17.14 Antimicrobial dressings

For additional information see Infected Wounds.

The major roles for antimicrobial dressings in the management of wounds are to:

  • reduce bioburden in acute or chronic wounds that are infected or are being prevented from healing by microorganisms
  • act as an antimicrobial barrier for acute or chronic wounds at high risk of infection or re-infection

It is not appropriate to use antimicrobial dressings:

  • In the absence of signs of localised (overt or covert), spreading or systemic infection
  • Clean surgical wounds at low risk of infection e.g. donor sites, closed surgical wounds
  • Chronic wounds healing as expected according to co-morbidities and age
  • Small acute wounds at low risk of infection
  • Patients who are sensitive to any of the dressing components
  • Wounds being treated with enzymatic debridement
  • During pregnancy or lactation
  • When contraindicated by the manufacturer, for example, some manufacturers recommend that their silver dressings are not used during magnetic resonance imaging (MRI), or on/near body sites undergoing radiotherapy

The Two Week 'Challenge'

It is recommended that antimicrobial dressings should be used for two weeks initially and then the wound, the patient and the management approach should be re-evaluated

Honey

Practitioners should check that patients are not allergic to bee stings as the use of honey can cause an anaphylactic reaction. In the event of an anaphylactic reaction, staff must take immediate steps to reduce harm to the patient in accordance with the Anaphylaxis Policy and Protocol. Once the initial emergency is over staff should report to the MHRA using the yellow reporting card and identify in patient's records and inform the medical practitioner of the reaction.

The honey products in this section all have similar anti-microbial and debriding properties and clinical judgment should be used to determine the correct product for wound.

  • For low to medium exudating wounds.
  • High exudating wounds which need packing when there is a colonization or critical colonization wound.
  • Not to be used as a normal packing or prophylactically for possible wound infection.
  • Mainly used on crater type wounds with large amounts of slough and can be left in place for 3 – 4 days.

Sheet dressings

Actilite®
  • Gauze 5cm x 5cm (£0.57), 10cm x 10cm (£0.98), 10cm x 20cm (£1.90)
Medihoney®
  • Tulle 10cm x 10cm (£2.98)
  • Gel sheet 5cm x 5cm (£1.75), 10cm x 10cm (£4.20)
  • Apinate® 5cm x 5cm (£2.00), 10cm x 10cm (£3.40)
Medihoney® HCS
  • 6cm x 6cm (£2.24), 11cm x 11cm (£4.47)
  • With adhesive border 11cm x 11cm (£3.06), 15cm x 15cm (£5.79)

Honey-based topical application

These products will help in autolytic debridement, reduce odour and facilitate good wound bed preparation.

Activon® Tube
  • 100% Medical Grade Manuka Honey 25g (£2.05)

Notes

  1. Activon® Tube is a single patient use only product, once opened use within 90 days
  2. Do not use on patients with extreme sensitivity to honey, bee stings or bee products

Iodine

Avoid if iodine sensitive. There is a risk of systemic absorption, do not use in pregnancy or lactating women. Use caution if the patient has thyroid disorder.

Iodine should not be used in infants under 6 months of age without medical supervision. Do not use if the patient has severely impaired renal function.

Treatment should not exceed 3 months continuous use.

Used for diabetic foot ulcers.

Inadine®
  • 5cm x 5cm (£0.33), 9.5cm x 9.5cm (£0.49)

Notes

  1. Inadine® is rapidly deactivated by wound exudate and should not be used with hydrogels.
Iodoflex®
  • Cadexomer-iodine paste 0.9%: 5g (£4.13), 10g (£8.25), 17g (£13.06)
Iodosorb®
  • Cadexomer-iodine ointment 0.9%: 10g (£4.56), 20g (£9.12)

Silver

Silver dressings should only be considered for critically colonised and infected wounds.

If no improvement to the wound is noted within 2 weeks then the silver products should be replaced by a non-silver product.

Silver dressings for wounds with little or no exudate.

Aquacel® Ag + Extra
  • 5cm x 5cm (£1.95), 10cm x 10cm (£4.64), 15cm x 15cm (£8.75)

Other antimicrobials

Cutimed® Sorbact
  • Ribbon 2cm x 50cm (£4.03), 5cm x 200cm (£7.95)
  • Swabs 4 x 6cm (£1.65)
  • Gel dressing 7.5cm x 7.5cm (£2.70), 7.5cm x 15cm (£4.56)

Notes

  1. Antimicrobial wound dressing
  2. Bacteria are attracted to the dressing and become irreversibly bound to it. On removal of dressing bacteria are also removed.

Wound dressings containing PHMB (polyhexamethylene biguanide) have been shown to reduce microbial counts within the wound and are indicated for the treatment of critically colonised or infected wounds.

The use of PHMB has specific contraindications , PHMB must not be used:

  • For peritoneal lavage or for antiseptic/antimicrobial joint lavage (cartilage toxicity)
  • In applications involving any part of the central nervous system, including the meninges, and intralumbal applications
  • For applications involving the middle or inner ear, or for intraocular applications
  • During pregnancy
  • In patients allergic to PHMB
Kendall AMD®
  • Foam dressing without adhesive border 5cm x 5cm (£2.50), 8.8cm x 7.5cm (fenestrated) (£4.23), 10cm x 10cm (£4.71), 15cm x 15cm (£8.92), 10cm x 20cm (£8.92), 20cm x 20cm (£13.07)

Notes

  1. Contains PHMB
  2. Moderately exudating wounds
  3. Fenestrated dressings can be used around PEG/catheter/tracheostomy sites where critically colonising wounds are suspected
Suprasorb® X + PHMB
  • 5cm x 5cm (£2.57), 9cm x 9cm (£5.12), 14cm x 20cm (£11.64)

Notes

  1. Shown to kill multi resistant pathogens including MRSA and VRE
  2. Light to moderately exudating wounds
  3. Can be used on both superficial and deep critically colonised wounds.
  4. Can have a cooling effect on the wound
Prontosan® Irrigation fluid and gel
  • Irrigation fluid 350ml bottle (£4.78)
  • Irrigation fluid 40ml pod (£14.18 = 24 pods)
  • Gel 30ml (£6.38)

Notes

  1. Wound irrigation solution and gel for cleansing, moisturising and decontamination of acute and chronic wounds to aid in the efficient wound bed preparation
  2. Removes wound debris and biofilms
  3. Contains PHMB

 

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