WOUND MANAGEMENT FORMULARY - NHS North Somerset

Appendix Two
Using Antimicrobials in Wound Care
Signs of critical colonisation
Delayed healing (compared with
normal rate for site/condition)
Wound bed deterioration increase in
slough or necrosis
Wound has become malodorous
Increase in pain/discomfort
Increase in exudate and change of
colour/consistency
Wound static or deteriorating
The patient is not generally unwell
Use first line antimicrobial for
two weeks.
Silvercell or Iodofex/iodosorb
(mod-high exudate) Urgotul
SSD (low exudates)
Signs of wound infection
Wound bed deterioration increase in slough
and/or necrosis
Increased pain.
Wound has become malodorous.
Increase in exudates, which can be purulent
or contain blood.
Friable bleeding granulation tissue.
Bridging of the epithelium
Pockets of pus at the base of the wound
Spreading erythema
Patient usually feels unwell
Swab wound
Commence antibiotic therapy for
at least 10 days duration.
Use first line antimicrobial for two
weeks.
Silvercell or Iodofex/iodosorb
(mod-high exudates) Urgotul SSD
(low exudates)
Evaluate outcome of treatment
Signs and symptoms
resolved.
Stop Antimicrobials
Signs and symptoms
reduced
Continue for two more
weeks and then stop
Signs and symptoms
unchanged.
Stop
antimicrobials
Reassess patient
Seek advice from
specialist nurse if
required
Wounds that respond to silver but deteriorate once silver is stopped
should be treated with Cutimed Sorbact providing exudate is moderate.
Please seek tissue viability support for MRSA infected wounds with low
exudate.