Silver dressings for antimicrobial effect

Recommended use of silver dressings

Silver dressings are recommended for acute or chronic wounds with, or at risk of, a high level of bioburden or local infection. The wound infection continuum that describes the stages of impact microbes have on a wound proposes silver dressings for wounds that present localized (overt or covert), spreading or systemic infection.²⁾

It follows that the greater role silver dressings play is to

• reduce bioburden in infected or colonized wounds and to
• act as an antimicrobial barrier for wounds at high risk of infection or re-infection⁴⁾ and not to directly promote the healing of the wound.

Note: The use of silver dressings should also be combined with other aspects of standard wound care protocols such as a holistic assessment of the patient as well as the wound, the management of underlying comorbidities and appropriate wound bed preparation.⁵⁾

The two-week challenge

Antimicrobial dressings were recommended initially for a period of two weeks, to be followed by an extensive assessment of the wound and the patient to adapt further wound management.⁵⁾

These two weeks may be used to ‘challenge’ the efficacy of silver dressings.⁴⁾

If after two weeks

• the wound has improved, but there are still signs of infection, it may be clinically legitimate to continue the application of silver dressings with further regular assessment
• the wound has improved and there aren’t any signs or symptoms of wound infection, the treatment with silver dressing should be stopped
• no improvement in the wound has been observed, the silver-dressing treatment should be stopped and an alternative treatment with a different antimicrobial agent considered.⁴⁾

Choosing a dressing on the basis of patient and wound needs

Askina^® Calgitrol^®, and in general silver dressings, are available in different forms. The choice of dressing depends on the availability of the dressings in the clinical setting and of course on the needs of the wound and the patient, e.g. exudate level, wound depth, need for conformability, odor control, ease of removal , odor control, ease of removal and safety.⁴⁾ 

^References:

^{1) Cutting K, White R, Edmonds M. The safety and efficacy of dressing with silver - addressing clinical concerns. Int Wound J 2007; 4(2): 177-84.}

^{2) International Wound Infection Institute (IWII) Wound infection in clinical practice. Wounds International 2016}

^{3) Figure adapted from Molecular Expressions Web site. Michael Davidson and the Florida State University Research Foundation. https://micro.magnet.fsu.edu/ Accessed January 2012. / Feng QL, Wu J, Chen GQ, Cui FZ, Kim TN, Kim JO. A mechanistic study of the antibacterial effect of silver ions on Escherichia coli and Staphylococcus aureus. J Biomed Mater Res. 2000;52(4):662-668.}

^{4) International consensus. Appropriate use of silver dressings in wounds. An expert working group consensus. London: Wounds International, 2012. Available to download from: www.woundsinternational.com}

^{5) Sibbald RG, Goodman L, Krasner DL, et al. Special considerations in Wound Bed Preparation 2011: An Update. Adv Skin Wound Care 2011; 415-36.}

^{6) Best Practice Statement: The use of topical antiseptic/antimicrobial agents in wound management. 2nd edition. Wounds UK, London: 2011.}

^{7) Review on Antimicrobial Resistance. Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations. Review on AMR, Wellcome Trust, HM Government, 2014. Available at: http://bit.ly/1VOck4o (accessed 31.03.2017)}

^{8) Opasanon S, Magnette A, Meuleneire F, Harding K. Askina® Calgitrol® Made Easy. Wounds International 2012; 3(1). Available from http://www.woundsinternational.com2012}

^{9) Wounds International. Using Askina® Calgitrol® Paste for the treatment of diabetic foot infection: case studies. London: Wounds International 2013. Available from www.woundsinternational.com}

^{10) Bowler P et al (2010) Dressing conformability and silver containing wound dressings. Wounds UK 6(2): 14–20}

^{11) Instruction for use: Askina@ Calgitrol@ Ag, Askina@ Calgitrol@ THIN, Askina@ Calgitrol@ Paste}

^{12) Trial C, Darbas H, Lavigne J-P, Sotto A, Simoneau G, Tillet Y, et al. Assessment of the antimicrobial effectiveness of a new silver alginate wound dressing: a RCT. J Wound Care. 2010 Jan;19(1):20–6.}