Appropriate use of silver dressings

Transcription

1 Appropriate use of silver dressings David Keast, Center Director, Aging Rehabilitation and Geriatric Care Research Centre, St Joseph s Parkwood Hospital, London, Ontario, Canada

2 Role of antimicrobial dressings The main roles for antimicrobial dressings, such those containing silver, are to: reduce bioburden in wounds that are infected or are being prevented from healing by microorganisms act as an antimicrobial barrier Most healthcare practitioners rely on signs and symptoms to diagnose increase bioburden in wounds

3 Reducing bioburden Bacteria cause a continuum of effects These may be localised (covert or overt), spread into nearby tissues or cause systemic disease

4 Signs of increased bioburden In chronic wounds, the classical signs of infection (pain, heat, swelling, redness and loss of function) may not be present

5 Indications for silver dressings Silver dressings may be used on wounds that present with localised (covert or overt), spreading or systemic infection, eg: acute wounds (eg traumatic wounds, including burns, and surgical wounds) chronic wounds The diagnosis and rationale for the use of a silver dressing should be documented in the patients healthcare records Manufacturer s recommendations for indications, contraindications, wound cleansing and method of dressing application should be followed

6 When not to use silver dressings In the absence of localised, spreading or systemic infection Clean surgical wounds or small acute wounds at low risk of infection Chronic wounds healing as expected Sensitivity to silver or any of the dressing s components Wounds undergoing enzymatic debridement Pregnancy and lactation When contraindicated by the manufacturer of the silver dressing being considered

7 The two week challenge The consensus group recommended that first two weeks of treatment with a silver dressing can be seen as a challenge period during which the efficacy of the silver dressing can be assessed 1 Silver dressings should be used in the context of accepted standard wound care which involves holistic management of the patient and wound, management of underlying comorbidities, and wound bed preparation

8 The two week challenge If after two weeks: there is improvement in the wound but continuing signs of infection, it may be justifiable to continue the silver dressing the wound has improved and there are no signs of infection, the dressing should be discontinued there is no improvement consideration should be given to changing to a dressing containing an different antimicrobial agent and the patient reassessed for signs of systemic infection and untreated co-morbidities

9 Prophylactic use Antimicrobial dressings such as silver dressing may be used as a barrier to microorganisms in wounds at high risk of infection or re-infection There may also be a role for antimicrobial dressings in preventing entry of bacteria to medical device entry/exit sites When a silver dressing is used for prophylaxis, the rationale should be fully documented in the patient s health records and the use of the dressing should reviewed regularly

10 Tip for using silver dressings Conduct a comprehensive assessment before use Document the rationale for using a silver dressing Choose the silver dressing on the basis of patient and wound needs For infected wounds, initial use should be for a two week challenge Use within an appropriate management protocol Follow manufacturers instructions Use with caution in children and very large wounds Be aware that dressings containing SSD have different contraindications from those containing other forms of silver

11 References 1. International consensus. Appropriate use of silver dressings in wounds. An expert working group consensus. London: Wounds International, 2012.