appropriate use of silver dressings in wounds - Systagenix

Table 2 | ContinuedWound type Product(s) Reference OutcomesENTRY/EXIT SITESVascularcatheter sitesSubclaviancatheter entrysitesArglaes (silver filmdressing) versusTegaderm (film dressing)(n=31)Silver-impregnatedcollagen cuff versussemiocclusive dressingversus collodion (n=50)Madeo M, et al.Intensive Crit Care Nurs1998; 14(4): 187-91Babycos CR, et al. JParenter Enteral Nutr1993; 17(1): 61-63No statistical difference was found in bacterial growth at the insertion site or on the cathetertips between the two dressingsThere was no statistical difference in insertion site or catheter-related sepsis between thethree groupsCHRONIC WOUNDSWound type Product(s) Reference OutcomesPRESSURE ULCERSPressure ulcers(grades III andIV)LEG ULCERSVenous legulcers at risk ofinfectionInfected venousleg ulcerswith signs ofinflammationSilver mesh dressing(Tegaderm) versus SSD(n=40)AQUACEL Ag for 4weeks then AQUACELfor 4 weeks versusUrgotul Silver for 4 weeksfollowed by Urgotul for 4weeks (n=281)Contreet Ag (silver foam)versus Biatain (foam) for9 weeks (n=42)Chuangsuwanich A,et al. J Med Assoc Thai2011; 94(5): 559-65Harding K, et al.Int Wound J 2011;doi: 10.1111/j.1742-481X.2011.00881.xDimakakos E, et al.Wounds 2009; 21(1):4-8After 8 weeks of treatment, the mean healing rate and percentage reduction in PUSH scorewere higher in the silver dressing group than in the SSD group, although the difference wasnot statistically significantThe estimated average cost of treatment was significantly lower for the silver dressing thanfor SSD (p6 weeksChronic venousleg ulcers withsigns of criticalcolonisationCriticallycolonisedvenous legulcers withdelayed healingChronic venousor mixedvenous/arterialleg ulcerswith criticalcolonisationVenous legulcersSilver dressing chosen byclinician versus non-silverlow adherence dressingfor 12 weeks (n=213)VULCAN studyRestore Contact LayerSilver for 4 weeksfollowed by RestoreContact Layer (neutralcontact layer) for 4weeks versus RestoreContact Layer for 8weeks (n=102)Contreet Foam (silvercontainingfoam) versusALLEVYN Hydrocellular(foam) for 4 weeks(n=129)Silver foam dressingversus foam dressing for4 weeks (n=109)Activated charcoal silverimpregnated dressingversus non-silvercontaining therapies for 6weeks (n=38)Michaels JA, et al.Br J Surg 2009; 96:1147-56Lazareth I, et al.Wounds 2008; 20(6):158-66Jørgensen B, et al. IntWound J 2005; 2(1):64-73Romanelli M and PriceP. J Am Acad Dermatol2005; 52: 21Wunderlich U andOrfanos OE. Hautarzt1991; 42(7): 446-50There was no difference between the dressings in the proportion of ulcers healed at 12 weeks(59.6% in silver group; 56.7% in control group)There was no difference between groups in median time to healing or in health-related qualityof life scoresThe significantly higher cost for patients treated with antimicrobial dressings was partly dueto increased frequency of dressing change and partly due to cost of the dressingsAt the end of 8 weeks, reduction of surface area and clinical score were significantly greater inthe silver group (p=0.023)Median closure rate was significantly higher at week 4 (p=0.009) for the silver group, andremained so in the silver group up to week 8 after switching to the non-silver contact layer(p=0.001)At weeks 4 and 8 significantly more wounds in the silver group had no pre-specified signs ofheavy bacterial colonisation (week 4 p=0.0097; week 8 p=0.044)After 4 weeks there was a significantly greater reduction in ulcer area in the silver groupversus the control groupAfter 1 and 4 weeks, significantly fewer patients had wound odour in the silver group than inthe control groupAt final visit, there were significantly fewer leakages with the silver dressing than with thecontrol dressingAfter 1 week, odour perceived by the patient and by study personnel was reduced to asignificantly greater extent in the silver group (p