Wound care
damage. They also interact with enzymes and proteins, disrupting essential metabolic processes preventing cell division. Additionally, silver ions can generate reactive oxygen species (ROS), leading to oxidative stress and further cellular damage. Due to its multi-targeted mechanism, silver is highly effective against a broad spectrum of microorganisms9
and it
was thought that the likelihood of resistance development was low. Its recent surge in use reflects a wider shift in infection management. As multidrug-resistant bacteria have become more common, clinicians have increasingly turned to topical antimicrobial agents when systemic antibiotics are ineffective, inappropriate or unnecessary.7
Silver, with its
long history and perceived reliability, quickly became among the most frequently used of these agents.
But familiarity has tipped into overuse.
Silver dressings were designed for short- term, targeted application, yet many patients remain on them far beyond the recommended duration, even when signs of infection have resolved or when a non-biocidal option would be safer and more appropriate.2
This overuse
is largely caused by limited time and resources for regular wound review, procurement practices that prioritise familiar products over more appropriate alternatives, and a lack of awareness of the issue at hand.10 This directly undermines the principles of
antimicrobial stewardship. Silver dressings exert selective pressure on the wound microbiome in the same way antimicrobial medicines do, contributing to emerging silver-resistant strains7
. Dinić et al11 found that Staphylococcus
developed resistance to topical antibiotic treatments in 83% of all samples analysed. There is also an opportunity cost. When silver becomes a catch-all response to delayed healing, it can obscure the underlying cause
there may be some level of toxicity associated with the use of these agents, impacting the skin and impairing healing progression.7
wound care with Antimicrobial Stewardship principles, clinicians need to conduct regular routine review of antimicrobial treatment. Frequent comprehensive reassessment of the patient and wound should be undertaken to identify whether changes to management strategies are required.10
Physical-mode technologies: an alternative Over recent years, interest has grown in dressing technologies that manage bacteria without releasing antimicrobial substances; these include DACC technologies. DACC coated dressings have a purely physical mode of action. Bacteria and fungi, due to the lipids within their
To fully align
cell walls, are hydrophobic; they have a ‘fear of water’. In a moist environment, they will move and naturally adhere to other hydrophobic substances to become more stable, as droplets of oil will do in a glass of water. DACC is a fatty acid derivative that conveys a hydrophobic surface.13
When bacteria and
fungi come into contact with the DACC-coated dressings, binding between them occurs through hydrophobic interaction and expulsion of water.12
Husmark et al 14 found that bound
bacteria remained viable but their growth was inhibited and when the dressing was removed, the bound microorganisms were taken away with it. In simple terms, bacteria and fungi bind to the DACC-coated dressing, become inhibited and when the dressing is taken off, they are removed. For clinicians, this offers a clear alternative to
traditional antimicrobial dressings. DACC-coated dressings do not donate an active antimicrobial agent to the wound bed. Without this chemical interaction with host tissue, there are no known contraindications. In addition to this, due to the physical mode of action, AMR is not expected to develop. The AMS Best Practice Statement,10
was recently published by a panel of leading experts in wound care, states that antimicrobial dressings with a physical mode of action should be considered as first line, as they can provide a viable alternative to treat a variety of wounds.
Where bacteria-binding dressings make a difference DACC-coated dressings, like Essity’s Sorbact Technology, can be used for a wide range of wound types, including surgical wounds,
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