In some healthcare organisations
topical antimicrobials are restricted or
banned, particularly silver products
where cost effectiveness has been
an issue (Michaels et al, 2009). It is,
therefore important for clinicians to
be able to correctly identify wound
infection to ensure that these
products are used appropriately
and for the right length of time.
Antimicrobial dressings are not
appropriate for use throughout the
healing trajectory to wound closure
and should be stopped as soon as any
infection has resolved.
It has been suggested that
nurses use a ‘two-week challenge’
to ensure that silver dressings are
used for an appropriate time scale.
The dressings should be used for two
weeks then the wound reassessed. If
infection has resolved, the dressings
should be discontinued; if there
is no improvement the product
should be stopped and other
interventions considered. If there
is improvement but infection has
not fully resolved, the antimicrobial
should be continued for another
two weeks then reassessed (Wounds
International, 2012).
Considerations for use
›
Silver:
silver dressings contain
the silver ion Ag+ which is either
released into the wound bed
or draws the bacteria into the
wound. Silver products have a
broad spectrum of antimicrobial
action and a low toxicity, as well
as being available in a wide variety
of formats, including hydrofibres,
wound contact layers, foams and
alginates. Selection of a silver
product should be based on
exudate levels, condition of the
wound bed and what is available
on local formulary. Silver should
not be applied for long periods or
on patients with known allergies
and should be removed prior to
X-ray or radiotherapy treatment.
Some resistance to silver has been
identified
in-vitro
(Gottrup et al,
2013).
›
Iodine:
iodine is a chemical
element available in two
forms — cadexomer iodine
and povidone iodine. Iodine
products do not have the capacity
DRESSING CHOICE
›
WCT
to absorb exudate and may be
rendered ineffective if it is heavy.
Cadexomer iodine has the added
ability of being able to deslough
wounds. Iodine preparations
are not recommended during
pregnancy, breast-feeding or in
babies aged under six months.
Long-term iodine use should be
avoided in patients with impaired
thyroid function (Boothman,
2010).
›
PHMB:
PHMB is a disinfectant
that is available in a variety
of formations, which include
gels, solutions, wound contact
layers and foams. At present no
resistance has been identified
and PHMB is considered to be
non toxic to cells as well as
being hypoallergenic (Wounds
UK, 2010).
›
DACC:
DACC is a fatty acid
derivative and a strongly
hydrophobic substance. Some
dressings are coated with
DACC and as bacteria and
fungi also display hydrophobic
properties they are attracted to
and irreversibly binded into the
dressing. The product is safe to
use on a wide variety of patients
as no chemicals are donated into
the wound (Probst et al, 2012).
CONCLUSION
Correct dressing selection will help
nurses create an ideal environment for
wound healing and is an essential part
of treating a patient with a wound.
Successful treatment is partly
dependent on nurses’ skills in
assessment and their ability to
correctly identify and treat any
underlying pathologies.
If performed correctly, the
assessment process will ensure that
dressing selection is both cost-
effective and appropriate.
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WOUND CARE TODAY
2015,Vol 2, No 1
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