Reduce the wound’s bioburden Removal of necrotic tissue, pus and slough, all of which can act as a growth media for micro-organisms, will promote healing.


The bacterial load of the wound should also be reduced through effective and personal hygiene and preventative measures to maximise the effects of the antimicrobial dressing. This can be done through the use of appropriate infection control procedures and protecting the wound with an appropriate dressing.


Other than cases of peripheral ischaemia where a positive decision has been taken to ‘mummify’ a digit or wound, it is not helpful to place an antimicrobial dressing onto a wound that is covered in dry eschar — such tissue would need to be debrided before the antimicrobial dressing could have a therapeutic effect.


Wound cleansing at each dressing change by irrigation should effectively remove debris and micro-organisms without damaging the wound or driving micro-organisms into the tissues.


The importance of these factors should not be overlooked. Indeed, in some circumstances, particularly surgical wounds, infection control measures in addition to cleansing, debridement and drainage may be sufficient to reduce bacterial load to a level where healing can take place1


.


Current issues surrounding the use of antimicrobial dressings The publication of a study comparing silver-containing dressings with non-medicated dressings in venous ulcers19 and subsequent reviews20, 21


, , has resulted in some people


mistakenly presuming that antimicrobial dressings are not suitable for treatment of critical colonisation/local infection22


,


and has had repercussions on their availability and use in some areas of clinical practice. The lack of evidence from randomised controlled trials (RCTs) concerning antimicrobial dressings in general might also restrict their use.


Antimicrobial wound dressings, which are classed as medical devices, should not be judged as pharmaceuticals and other levels of evidence should be considered to guide their use in practice23, 24, 25


.


The use of antimicrobial dressings such as silver is a key component of the management of patients with signs of wound infection and without the use of these products, patients may be put at risk14


.


Improvement in diagnosing infection and recognising patients at risk will have important implications in knowing when intervention is needed and is an important part of future developments.


Laboratory and clinical studies are ongoing and required to better understand which agent to use when and with what delivery system to maximise the benefits of the antiseptic agent used.


For now, clinicians must draw on available literature and be vigilant in adhering to local protocols to avoid unnecessary and prolonged treatment.


By using antimicrobial dressings to stop local infection spreading, unnecessary complications and costs are prevented. The most obvious example being a reduction in hospitalisation.


It is important not to use these products when infection is not present, or where there is no significant clinical risk of infection14


since some antimicrobial dressings can result in damage to healthy tissue20, 21


.


Cost-effectiveness In vulnerable and critically ill patients, infection is obviously associated with increased risk of morbidity and mortality. It is possible to show that the costs of infections such as surgical site infections (SSIs) and cellulitis have a heavy financial and social burden and impact greatly on nurses’ time, costs of long-term treatment and hospital stays27, 28, 29


.


Although published studies on cost-effectiveness are currently lacking, clinicians are increasingly aware of the potential of antimicrobial dressings to reduce costs of care26


.


Future of antimicrobial dressings The current controversy surrounding the use of antimicrobial dressings such as silver has demonstrated the need for a framework for antimicrobial dressing usage. Work is ongoing aimed at developing and integrating better strategies to facilitate appropriate and judicious use of topical antimicrobial dressings1, 14 institute.com).


(see also www.woundinfection- ,


. A lack of knowledge regarding the use of this product


group could put patients at risk of delayed healing and untreated local infection which could progress to systemic sepsis26


Supported by an educational grant from Smith & Nephew. The views expressed in this ‘Made Easy’ section do not necessarily reflect those of Smith & Nephew.


S.5 © Wounds International 2011


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