Management of chronic wounds: the role of silver-containing dressings

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Templeton S Management of chronic wounds: the role of silver-containing dressings Figure 4. Protocol 2. Wound meets criteria for use of silver-containing dressing Use silver containing dressing for 2 weeks then reassess wound progress Positive response to silvercontaining dressing No response to silvercontaining dressing. Continue silver dressing for another 2 weeks then reassess wound progress. Cease silver-containing dressing. Reassess. Investigate and treat other possible causes of non-healing. Reassess. Investigate and treat other possible causes of non-healing Cease silver-containing dressing. Resume standard treatment. Reassess wound progress after 1-2 weeks Factors impairing healing unable to be controlled. Consider: Factors impairing healing controlled Wound fails to continue improving or wound deteriorates Continued wound improvement. Continue conventional management regimen and regular reassessment Topical antiseptics or conventional treatment 2 week ‘course’ of silver-containing dressings Primary Intention 177 Vol. 13 No. 4 november 2005
Templeton S provide dressings free of charge to patients, whilst in other States patients must pay for their dressings. Residential aged care facilities and general practitioners do not receive additional funding to support wound dressings. These factors can have considerable influence on which products are available to and chosen by clinicians. Discussion In order to promote cost-effective, evidence based practice, clinicians, researchers and wound management professional bodies need to debate, refine and endorse protocols and guidelines for the use of silver-containing dressings such as those suggested in this paper. At the present time, the explosion in the use of silver-containing dressings is based primarily on company data and marketing, expert opinion and case study reports. However, in a world of shrinking resources and increasing demand and accountability, clinicians cannot base decisions on opinion alone 53 . Standardised treatment protocols can provide clinicians with general guidelines to optimal treatment 48 . Whilst individual patient variance must be taken into account, standardised treatment protocols or guidelines can assist in achieving sustainable quality and cost-effectiveness 53 . Conclusion Wound management in the 21st century will continue to bring technological advances which will undoubtedly radically change the way in which persons with wounds are treated. There are already numerous local and systemic therapies which are greatly improving outcomes and the quality of life for persons living with a wound. Greater understanding of the pathophysiology of the chronic wound and wound bed preparation are bringing about significant clinical changes in practice. The advent of the new generation of antimicrobial dressings has provided clinicians with advanced, yet accessible tools to assist patients with wounds achieve optimal outcomes. However, whilst therapies such as the silver-containing dressings are improving wound healing rates, there are still some important questions which require further research and clarification. The enthusiasm with which silver-containing dressings have been taken up by wound management clinicians is astounding. However, clinicians should be mindful that silver-containing dressings vary considerably in their composition, method of silver delivery and amount of silver delivered. Like any local wound treatment, silvercontaining dressings form only one part of a comprehensive wound management programme which considers the patient from a holistic perspective. Management of chronic wounds: the role of silver-containing dressings References 1. Enoch S & Harding K. Wound bed preparation: the science behind the removal of barriers to healing. WOUNDS 2003; 15:213-229. 2. Moore K. Wound physiology: from healing to chronicity. J Wound Care 2003; (Suppl):2-7. 3. Sibbald R, Orsted H, Schultz GS, Coutts P & Keast D. Preparing the wound bed 2003: Focus on infection and inflammation. Ostomy Wound Manage 2003; 49:24-51. 4. Chin G, Schultz G & Stacey M. Principles of wound bed preparation and their application to the treatment of chronic wounds. Primary Intention 2003; 11:171-182. 5. Schultz GS, Barillo DJ, Mozingo DW & Chin GA. Wound bed preparation and a brief history of TIME. Int Wound J 2004; 1:19-32. 6. Falanga V. Wound bed preparation: science applied to practice. In: European Wound Management Association (EWMA) position document. Wound Bed Preparation in Practice. London: Medical Education Partnership, 2004. 7. Ovington LG. Battling bacterial in wound care. Home Healthc Nurse 2001; 19:622-630. 8. White RJ. The wound infection continuum. In: White RJ (Ed). Trends in Wound Care. UK: Quay Books, 2003. 9. Sibbald RG, Williamson D, Orsted HL, Campbell K, Keast D, Krasner D & Sibbald D. Preparing the wound bed – debridement, bacterial balance and moisture balance. Ostomy Wound Manage 2000; 46:14-35. 10. AWMA (Australian Wound Management Association). Standards for Wound Management. Australian Wound Management Association 2002. 11. Derbyshire A. The use of combination treatments and dressings for a traumatic wound. Br J Nurs 2004; 13:987-993. 12. Cooper R. A review of the evidence for the use of topical antimicrobial agents in wound care. World Wide Wounds 2004; February; http://www. worldwidewounds.com 13. Moffatt C, Morison MJ & Pina E. Wound bed preparation for venous leg ulcers. In: European Wound Management Association (EWMA) position document. Wound Bed Preparation in Practice. London: Medical Education Partnership, London, 2004. 14. Sundberg J & Meller R. A retrospective review of the use of cadexomer iodine in the treatment of chronic wounds. WOUNDS 1997; 9:68-86. 15. Molan PC. Selection of honey for use as an antimicrobial agent. Primary Intention 2000; 8:87-92. 16. Wright JB, Lam K & Burrell RE. Wound management in an era of increasing bacterial antibiotic resistance: a role for topical silver treatment. AJIC 1998; 26:572-577. 17. Lansdown ABG. Silver 1: its antibacterial properties and mechanism of action. J Wound Care 2002; 11:125-129. 18. Lansdown ABG. Silver 2: toxicity in mammals and how its products aid wound repair. J Wound Care 2002a; 11:173-177. 19. Ovington L. The value of silver in wound management. Pod Today 1999; December:59-62. 20. Lansdown ABG. A review of the use of silver in wound care: facts and fallacies. Br J Nursing 2004; (Suppl); S6-S19. 21. Thomas S & McCubbin P. An in vitro analysis of the antimicrobial properties of 10 silver-containing dressings. J Wound Care 2003a; 12:305-308. 22. Burrell RE. Polishing the information on silver (letter to the editor). Ostomy Wound Manage 2003a; 49:10-18. 23. Burrell RE. A scientific perspective on the use of topical silver preparations. Ostomy Wound Manage 2003; 49(Suppl):19-24. Primary Intention 178 Vol. 13 No. 4 november 2005
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