Clinicians should remain clinically suspicious of wound infection, particularly in patients at increased risk, and be ready to act quickly to initiate antimicrobial dressings or refer to relevant diagnostic or clinical services.


What factors should be considered when selecting an antimicrobial dressing? Once the need for topical antimicrobial dressings has been identified, it is important to select a product that provides optimum conditions to support healing12


Figure 1 Simple checklist before the selection and use of antimicrobial dressings.


Why is an antimicrobial dressing required? Choose one of the following: n


Prevention in patient at risk of infection n n n


Treatment of critical colonisation/covert infection Note: If for non-healing wound, have other causes been excluded?


Treatment of overt infection, consider using in conjunction with systemic antibiotics


Treatment of spreading infection in conjunction with systemic antibiotics


. All of


the antimicrobial products available have different physical properties, such as the level of antimicrobial they release, the duration of effective action, the carrier dressing’s ability to handle different volumes of exudate, or manage odour or pain. Therefore, specific products should be chosen to reflect the overall treatment requirements of the wound following thorough wound assessment. Clinical condition, comorbidities, personal circumstances, preferences and expectations of the patient should also influence choice14, 15, 16


. The properties of an


ideal antimicrobial dressing are outlined in Box 3,while Figure 1 details a checklist of factors to be considered before the selection and use of antimicrobial dressings.


An understanding of how the product works and its efficacy and safety is important, as well as knowledge of the costs involved and the dressing’s availability. The clinical problem on page 4 gives an example of the use of an antimicrobial dressing in clinical practice.


Box 3 Properties of the ideal antimicrobial dressing (adapted from Vowden and Cooper, 200615


) n


Broad spectrum of activity against micro-organisms, including resistant strains of bacteria


n Bacteriocidal not just bacteriostatic n Rapid but sustained activity n


n n n


Has the wound been effectively debrided, cleaned and exudate controlled?


Is the antimicrobial agent (e.g. silver, iodine) chosen likely to be effective against the known or suspected mirco-organisms?


Are the technical properties of the dressing/delivery system appropriate for managing the current state of the wound?


Is there laboratory or clinical evidence showing that the dressing/ delivery system provides a sufficient amount of the agent to the wound bed to be effective?


Are there any contraindications such as known allergies to any of the dressing’s components?


Is there a clear plan to review treatment and discontinue antimicrobial therapy when no longer required?


When should antimicrobial therapy be started and stopped? The use of antimicrobial dressings in wound management is


recommended for: n


n n


Prevention of infection in patients at increased risk of wound infection


Treatment of localised wound infection


Local treatment of wound infection in cases of spreading or systemic wound infection in conjunction with systemic antibiotics.


Suitable for use on broken skin/mucus membrane Non-irritant and non-toxic to tissue/environment Easily soluble in a non-toxic carrier


Not inhibited by body fluids, wound exudate or biofilms n Stable, easy to use and store


n


Assists in wound bed preparation, e.g. debridement/ moisture management


n Cost-effective n Reduces malodour


n Conforms to site and shape of the wound n Satisfies patient and clinician expectations


For most wounds antimicrobial dressings can be stopped at this stage, but careful observation of the wound should continue in case signs of an increasing bacterial load recur.


S.3


Once started, the effect of antimicrobial dressings on the wound must be closely monitored. A failure to respond or a further deterioration of the wound will indicate the need for a full reassessment to exclude contributing causes other than infection and may indicate the need for an alternative approach or the addition of systemic therapy.


For wounds that improve, antimicrobial dressings should be continued for 14–21 days14


antimicrobial therapy should be re-assessed. , at which time the need for further


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