With the current, and much reported, rise in antibiotic resistance and hospital-acquired infections, the need for new and effective antibacterial agents has never been greater. Silver has long been known to exhibit antimicrobial properties, and silver ions have also been found to interfere with the microbial electron-transport system, to bind DNA and to inhibit DNA replication. Acticoat is a dressing from Smith & Nephew that incorporates “nanocrystalline silver”, offering antimicrobial protection by releasing silver ions directly into the wound. The nanocrystalline structure effectively increases the activity of the silver and allows for a steady, sustained release of silver ions over a longer period of time than would be possible with “standard” silver.

 

• An antimicrobial barrier in direct contact with the wound bed¹
• Ability to kill micro-organisms within 2 hours (in vitro)
• Broad spectrum activity against over 150 pathogens (in vitro)
• Sustained activity throughout the wear time of the dressing.

Honey has been used for centuries for the treatment of wounds, including leg ulcers in particular. Many types of honey possess low levels of antiseptic agents, such as gluconic acid and hydrogen peroxide, which may be released to inhibit the growth of skin bacteria. However, certain types of honey, especially those native to Australia and New Zealand, have been found to contain additional substances that have a more powerful antimicrobial action.

• diabetic foot ulcers
• venous stasis leg ulcers
• arterial leg ulcers
• leg ulcers of mixed etiology 
• pressure ulcers (I-IV)
• 1st and 2nd degree burns
• donor sites
• traumatic and surgical wounds 

What is Hydrofera Blue?

Hydrofera Blue is a product which is made of a polyvinyl alcohol sponge impregnated with Methylene Blue and Gentian Violet, substances which have been in use for over 50 years and are proven to provide broad-spectrum bacteriostatic protection.

What types of wounds can Hydrofera Blue be used on?

Hydrofera Blue is highly absorptive and is effective against numerous bacteria, including MRSA and VRE. It can be used on a variety of wounds, including:

• Pressure ulcers
• Venous stasis ulcers
• Radiation burns*
• Orthopedic wounds
• Arterial ulcers
• Donor sites
• Lacerations/abrasions
• Post-op incisions

*Hydrofera Blue is not indicated for the treatment of third-degree burns.

Advantages of Hydrofera Blue

Hydrofera Blue dressings are highly absorptive and can be used on wounds which are draining heavily. They are also very durable and can be compressed to 1/10th their normal size. They are quite soft and unlikely to damage or irritate healthy tissue. Hydrofera Blue is biocompatible and is highly resistant to chemicals.

How to use Hydrofera Blue dressings

The dressing should be wet with sterile normal saline or sterile water. Squeeze the dressing and leave some fluid in for drier wounds; for heavily exudating wounds, squeeze the dressing until it is almost dry. Position the dressing so that it is in contact with the wound. Hydrofera Blue may be used as a packing or as a wound cover, overlapping the edges of the wound by at least 1 inch.

It is important to make sure that the dressing does not completely dry out. The dressing should be changed every one to three days, or when the area of dressing over the wound becomes saturated. Also, if the dressing turns white, this indicates that it has used all its antimicrobial substance, and the dressing should be changed.

Cover Dressings

Because it is so important to ensure that the Hydrofera Blue dressing does not dry out, care should be taken to choose an appropriate cover dressing:

If the wound bed is dry, a cover dressing which prevents the wicking away of moisture should be chosen. Good examples of appropriate cover dressings may include hydrocolloids, adhesive foams, film dressings, or composite dressings.

If the wound bed is draining heavily, a dressing which will absorb this excess moisture should be chosen. ABD pads, foam dressings and composites may be used to serve this purpose. When the outer dressings are soaked, they should be removed, but the Hydrofera Blue dressing may be left in place until it changes color to white, at which time it should be changed.

Hydrofera Blue is a good multi-purpose dressing that can be used to treat a variety of wounds and is effective against a variety of microbes, including VRE and MRSA. The main components, Gentian Violet and Methylene Blue, have been used for many years and have proven to be safe. A major advantage of the dressing is its ability to handle large amounts of exudate, its durability, and its ability to conform to virtually any wound bed size or shape.

If you are interested in learning more about wound care management, or are ready to take the next step in becoming a certified wound care specialist, please contact us for more information. Woundeducators.com is dedicated to bringing you the most current information in wound care available.

Chronic wounds often require that more than one agent be used to treat the wound, depending on the stage of wound healing. You might often hear the term “bacterial load” to denote the amount of bacteria present in and on a wound. Bacterial load can have a deleterious effect on wound healing. All chronic wounds are believed to be contaminated to some degree with bacteria.  Depending on the amount of bacteria present, wounds may be classified as:

• Contaminated
• Colonized
• Critically colonized
• Infected

The first two categories, contamination and colonization, are not treated routinely with antibiotics. Wounds that are critically colonized should be treated, or they may progress to the infected stage. Wounds in the infected stage usually show all the classic signs and symptoms of infection; that is, erythema, edema, increased odour and pain, a rise in white blood cell count and a rise in temperature.  It is important to note that an infection may be clinically "silent" or unapparent.  Individuals who are immunocompromised or who have inadequate perfusion to the involved area are not only at greater risk for infection but also less likely to exhibit the classic signs of infection (Myers, Betsy, 2008).

What is Polyhexamethylene Biguanide?

PHMB is a commonly used antiseptic, and can be found in such substances as perioperative cleaning products, contact lens cleaning solutions, swimming pool cleaners, and the like. In-vivo and in-vitro studies have shown the safety and effectiveness of PHMB. PHMB interacts with the surface of the bacteria, and then is transferred to the bacteria’s inner cytoplasm and the cytoplasm membrane and eventually causes cell death.

There are several products commercially available which contain PHMB:

• Kerlix AMD99
• Excilon AMD99
• Telfa AMD99
• Xcell AE Cellulose Wound Dressing

Such products are intended for use on partial-and-full thickness wounds. Advantages of these dressings are that  they:

• absorb wound exudate
• support autolytic debridement of non-viable tissue
• provide a moist wound bed
• reduce pain

In addition, PHMB has been shown to be effective against MRSA, Enterococcus faecalis, Candida albicans, Eschirichia coli, and Bacillus subtilis. Polyhexamethylene biguanide (PHMB) has been studied in recent literature and no evidence of resistance to PHMB has been observed.

Cost-Effectiveness of PHMD

Estimated costs associated with treating chronic wounds are estimated to be around $40,000.00, including the costs of supplies and services. Any delay in wound healing, such as occurs when wounds become infected, will increase the cost associated with care. Studies have shown that the cost of PHMD is similar to that of other advanced dressings.

“Currently, PHMB does not have a history of resistance or cytotoxicity, has demonstrated promotion of healing, and may play a new and important role as an antimicrobial agent in dressings” (Cavorsi, Lee, & Mulder, 2007).

Polyhexamethylene biguanide is one of a series of wound care treatments we are happy to present you with at WoundEducators.com. If you are interested in taking the next step and becoming wound care certified, please contact us.
 

Iodine has long been in use as an antibacterial agent and a skin disinfectant. It was discovered in 1811, and gained widespread popularity during the American Civil War, where it was used liberally to treat the wounds of soldiers. In its original form, iodine caused pain and irritation when applied to wounds, it has been shown to impair the function of cells involved in wound healing, and it also had the unfortunate side effect of skin discoloration.

Since the late 1940’s, newer, safer, and less painful formulations of iodine in the form of iodophors have come into use. These products release sustained low levels of iodine, which bind to proteins, fatty acids, and nucleotides. These products have a broad spectrum of activity against bacteria, mycobacterium, fungi, and protozoa.

Cadexomer Iodine

Cadexomer iodine is a slow release antimicrobial which has the capability to absorb excess wound exudate while maintaining a sustained level of iodine in the wound bed. Cadexomer iodine is available both as a dressing and as an ointment. In studies it has been shown to be effective in reducing counts of MRSA (methicillin-resistant staphylococcus aureus) and Pseudomonas aeruginosa. It is estimated that 1 gram of Cadexomer iodine can absorb as much as 7 ml of fluid. The iodine is slowly released as the iodine is absorbed, which helps to reduce the bacterial load while simultaneously debriding the wound. It requires moisture to be activated.  Unlike povidone iodine dressings which release iodine immediately upon application, the sustained release of iodine from cadexomer iodine dressings does not cause cytotoxic effects.

Potential Contraindications

Studies have shown that cadexomer iodine is effective in healing chronic ulcers; however, one of the serious potential side effects of using iodine for the treatment of wounds is that there is the potential for the absorption of iodine. For this reason, thyroid function should be monitored in patients who use this therapy for extended periods of time. In addition, iodine can interact negatively with lithium, and should be used with caution in patients who are on lithium concurrently. Iodine should not be used at the same time as mercurial antiseptics, such as mercurochrome.

Given the growing concern over the rise of antibiotic-resistant organisms, cadexomer iodine is an effective alternative for the treatment of chronic wounds. Reports of resistance to iodine are scarce, despite the fact that iodine has been in use for over 150 years. Cadexomer iodine can be safely used on most patients (providing they are not sensitive to iodine itself) and provides good coverage of bacteria, mycobacterium, fungi, and protozoa, as well as being effective against MRSA.

Woundeducators.com strives to bring you the most current knowledge in the field of wound care management. Interested in achieving wound care certification in this growing field? Please contact us for further information or if we can answer any questions in regards to how you can enhance your career in this exciting and rapidly-expanding field.
 

The use of silver in wound care has a long history. A recent resurgence in interest in silver dressings as antiseptic agents has come about, largely due to an increase in antimicrobial-resistant organisms such as MRSA (methicillin-resistant staphylococcus aureus).

What is silver’s mechanism of action?
Silver is effective as an antimicrobial because it binds to and destroys bacteria cells at multiple sites. This ability to bind to several sites is the main reason why bacterial resistance to silver is rare, making silver an attractive option.  When the silver cation binds to proteins in the bacteria, the following can result:

• The protein structure is altered, causing structural and functional changes in the cell
• The bacterial cell wall can rupture, causing its contents to leak out, leading to cell death
• The bacteria is prevented from carrying out functions necessary for its survival, such as respiration and taking in nutrients, leading to cell death
• Antibiotics usually only have one method of killing bacteria (i.e. preventing replication) while silver has several methods of killing bacteria.

What types of silver dressings are available?
Silver dressings are commercially available in several forms. The main difference in these dressings is in how much silver they contain and how quickly they release the silver cation. At present silver dressings are found in the following forms:

• Films
• Foams
• Alginates 
• Hydrogels
• Hydrocolloids

The form in which you choose to deliver silver to the wound will depend on the type of wound, where it is located, and the amount of drainage present.

When should I use silver?
Dressings containing silver may be appropriate for short-term use on wounds that are critically colonized or infected.  You should be cautious about using silver for wounds that show signs of cellulitis or a systemic infection, wounds that are colonized with fungus, in clients with interstitial nephritis or leucopoenia, and when signs of possible side effects are present, such as erythema multiforme. Silver should not be used solely to treat an infection, but as an adjunct to help decrease the number of bacteria on the surface of a wound. Keep in mind that using more silver is not necessarily better, as silver has been found to be cytotoxic to fibroblasts and single layers of epithelial cells in vitro as well and retards wound epithelialization in vivo.  Use dressings with the least amount of silver necessary to “get the job done”. Note that there are two substances that should not be used in conjunction with silver: Saline- Saline will react with the silver cation to form silver chloride crystals, consequently decreasing the amount of silver released. This is important to know, as many times saline is used as a cleansing agent during dressing changes. Papain-urea deriding ointment- The ointment will be deactivated by the silver, thus rendering it useless as a debriding agent. In addition, silver dressings must be removed if a patient is to undergo an MRI. They should be discontinued once wound bioburden is controlled and wound healing progresses. Silver dressings should also be discontinued, and alternate treatments initiated, if no improvements in wound status are noted after 1 or 2 weeks of use. Silver is making a comeback as a treatment option to help decrease bacterial loads in wounds. Although it has many advantages, silver also has its drawbacks. Woundeducators.com strives to bring you the latest in wound care treatment to keep you informed in today’s competitive and changing world. If you are interested in learning more about this topic, or others like it, or are interested in obtaining wound care certification, contact us today.