A charcoal dressing with silver in wound infection: clinical evidence

A prospective randomised open label study to evaluate the potential of a new silver alginate/carboxymethylcellulose antimicrobial wound dressing to promote wound healing

The aim of this study was to observe both the clinical signs and symptoms of wounds at risk of infection, that is critically colonised (biofilm infected) and antimicrobial-performance of an ionic silver alginate/carboxymethylcellulose (SACMC) dressing, in comparison with a non silver calcium alginate fibre (AF) dressing, on chronic venous leg and pressure ulcers. Thirty-six patients with venous or pressure ulcers, considered clinically to be critically colonised (biofilm infected), were randomly chosen to receive either an SACMC dressing or a non silver calcium AF dressing. The efficacy of each wound dressing was evaluated over a 4-week period. The primary study endpoints were prevention of infection and progression to wound healing. The SACMC group showed a statistically significant (P = 0.017) improvement to healing as indicated by a reduction in the surface area of the wound, over the 4-week study period, compared with AF controls. In conclusion, the SACMC dressing showed a greater ability to prevent wounds progressing to infection when compared with the AF control dressing. In addition, the results of this study also showed an improvement in wound healing for SACMC when compared with a non silver dressing.

Cost-effective faster wound healing with a sustained silver-releasing foam dressing in delayed healing leg ulcers--a health-economic analysis

The aim of this analysis was to examine the cost-effectiveness of Contreet Foam (A) in comparison with three other commonly used venous leg ulcer treatment protocols: Aquacel Ag (B), Actisorb Silver (C) and Iodoflex (D). A health-economic analysis reflecting the UK treatment practice and cost structure was performed. The analysis was set up to assess the cost of relative wound area reduction over a 4-week treatment period. The model was validated by a UK expert panel consisting of four wound care specialists. To assure that the 4-week model had a realistic link to cost-effectiveness of complete wound healing, a Markov analysis was also performed. Sensitivity analyses were carried out to ensure validity. Protocol A and C proved to be the most effective treatments. The mean relative reduction in wound area after 4 weeks of treatment was 50.2% (protocol A), 23.9% (protocol B), 44.6% (protocol C) and 36.0% (protocol D). Cost-effectiveness ratios showed that protocol A proved to be the most cost-effective treatment, and protocol B the least. The cost per percentage reduction in wound area was 9.50 UK pounds for protocol A, compared to 16.50-17.60 UK pounds for the other treatment options. The cost-effectiveness of complete healing (Markov analysis) and sensitivity analyses confirmed these results. Using Contreet Foam instead of the other dressing alternatives may imply savings of 2.2-4.4 million UK pounds per year to the National Health Service.

Assessment and management of fungating wounds: a review

Fingating wounds always present a management challenge. Not only is it often difficult to manage the physical aspects of the wound - pain, bleeding, exudate and odour - but also the psychological impact of a fungating wound on the patient and their family or carers is often considerable. This review examines current practice in relation to fungating wounds, and emphasizes the central important of assessment, communication and sensitivity in nursing management.

The use of combination treatments and dressings for a traumatic wound

With demographics, an ageing population and faster hospital discharges against us, district nurses are likely to be faced with more complicated wounds that require specialist attention. With national and local guidelines, the restriction of cost implications, patient compliance and 'best practice' to achieve, the nurse can find the task of choosing the correct course of treatment a daunting one. Nurses must not only consider the patient holistically, assess the wound and the predisposing factors that may be present, but also prescribe an effective treatment while being aware of what effects the treatment may have and be prepared to justify their actions when called to task. This article takes one case study detailing a traumatic wound and follows through the whole assessment and evaluation process to demonstrate how all of these demands were met. Dressings used in the case study are Promogran, Actisorb Silver 220 and Tielle Plus manufactured by Johnson & Johnson.

A review of the use of silver in wound care: facts and fallacies

This review traces the use of silver in wound care, discussing its merits as an antibacterial agent and constituent of many new dressings, which are increasingly tailored to the treatment of wounds ranging from acute surgical lesions to chronic and diabetic leg ulcers. Misconceptions regarding the biological properties of silver, its possible physiological value in the human body and wound bed, absorption through the skin, and safety factors are addressed. The article aims to present silver and the new range of sustained silver-release dressings as important features in the management of skin wounds, providing effective control of wound infections while ensuring patient comfort and quality of life.

PEG site infections: a novel use for Actisorb Silver 220

Any breach in the integrity of the skin, such as occurs in wounds and incisions, and intravascular catheters, can act as a portal for the ingress of microorganisms and thereby predispose the patient to infection. The infection, if unchecked, can put the patient at risk of bacteraemia. We have reviewed the care of percutaneous enterostomal gastrostomy (PEG) sites in our trust hospital and in the local community and have implemented practice guidelines to reduce infection risks. These include protocols for skin care around PEG sites, and the use of an antibacterial dressing - Actisorb Silver 220 - to manage local colonization. The preliminary results of this exercise indicate that patient comfort can be improved, hypergranulation reduced, and methicillin-resistant Staphylococcus aureus colonization and infection eradicated.