC (2006). 18)Guest, J. F., Fuller, G. W. & Vowden, P. Diabetic foot ulcer management in clinical practice in the UK: costs and outcomes. Int. Wound J. 15, 43–52 (2018).
19)Nathwani, D. & Sneddon, J. Practical Guide to Antimicrobial Stewardship in Hospitals. BioMérieux Prints 21–23 (2013). doi:10.1016/S0031- 398X(10)70372-6.
20)Newton, H. Reducing MRSA bacteraemias associated with wounds. Wounds UK, 6, 56–65 (2010).
21)Gago, M. et al. A Comparison of Three Silver-containing Dressings in the Treatment of Infected, Chronic Wounds. Wounds a Compend. Clin. Res. Pract. 20, 273–8 (2008).
22)Woodmansey EJ and Roberts CD. Appropriate use of dressings containing nanocrystalline silver to support antimicrobial stewardship in wounds. Int Wound J. 2018;15: 1025-1032. Available at: International Wound Journal.
23)Akiyama H, Oono T, Saito M, Iwatsuki K. Assessment of Cadexomer Iodine against Staphylococcus aureus Biofilm In vivo and In vitro Using Confocal Laset Scanning Microscopy. The Journal of Dermatology. 2004;31: 529-534. 6
24)Smith & Nephew 2018. Antimicrobial activity of IODOSORB range against a broad spectrum of wound pathogens. Internal Report. 1801001.
25)Smith & Nephew 2009. A comparison of the antimicrobial activity of a cadexomer iodine dressing and a povidone iodine dressing. Internal Report. 6763.
26)Smith & Nephew 2018. Antimicrobial activity of IODOSORB range in a 3 day repeat challenge model. Internal Report. 1801002.
27)Smith & Nephew 2018. Release of Iodine from IODOSORB / IODOFLEX Dressing into 0.9% saline solution over a three day period. Internal Report. DS/18/026/R.
28)Smith & Nephew 2001.The in vitro activity of sliver sulphadiazone and cadexomer iodine against recent clinical isolates of methicillin-resistant Staphylococcus aureus, methicillin resistant coagulase-negative staphylococci and Pseudomonas aeruginosa. Internal Report. 194-03-01.
29)Smith & Nephew 2009.A comparison of the antimicrobial activity of a cadexomer iodine dressing and a povidone iodine dressing. Internal Report. 6763.
30)Bjarnsholt, T. et al. Silver against Pseudomonas aeruginosa biofilms. APMIS 115, 921–8 (2007).
31)Johani, K. et al. Evaluation of short exposure times of antimicrobial wound solutions against microbial biofilms: from in vitro to in vivo. J. Antimicrob. Chemother. 73, 494–502 (2018).
32)Driffield, K., Woodmansey, E. & Floyd, H. The use of silver-containing dressings to prevent biofilm formation by single and mixed bacterial flora. in SAWC (2007).
33)Searle, R. et al. Dressing strategies for the management of infected wounds in community wound care: impacts and implications. Poster presented at Wounds UK, Harrogate 2010.
34)Hill R, Rennie MY, Douglas J. Using bacterial fluorescence imaging and antimicrobial stewardship to guide wound management practices: a case series. Ostomy Wound Management. 2018;64:18–28. Available at: Ostomy Wound Management. 35)Ousey K, Gilchrist B, Jaimes H. Understanding clinical practice challenges: a survey performed with wound care clinicians to explore wound assessment frameworks. Wounds International. 2018;9(4):58-62.
36)Moore Z, Dowsett C, Smith G, et al. TIME CDST: an updated tool to address the current challenges in wound care. J Wound Care. 2019;28(3):154-161. Available at: Journal of Wound Care.