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N News Wounds update linical innovations ews Book review Book review


A Closer Look At Silver: A Clinical Information Tool (CIT) To Help You Choose The Right Silver Wound Dressing For Your Patient!


Author: Zena Moore treatment regimen selection is difficult[1]


providing quality wound management services. Whereas this espoused principle may seem relatively straightforward, in reality it is not. A lack of evidence to support dressing use, along with a lack of sustained availability of the right dressing for the right patient, often means . A Closer Look at


T


Silver reviews a clinical information tool (CIT) to provide clear guidance and advice for clinical practice. Since the first use of silver in wound management, the number of products containing silver has risen sharply. Product variety, though welcomed, can cause confusion, especially if there is a lack of clarity regarding the relative merits of one product over another[2]


. The authors here tackle this problem


at the outset, clearly articulating silver’s mode of action and how it works as a bioactive agent against harmful micro- organisms. The key message is that all silver products are not the same; silver exists in several forms, such as silver nitrate, silver chloride, and silver oxysalts. Silver is either ionic (carries a positive electrical charge) or non-ionic and to become biocidal (able to destroy micro-organisms) it must be in ionic form. However, not all silver products have the same bioactivity (the ability to exert an adverse effect on micro-organisms)[3] The authors suggest there are advantages to using products


.


that contain silver compounds with a higher reactivity and oxidation state as in these situations the dressing itself can contain a lower silver content yet still provide an effective biocidal effect. The advantages relate to production costs (less silver = less cost), toxicity (less silver = less risk), and an overall gentler product action (more neutral pH). Understanding how silver dressings work makes product


selection easier. However, an understanding of the importance of assessment, wound bed preparation, and an ability to articulate the key objectives in wound management are also central to success[4]


. The speed of biocidal activity is one key


factor influencing product selection and a useful table is included in the CIT to aid decision making. A unique element of this CIT is the guidance on how to ensure the right products are available in the clinical setting.


26


REVIEWER DETAILS Zena Moore is Professor and Head of Nursing, School of Nursing, Royal College of Surgeons in Ireland, Dublin, Ireland.


Wounds International Vol 5 | Issue 1 | ©Wounds International 2014 | www.woundsinternational.com


he cost-effective, efficient management of individuals with wounds is a key factor in


Editors: Heather Orsted, Carla Spina, Edie Attrell, Chester Ho, Lindsay Kalan, David Keast


Publisher: Exciton


Available at: http://bit.ly/19MICHq


This guidance includes advice on evaluating relevant dressings and the methods available for communicating evaluation outcomes to the appropriate purchasing individuals. Finally, the importance of clinician education is stressed. This


is critical in ensuring adherence to patient safety standards. Wound management occupies a significant part of health


care delivery today and is likely to increase in the future due to predicted changes in population demographics. Silver is one important treatment modality, however, due to the vast array of silver products available, there is some confusion among clinicians surrounding which product to use and when. This CIT addresses this by providing clear guidance and is, therefore, of particular importance to practicing clinicians and will assist in decision making when combined with accurate and ongoing patient and wound assessment. n


References


1. Gottrup et al (2010) Outcomes in controlled and comparitive studies on non-healing wounds: recommendations to improve the quality of evidence in wound management. J Wound Care 19(6): 239–68


2. Ayello E et al (2012) International Consensus. Appropriate Use of Silver Dressings in Wounds. An Expert Working Group Consensus. Available at: http://bit.ly/1lW90yc (accessed 09.01.2014)


3. Bergin S, Wraight P (2006) Silver based wound dressings and topical agents for treating diabetic foot ulcers. Cochrane Database Syst Rev 25(1): CD005082


4. Moore Z (2012) The important role of debridement in wound bed preparation. Wounds International 3(2): 1–4


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