The role of antimicrobial agents in wound care

Polyhexamethylene biguanide and its antimicrobial role in wound healing: a narrative review

A wound offers an ideal environment for the growth and proliferation of a variety of microorganisms which, in some cases, may lead to localised or even systemic infections that can be catastrophic for the patient; the development of biofilms exacerbates these infections. Over the past few decades, there has been a progressive development of antimicrobial resistance (AMR) in microorganisms across the board in healthcare sectors. Such resistant microorganisms have arisen primarily due to the misuse and overuse of antimicrobial treatments, and the subsequent ability of microorganisms to rapidly change and mutate as a defence mechanism against treatment (e.g., antibiotics). These resistant microorganisms are now at such a level that they are of grave concern to the World Health Organization (WHO), and are one of the leading causes of illness and mortality in the 21st century. Treatment of such infections becomes imperative but presents a significant challenge for the clinician in that treatment must be effective but not add to the development of new microbes with AMR. The strategy of antimicrobial stewardship (AMS) has stemmed from the need to counteract these resistant microorganisms and requires that current antimicrobial treatments be used wisely to prevent amplification of AMR. It also requires new, improved or alternative methods of treatment that will not worsen the situation. Thus, any antimicrobial treatment should be effective while not causing further development of resistance. Some antiseptics fall into this category and, in particular, polyhexamethylene hydrochloride biguanide (PHMB) has certain characteristics that make it an ideal solution to this problem of AMR, specifically within wound care applications. PHMB is a broad-spectrum antimicrobial that kills bacteria, fungi, parasites and certain viruses with a high therapeutic index, and is widely used in clinics, homes and industry. It has been used for many years and has not been shown to cause development of resistance; it is safe (non-cytotoxic), not causing damage to newly growing wound tissue. Importantly there is substantial evidence for its effective use in wound care applications, providing a sound basis for evidence-based practice. This review presents the evidence for the use of PHMB treatments in wound care and its alignment with AMS for the prevention and treatment of wound infection.

Antiseptics, iodine, povidone iodine and traumatic wound cleansing

Wound cleansing is an integral part of the management of acute traumatic wounds. There is consensus that it reduces infection rates. However, the choice of cleansing agent remains controversial, especially the use of antiseptics has been questioned. This article reviews the current literature on the use of antiseptics particularly povidine iodine in traumatic wound cleansing and discusses the beneficial and harmful effects of such practice.

The effect of a silver-containing Hydrofiber dressing on superficial wound bed and bacterial balance of chronic wounds

The treatment of chronic wounds represents a major cost to society and has a profound effect on the participant's quality of life. Chronic wounds may have an increased bacterial burden that can impair healing without all the clinical signs of infection. Silver dressings may provide an alternative topical method to control bacterial burden. The primary aim of this study was to evaluate the clinical improvement in chronic wounds through the effect on wound size, maceration, resolution of surface slough and conversion to healthy granulation during a 4-week application of the silver-containing Hydrofiber dressing. This was a single centre, open-label case series study which included a total of 30 evaluable participants: four with diabetic neuropathic foot ulcers, 13 venous stasis ulcers, four pressure ulcers and nine miscellaneous wounds that did not fit any of the previous categories. All participants had adequate vascular supply, indicating the potential to heal. The wounds were stalled or had the signs and symptoms consistent with critical colonisation. The underlying cause of the ulceration was identified and corrected, or the symptoms and signs were treated. This was followed by the application of silver-containing Hydrofiber dressings for a period of 4 weeks. The majority of wounds treated decreased in size (70%) with decreased exudate, decreased purulence and resolution of surface slough (75%). There was an increased quality and quantity of healthy granulation tissue. Unlike some silver dressings, the Hydrofiber and silver combination dressing was unlikely to cause burning and stinging on application. Peri-wound maceration was present in 54% of participants at baseline, and 85% of these resolved with this dressing. A desloughing action was seen in those patients with pre-existing slough at baseline and its removal will lower the bacterial burden of the wound.

Case 40: ward management. Ward sister who failed to manage her ward appropriately

This article reviews the factors that impinge on the application of topical medications in wound care. The role of systemic and topical antibiotics in wound care is reviewed. Similarly, two antiseptics — iodine and silver, of great current interest in wound management — are scrutinized. The value of these topical agents in the management of wound bioburden should be ascertained from the perspective of understanding the advantages and disadvantages of their use and not established from what is currently the trend.

Metrotop: a topical antimicrobial agent for malodorous wounds

The eradication of pungent wound odour is one of the most challenging problems for health professionals involved in wound management. The presence of malodour can cause immeasurable distress for the patient and his/her family, making many sufferers' lives one of self-imposed exile. Clinical research using topical metronidazole over the past 20 years clearly indicates that metronidazole is effective against the anaerobic bacteria that cause these foul and distressing odours. Seton Healthcare produces a commercial preparation called Metrotop--a topical metronidazole gel which is available on prescription.