17.3.3 Silver

There is a large selection of antimicrobial dressings on the formulary, silver should be considered as a final option.

Antimicrobial dressings containing silver should be used only when infection is suspected as a result of clinical signs or symptoms (BNF).

It is recommended that these dressings should not be used on acute wounds as there is some evidence to suggest they delay wound healing. There is little evidence of the efficacy of silver against anaerobes, although these are often present in chronic wounds.

There is no evidence to support the use of silver dressings under compression bandaging for the healing of venous leg ulcers when compared with non-silver low adherent dressings.

Silver-impregnated dressings should not be used routinely for the management of uncomplicated ulcers.

The two-week challenge

  • It is recommended that silver dressings should be used for no longer than two weeks initially and then the wound, the patient, and the management approach should be re-evaluated
  • If no improvement to the wound is noted within 2 weeks, then the silver products should be replaced by a non-silver product.

Silver ions exert an antimicrobial effect in the presence of wound exudate; the volume of wound exudate as well as the presence of infection should be considered when selecting a silver-containing dressing.

High deposits of silver can have a toxic effect on internal organs and there is evidence for bacterial resistance.

Silver can permanently stain the skin (argyria) and will reduce keratinocyte (skin) production.

Hydrocolloid dressings

For low exuding wounds
UrgoTul Silver

(Non-adherent soft polymer wound contact dressing, with silver)

  • Dressing 10cm x 12cm (£3.34), 15cm x 20cm (£9.45)

Notes

  1. Primary dressing for non to low exuding wounds that show signs and symptoms of infection
  2. Change frequency / wear time = every 7 days for up to 2 weeks
For moderately to highly exuding wounds
Aquacel Ag + Extra

(Soft, sterile non-woven dressing impregnated with silver)

  • Dressing 5cm x 5cm (£2.13), 10cm x 10cm (£5.07), 15cm x 15cm (£9.56), 4cm x 10cm (£3.09), 4cm x 20cm (£4.03), 4cm x 30cm (£6.03), 20cm x 30cm (£23.71)

Notes

  1. Primary dressing for moderately to highly exuding wounds that show signs and symptoms of infection
  2. Change frequency / wear time = every 3 to 4 days for up to 2 weeks
  3. Ensure "Aquacel Ag+ Extra" is written in full when prescribing to ensure correct product is provided to the patient

Low adherence dressings

Acticoat

(Three-layer antimicrobial barrier dressing consisting of a polyester core between low adherent silver-coated high density polyethylene mesh)

  • Dressing 5cm x 5cm (£3.80), 10cm x 10cm (£9.28), 10cm x 20cm (£14.50), 20cm x 40cm (£49.62)

Notes

  1. Used for partial and full-thickness wounds, e.g. burns, donor sites and graft recipient sites, that show signs and symptoms of infection
  2. Change frequency / wear time = every 3 days for up to 2 weeks
Acticoat Flex 3

(Conformable antimicrobial barrier dressing consisting of a polyester core between low adherent silver-coated high density polyethylene mesh)

  • Dressing 5cm x 5cm (£3.84), 10cm x 10cm (£9.38), 10cm x 20cm (£14.66), 20cm x 40cm (£50.17)

Notes

  1. Used for partial and full-thickness wounds, e.g. burns, donor sites and graft recipient sites, that show signs and symptoms of infection
  2. Used when body contour requires a conformable dressing
  3. Change frequency / wear time = every 3 days for up to 2 weeks

Desloughing dressings

UrgoClean Ag

(Sterile absorbent dressing made of polyabsorbent fibres impregnated with silver)

  • Dressing 6cm x 6cm (£2.04), 10cm x 10cm (£4.64), 15cm x 20cm (£8.75)

Notes

  1. Used forwound sites that show signs and symptoms of infection and require debridement
  2. Change frequency / wear time = every 7 days for up to 2 weeks

 

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