Herefordshire Wound Management Formulary Wye Valley NHS Trust

Herefordshire Wound Management Formulary Wye Valley NHS Trust

Contents Page 3 Introduction 6 Important & further information 7 Wound care objectives 8 Wound formulary Absorbent cellulose 9 Wound formulary Alginate/Hydrofibre 10 Wound formulary Film dressings 11 Wound formulary Foam dressings 12 Wound formulary Foams dressings with silicone & Polyurethane foams 13 Wound formulary Hydrocolloid dressings & Hydrogels 14 Wound formulary IV dressings & Low/non adherent dressings 15 Wound formulary Skin protectants & Soft Cloth 16 Wound formulary Adhesive Tape & Charcoal odour dressings 17-21 Wound formulary Antimicrobial dressings 22 Wound formulary Saline/ Emollients & Soap substitutes 28 Wound formulary Debridement Pads 29 Wound formulary Tubular Bandaging & Retention Bandaging 30 Wound formulary Medicated bandaging & Pressure relieving pads 32- Wound formulary Pathways Next routine review Jan 2020 Page 2 of 2 4

INTRODUCTION This formulary is a revised edition for 2019 2021. It is based on the previous formulary, which was developed by the Herefordshire Tissue Viability Steering Group comprising of representatives from Wye Valley NHS Trust and Herefordshire Clinical Commissioning Group. This formulary has been reviewed by Wye Valley NHS Medicines Management Team, with the support of the Lead Tissue Viability Clinical Nurse Specialists and Procurement. Key Messages There must always be a clear rationale for the choice of dressings Layers of expensive dressings should be avoided The nurse managing the wound should be aware of the total cost of the dressing regimen Dressing choice should cut the frequency of dressing changes, where appropriate Aims Promoting evidence based practice in wound management for patients in Herefordshire To guide practitioners in appropriate dressing choice Standardisation of appropriate practice Cost effectiveness (prices used are Nov 2018 and individual prescribers should be aware of price changes when possible) Dressings are applied to a wound to deliver many benefits: Facilitate rapid and cosmetically acceptable healing Reduce pain Prevent or combat infection Exudate Management Prevent or reduce scar formation Remove or contain odour Provide maximum comfort for the patient These formulary choices are based on performance and stability of both the item and the manufacturing / supplying company, as well as consideration of price. Please order the exact amount of dressings required, and not necessarily the listed pack size. Supplier details and contact numbers can also be obtained from the BNF. Wound healing is a dynamic process and the characteristics of a dressing require by the wound can change as the wound moves through the different phases of the healing process. This means it is important to reassess the wound and dressing regimen regularly and not to order too many dressings at one time. The dressings on the formulary are suitable for the majority of wounds and for each wound stage there are appropriate product choices, to accommodate practitioner s preference. The first choice of dressing should be taken from the formulary. However, where a satisfactory outcome is not achieved, practitioners should discuss care with Tissue Viability and following this, other products may be recommended based on a clear rationale and evidence base. Please Remember Prescribing outside of this formulary must be justified by a specific patient need and this will be monitored by Tissue Viability. Exemption forms must be completed for each occasion a dressing is prescribed off formulary. Exemption forms can be found on the Tissue Viability Intranet Site. Please do not accept samples of dressings to try on patient without the consent of a Tissue Viability Clinical Nurse Specialist. Page 3 of 2 4

Important Information Cutimed Sorbact (DACC-coated antimicrobial dressings) Unlike dressings which depend on antimicrobials or antiseptics to remove bacteria from contaminated and infected wounds, Cutimed Sorbact is the first range of wound dressings to work without a chemically active agent. By the physical principle of hydrophobic interaction, within 30 seconds 1, bacteria and fungi become physically and irreversibly bound to the dressings' specially coated surface of DACC. Therefore, with every dressing change, the bound bacteria and fungi are simply removed from the wound bed 2. The use of Cutimed Sorbact dressings are also not linked to contraindications and side effects that are associated with the use of other antimicrobial dressings. How it works Hydrophobic interaction is a basic physical principle. Hydrophobic substances and organisms attract and bind to each other in an aqueous environment and are held together by the forces of the surrounding water molecules. Cutimed Sorbact dressings are coated with DACC, a hydrophobic fatty acid derivative which gives the dressings their highly hydrophobic properties. In the moist environment of an infected wound, bacteria are attracted to the dressing and become irreversibly bound to it. Pathogenic wound bacteria and fungi also display hydrophobic properties so will readily attach to the dressings 3, 4. Flaminal Forte & Hydro Alginate gel containing two antimicrobial enzymes, glucose oxidase and lactoperoxidase, which exert their effect without damaging healthy skin cells. Debrides the wound and manages moisture balance. Can be used on a wide range of wound types and at every stage of healing Flaminal Forte and Flaminal Hydro should be used for moist wound healing, especially on those wounds where there is the potential for an acquired wound infection Flaminal Forte contains a larger amount of alginate and should be used on moderate to heavily exudating wounds Flaminal Hydro contains less alginate and should be used on light to moderate levels of exudate Page 4 of 2 4

WOUND CARE OBJECTIVE AGENT Rehydrate /debride necrotic tissue Achieve autolysis (de-slough wound) Manage wounds with high exudate Manage wounds with moderate exudate Manage wounds with low exudate Cavity wounds Promote granulation Promote epithelialisation Hydrogel/Hydrocolloid Hydrogel/Hydrocolloid Alginate Foam Hydrocolloid Fibre /High absorbent Super absorbents Alginate Foam Hydrocolloid Transparent Absorbent Acrylic Foam /light Foam Hydrocolloid thin Vapour permeable adherent dressing Low adherent dressing Transparent Absorbent Acrylic Alginate/Hydrocolloid Fibre Foam Hydrocolloid Transparent Absorbent Acrylic Light Foam or Hydrocolloid Ensure maturation /protection /occlusion Manage infection (antimicrobial activity) Manage over granulation Reduce odour Achieve haemostasis Manage radiation burns/skin reactions Manage burns Vapour Permeable Adhesive Film Low Adherent Dressings Iodine/Silver/Honey Haelan tape/cream, must be prescribed by G/P Activated Charcoal Calcium Alginate Fibre Discuss with radiotherapy unit at Wye Valley NHS Trust Hydrocolloid, hydrogel, antimicrobial gel Page 5 of 2 4

Wound Formulary Absorbent Dressings or Pads These are indicated for high-exudate, difficult-to-manage wounds such as weepy legs *. Quite often, part of the management is the use of tertiary large absorbent pads; these are necessary to manage the high levels of exudate. Refer to wound classification chart for wound exudate levels. * Ensure underlying causes of weepy legs are addressed Absorbent Cellulose Name Sizes Costs Use Avoid Application Tips Mesorb (Hospital Use Only) Mesorb (Hospital Use Only) 10x20 1.01 Soft highly absorbent dressing with fluid repellent backing which prevents external contamination of the wound and protects from strike-through. Used on heavily exuding wounds, leaky legs. 30x20 2.57 Flivasorb Flivasorb 10x10cm 10x20cm 0.89 1.05 Superabsorbant wound dressing with nonadherent contact layer.for heavily exuding wounds, leaky legs, lymphorroea etc. Suitable Known sensitivty to any components. Not suitable for lightly exuding wounds or as a primary Flivasorb 20x20cm 1.88 under compression. dressing for a fistula or deep tunnelling wound. Flivasorb 20x30cm 2.37 Page 6 of 2 4

Alginate/Hydrofibre Dressings Suitable for a wide range of wound types including cavities, granulating, small amounts of slough and moderate-to-high levels of exudate (alginate dressings can absorb 15-20 times their weight in fluid). Unsuitable for dry wounds or dry hardened necrotic tissue. Refer to wound classification chart for wound exudate levels. These dressings have haemostatic properties and can help manage wounds with minor bleeding or where blood is present in the exudate. Alginate/Hydrofibrre Name Sizes Costs Use Avoid Application Tips Kerracel 5 x 5cm 0.60 Kerracel 10 x 10cm 1.43 Kerracel 2.5 x 45cm 1.90 Flaminal Hydro 15g tube 7.73 50g tube 25.60 Gelling Fibre dressing for use on moderate and heavily exuding wounds including Leg ulcers, Pressure ulcers, Diabetic foot ulcers, Donor sites, Cavity wounds & Partial thickness burns. KerraCel locks in exudate to protect periwound skin, forms a soothing gel when wet helping maintain a moist healing environment. Suitable for use under compression. KerraCel maintains it's integrity without the need for stitching. Please see antimicrobials for details Can control minor bleeding but not for use on heavily bleeding wounds. Not for use on patients with known allergy or hypersensitivity to carboxymethyl cellulose. Not to be used for surgical implantation. Please see antimicrobials for details Cleanse wound according to local procedures, select appropriate size dressing, apply to wound and cover with appropriate secondary dressing. When using ribbon leave at least 2.5cm outside wound for ease of removal. Check dressing at regular intervals and change according to the clinical condition of the wound. Please see antimicrobials for details Overlap wound margin by approximately 1cm (5cm for partial thickness burns) to allow for shrinkage. For Dry wounds KerraCel can be moistened with saline over the wound area. Please see antimicrobials for details Flaminal Forte 15g tube 7.73 50g tube 25.60 Page 7 of 2 4

Vapour-Permeable Film Dressings Suitable for superficial and shallow wounds, these dressings protect newly epithelialising wounds from trauma. They can also be used as a secondary dressing over gels and alginates to retain them. Care needs to be taken when removing film dressings and many have a specific method to break the adhesive bond to ensure a non-traumatic removal. They also promote pain relief. Refer to wound classification chart for wound exudate levels. Name Sizes Costs Use Avoid Application Tips Opsite Post Op 8.5x9.5 0.89 12x10 1.21 15.5x8.5 1.23 Vapour permeable adhesive film dressing with absorbent pad used for post op and surgical wounds or lightly exuding wounds. Vapour permeable adhesive film dressing with absorbent pad used for post op and surgical wounds or lightly exuding wounds. Vapour permeable adhesive film dressing with absorbent pad used for post op and surgical wounds or lightly exuding wounds. Heavily exuding wounds and beneath compression. Apply directly to the wound. Do not stretch when applying. Showerproof. May be left in place for up to one week. Allows constant monitoring on the wound and peri-wound area. Film Dressings Opsite Flexigrid 10x20 2.03 Vapour permeable adhesive film dressing with absorbent pad used for post op and surgical wounds or lightly exuding wounds. 10x25 2.56 Vapour permeable adhesive film dressing with absorbent pad used for post op and surgical wounds or lightly exuding wounds. 10x35 3.37 Vapour permeable adhesive film dressing with absorbent pad used for post op and surgical wounds or lightly exuding wounds. 6x7 0.41 Transparent adhesive film with a unique wound measurement grid. The film is moisture vapour permeable and has a superior acrylic adhesive. It is widely used for superficial 12x12 1.16 wounds such as shallow pressure sores, minor burns, cuts and abrasions. It can also be used as a secondary dressing and also to provide catheter fixation. 15x20 2.93 Can be used on clinically infected wounds but only if the patient is under medical supervision and the dressing is changed daily and the patient is receiving suitable systemic treatment. Immune-compromised patients and diabetic patients may require extra supervision. Care should be taken with fragile skin. Simple effective application. The flexible carrier enables single handed application allowing the dressing to conform to the contours of the body. Transparency enables accurate positioning over the wound site. Showerproof Good for awkward areas and can cut into strips or shapes for heels, elbows, knees. Unique wound measurement device allows simple but accurate assessments of the healing process. Can be left in place for up to 7 days. Page 8 of 2 4

Foam Dressings Foams can be used on a variety of wounds including pressure ulcers, leg ulcers, burns, surgical wounds etc. They are available with an adhesive border as well as non-adhesive. Some are more suitable for delicate or problematic skin. Foams are best suited for exuding wounds and are not recommended for dry superficial wounds. Refer to wound classification chart for wound exudate levels. Name Sizes Costs Use Avoid Application Tips Allevyn Adhesive 10x10 2.24 12.5x12.5 2.74 17.5x17.5 5.41 Adhesive polyurethane foam dressing with unique triple layer formation designed to manage chronic or acute wounds including full and partial thickness wounds such as pressure ulcers, leg ulcers and diabetic foot ulcers, surgical wounds, first and secondary burns and donor sites. For use on low to moderate exuding wounds. NOT to be used under compression.. Can be left in place for up to 7 days. Can be used in conjunction with gels for necrotic/sloughy wounds. A 2cm overlap around the wound is advisable. Showerproof. Foam Dressings Allevyn Life Non Border Biatain Non Adhesive 10.5x10.5 2.52 10x20 4.03 16x16 4.86 5x7 1.32 10x10 2.40 15x15 4.43 10x20 3.96 20x20 6.75 Non bordered silicone foam dressing with 5 layer structure designed with instant fluid lock technology to absorb and lock in instantly. For use on moderate to heavily exuding wounds. For fragile, sensitive skin. Suitable for use under compression therapy.for use on variety of wounds such as pressure ulcers, leg ulcers, surgical wounds, diabetic foot ulcers, skin tears, fungating wounds, first and second degree burns, Can handle range of viscosities. A soft, conformable polyurethane foam dressing that affectively absorbs & retains wound exudates with a semi- permeable splashproof backing. Suitable for Low to high exuding wounds including leg ulcers, pressure ulcers, second degree burns, donor sites, postoperative wounds, skin abrasions and skin tears. Suitable under compression Do not use with oxidizing agents such as hypochlorite solutions or hydrogen peroxide. Do not use with oxidising solutions such as hypochlorite and hydrogen peroxide Needs a secondary dressing to secure. Can be left in place for up to 7 days depending on level of exudate. Soft low tack silicone aids application. Recommended for use on patients requiring 3 or more dressing changes per week to reduce amount of changes. Needs secondary dressing e.g. retention bandage or tape to secure around edge of dressing. May be left in place for up to 7 days depending on exudate levels Can be cut to fit more awkward areas. Opaque pink film helps prevent bacterial strikethrough and aids in dressing being showerproof. Dressing to be changed when exudate is within 0.5cm of dressing edge. A 1cm overlap around the wound is advisable Biatain Soft Hold 5x7 1.32 10x10 2.61 10x20 3.96 15x15 4.34 As Non adhesive with added gentle tack across 50% of the foam to help provide that 3rd hand when dressing difficult areas. Do not use with oxidising solutions such as hypochlorite and hydrogen peroxide Needs secondary dressing e.g. retention bandage or tape to secure around edge of dressing. May be left in place for up to 7 days depending on exudate levels A 1cm overlap around the wound is advisable Page 9 of 2 4

Foams with Silicone Silicone foams can be used on a variety of wounds including pressure ulcers, leg ulcers, burns, surgical wounds etc. They are designed with a soft silicone adhesive for fragile or delicate skin. Foams are best suited for exuding wounds and are not recommended for dry superficial wounds. Refer to wound classification chart for wound exudate levels. Foam with Silicone Name Sizes Costs Use Avoid Application Tips Allevyn Gentle Border Allevyn Gentle Border Lite Allevyn Life 7.5x7.5 1.53 10x10 2.25 12.5x12.5 2.75 15x15 4.08 Soft silicone foam dressing with highly permeable showerproof film backing designed to suit a variety of wound types such as pressure ulcers, leg ulcers, diabetic foot ulcers, surgical wounds, first and second degree burns, skin tears, donor sites. Suitable for sensitive, fragile skin. For low to moderate exuding wounds. 7.5x7.5 1.42 Soft silicone foam dressing with highly 10x10 2.22 permeable showerproof film backing designed for use on low exuding wounds such as skin tears, chronic and acute wounds, burns. Suitable for fragile and sensitive skin. 10.3x10.3 12.9x12.9 15.4x15.4 1.74 2.55 3.12 Soft silicone 5 layer foam dressing with hydrocelluar foam, hyper-absorber lock away core and masking layer which also acts as a change indicator. Suitable for moderate to heavily exuding wounds such as chronic and acute wounds, pressure ulcers, leg ulcers, diabetic foot ulcers, first and second degree burns, donor sites. Do not use with oxidizing agents such as hypochlorite solutions (eg Eusol) or hydrogen peroxide. Do not use with oxidizing agents such as hypochlorite solutions (eg Eusol) or hydrogen peroxide. Do not use with oxidizing agents such as hypochlorite solutions (eg Eusol) or hydrogen peroxide. Can be left in place for up to 7 days. Up to 7 day wear time. Can be left in place for up to 7 days. Recommended for use on patients requiring 3 or more dressing changes per week to reduce amount of changes. Change when the exudate is within 1.5cm of the edge of the dressing pad. Showerproof. Can be cut to help dress awkward areas. Can be repositioned easily without losing its adherent properties. 2mm foam core allows excellent flexibility. Showerproof. Can be repositioned without losing adhesion. Can be cut to help dress awkward areas. Change when the exudate is within 0.5cm of the edge of the dressing pad. Change when exudate covers more than 50% of the absorbent pad. Do not cut dressing. Page 10 of 2 4

Foams with Polyurethane Foam with Polyurethane Name Sizes Costs Use Avoid Application Tips Polymem (TVN use only) 8x8cm 1.59 10x10cm 2.47 13x13cm 4.12 17x19cm roll 3.10 10x61cm 30.90 Non adhesive polyurethane foam with vapour permeable film backing. For low- moderately exuding wounds including burns, supra pubic sites & radiotherapy induced skin reactions. Avoid use on full thickness burns or with use of solutions containing hypochlorite. Page 11 of 2 4

Hydrocolloids Hydrocolloids can be used on a variety of wounds including pressure ulcers, leg ulcers, surgical wounds and minor burns. They can also be used in granulating, sloughy or necrotic wounds and they can aid in the rehydration and debridement of dry, sloughy and necrotic wounds. Refer to the wound classification chart for wound exudate levels Name Sizes Costs Use Avoid Application Tips Hydrocolliods Comfeel Plus Transparent 5x7 0.68 10x10 1.29 Thin and flexible hydrocolloid dressing used for the treatment of low to non exuding chronic and superficial acute wounds in the final stages of wound healing. Used for superficial burns, superficial partial thickness burns,donor sites, post-operative wounds and skin abrasions. Faster wound healing by sealing and protection of the wound. Patients with known sensitivity to one of the ingredients. When the dressing comes into contact with exudate it forms a viscous gel that absorbs exudate but does not adhere to the wound. Transparency for wound inspection. Ultra thin dressing that makes it very flexible it also offers excellent support for closure of wounds. Bacteria and waterproof top film Hydrogels These can be used on dry and sloughy wounds and are good at hydrating dry wounds by providing a most wound environment. They also promote pain relief. Refer to wound classification chart for wound exudate levels. Name Sizes Costs Use Avoid Application Tips Hydrogels Intrasite Conformable 10x10 1.85 10x20 2.50 Conformable hydrogel dressing which combines the advantages of Intrasite gel with a non woven dressing to aid in the gentle packing of deep, open or undermined wounds. It is suitable for necrotic, sloughy and granulating wounds. For debriding and desloughing wounds. Convenient and ready to use. Known sensitivity to Intrasite Conformable. Should be used with care near the eye. Avoid injestion. Avoid use on cracked nipples. Apply dressing loosely. Cover with secondary dressing. To remove use forceps and irrigate with sterile saline. Recommended the dressing is changed at least every 3 days. Safe to use throughout the wound healing process. Page 12 of 2 4

Intravenous Line Film Dressings Transparent film dressings designed to secure the catheter in challenging I.V. applications Intravenous dressing Name Sizes Costs Use Avoid Application Tips Tegaderm Paediatric IV1610 Tegaderm Peripheral IV1633 Tegaderm Peripheral IV1633p 5x5.7 NA 7x8.5 NA 7x8.5 0.59 Tegaderm Central IV1635 8.5x10.5 1.16 Tegaderm IV Advanced PICC 1689 10x15.5 1.67 Secure and protect intravenous cannula and catheters including: PIVs, CVCs ( Subclavian, Femoral, Jugular, Tunnelled & Implanted), PICCs, Midlines and Paediatric/Neonatal catheters Infected sites. Sites which are bleeding. Do not stretch the dressing during application. Picture-frame delivery makes placement accurate and easy. Additional securement strips and date strip included. ANTT non - touch technique enabled by use of application 'handles' (Advanced only). Use application guides or book training with local representative. Recommend use of waterproof cover over dressing and I.V. site when showering. Low/Non-Adherent Dressings Low or non-adherent dressings can be used on lightly exuding wounds. Some combine an absorbent layer that can be used in moderately to highly exuding wounds. Refer to wound classification chart for wound exudate levels Low/Non-Adherent Dressing Name Sizes Costs Use Avoid Application Tips NA-Ultra Adaptic Touch 9.5x9.5 0.32 19x9.5 0.63 5x7.6 1.13 7.6x11 2.25 12.7x15 4.65 Wound contact layer for use on superficial wounds, beneath multi-layer compression, leg ulcers, pressure ulcers, burns & granulating wounds for use in the management of dry to heavily exuding, partial and full thickness chronic wounds including venous ulcers, pressure ulcers Moderate-heavily exudating wounds -- does not have absorbent properties. Patients with a known sensitivity to silicone or cellulose acetate fabric. Do not cut to fit, overlap onto healthy skin is necessary.secondary dressing is required. Select a size larger than the wound to ensure dressing can be applied to intact skin surrounding the wound margins. Cut to size if necessary. Dressing will not unravel. Use instead of gauze. When adherence is a problem moisten with s sterile saline before removal to minimise trauma. Low risk of sensitisation. Easily applied and removed. Last up to 7 days. Page 13 of 2 4

Skin Protectants Please refer to Skin care pathway Name Sizes Costs Use Avoid Application Tip s Cavilon Cream 28g 3.98 92g 8.12 2g (box of 20) 7.47 Creates an invisible and breathable barrier over the skin to moisturise and protect skin from the irritating effects of incontinence. Cavilon products are contraindicated on infected areas of the skin, eg areas with fungal infection. Use on clean, dry skin. Apply a pea-sized amount at a time to cover the affected area. Apply morning and evening as part of a daily skin care routine - no need to remove between applications. Make sure the skin is dry before application. A little goes a long way. When using correct pea sized amounts, adhesive dressings will still adhere to the skin. Cavilon Spray 28ml 5.98 3ml (box) 8.03 Protects damaged or 'at-risk' skin from urine/faeces, other body fluids, adhesive trauma and friction. Used on both intact and damaged skin. Cavilon products are contraindicated on infected areas of the skin, eg areas with fungal infection. Apply every 48-72 hours to protect Remember F.A. B against incontinence. Peri-wound Friction / Adhesives / protection, apply at every dressing change. Peri-stomal protection, apply at every pouch/application change. Bodily Fluids as a helpful way to remember when to use Cavilon NSBF. Use to protect against medical adhesive related skin injury (MARSI) apply underneath adhesive dressing or tape. 1ml (box) 5.00 Proshield (Specialist use only) 115g 9.94 Skin protectant which helps protect irritated skin and moisturize dry, rough and itchy skin. Helps with effect of incontinence. Patients with known allergy to any of the components of the product. Apply to skin damaged by incontinence. Page 14 of 2 4

Soft Cloth Dressings Absorbent, perforated dressings with adhesive border. The absorbent pad is non adhesive, protecting the wound whilst absorbing drainage. Refer to wound classification chart for wound exudate levels Name Sizes Costs Use Avoid Application Tips Soft cloth dressing Softpore 6x7 0.06 10x10 0.13 10x15 0.20 10x20 0.35 10x25 0.40 10x30 0.49 10x35 0.58 Non-woven fabric dressing with an absorbent pad for low/moderately exuding wounds including post op and surgical wounds, and wounds healing by primary intention Heavily exuding or cavity wounds Apply directly to the wound Shower-proof. Maybe left on for up to one week Tape Tape Name Sizes Costs Use Avoid Application Tips Scanpor 2.5x5 0.68 5x5 1.18 Securing dressings. Skin closure for small incisions. Retaining dressings on joints or awkward body parts Can cause irritant and allergic reactions. Maybe applied directly on to the skin Do not apply under tension as this may apply a tourniquet effect Activated Charcoal Dressings Charcoal Name Sizes Costs Use Avoid Application Tips Clinisorb 10x10 1.91 10x20 2.54 15x25 4.09 Activated charcoal has the ability to absorb volatile molecules from the air such as those which are liberated by a wound that are responsible for odour production It is not intended to be placed in direct contact with the wound, but should be applied over a suitable primary dressing, and held in place with tape or a bandage as appropriate. Once the charcoal cloth comes into contact with exudate, its odour absorbing properties are reduced and a change is recommended. May be cut to fit Both sides of the dressing are identical Indications for use include malodorous exuding wounds such as fungating and/or malignant wounds and also infected wounds. Please note that the charcoal becomes rapidly deactivated in its ability to manage malodour once it becomes wet. Refer to wound classification chart for wound exudate levels Page 15 of 2 4

Anti-Microbial Dressings Anti-microbial dressings should generally be reserved for situations where the wound is critically colonised and a need to reduce the bacterial burden has been identified (when the practitioner suspects bacteria are contributing to delayed healing or wound breakdown) and/or the patient is particularly susceptible to infection, e.g. due to diabetes, ischaemia, or immunosuppression. Evidence to support the use of these products is limited. Antimicrobial products must not be used long term. Dressing selection should be based on the tissue type in the wound and exudate levels. If the wound does not respond within 2 weeks of antimicrobial therapy, it is not going to be effective and should be discontinued. Honey Dressings Honey has been shown to provide a wide variety of supporting benefits in the management of chronic wounds, including the reduction of odour (antimicrobial activity), promoting autolytic debridement, anti-inflammatory activity (pain reduction), the stimulation of healing and even the reduction of scarring. Refer to wound classification chart for wound exudate levels. Name Sizes Costs Use Avoid Application Tips Actilite 10x10 0.98 10x20 1.90 Best suited for granulating or epitheliasing wounds, Actilite offers antibacterial protection whilst promoting the ideal mosit wound healing environment. Suitable for all wound types where primary layer is indicated and an antibacterial effect may be advantageous such as cuts, abrasions, burns, surgical wounds, leg ulcers, pressure ulcers, diabetic ulcers and infected wounds. Can be used to debride, deslough, infected and malodourous wounds. can be kept on wound for up to 7 days Honey is not absorbed into the blood stream however we do recommend check blood glucose levels on diabetics. Avoid anyone who is allergic to honey or bee stings. The dressing is designed to be applied as a triple layer as packaged, it may be unfolded but this will reduce the efficacy of the honey, do not introduce any creases that may cause pressure areas. Osmotic action may increase the exudate levels to begin with so cover with a secondary absorbent dressing Pre warm prior to application. Has osmotic action and fluid will be drawn from the wound and can increase pain. Change dressing when honey is diluted by exudates, change in colour is a useful indicator of when to change a dressing Antimicrobial 5x5 1.96 Algivon Plus 2.5x20 ribbon 3.36 10x10 3.36 Activon 25g 2.05 Slow releasing dressing best suited for wetter wounds as the alginates has a small capacity to absorb, meaning the honey isn't washed away with exudate. Can be used on all wound types but especially pressure ulcers, leg ulcers, diabetic ulcers, surgical wounds, burns, graft sites and infected wounds. Can be used to debride, deslough, infected and malodourous wounds. Can be kept on wound for up to 7 days Ideal for debriding necrotic tissue, or for topping up dressings where the honey has been washed way by exudate. great for using in cavities. Just wash away with saline solution. Can be used on all wound types especially pressure ulcers, leg ulcers, diabetic ulcers, surgical wounds, burns, graft sites, infected wounds, cavity wounds and sinuses. Can be on wound for up to 7 days. Once opened can be kept for 90 days. Page 16 of 2 4 Honey is not absorbed into the blood stream however we do recommend check blood glucose levels on diabetics. Avoid anyone who is allergic to honey or bee stings. Some dicomfort may be felt, if applicable consider appropriate level of analgesic Honey is not absorbed into the blood stream however we do recommend check blood glucose levels on diabetics. Avoid anyone who is allergic to honey or bee stings. Placed (either side down) onto the wound surface; dressings can be placed side by side to cover large wound areas or cut to size. Depending on the tissue type within the wound bed and level of exudate your secondary dressing of choice. In wounds with a high level of exudate an additional highly absorbent dressing can be introduced to help manage exudate. Osmotic action may increase the exudate levels to begin with so cover with a secondary absorbent dressing May be applied directly to a wound or used with other Activon dressing s.requires secondary absorbent dressing. Osmotic action may increase the exudate levels to begin with so cover with a secondary absorbent dressing Has osmotic action and fluid will be drawn from the wound and can increase pain. Change dressing when honey is diluted by exudates, change in colour is a useful indicator of when to change a dressing Change dressing when honey is diluted by exudates, change in colour is a useful indicator of when to change a dressing

Iodine Inadine is non adherent dressing with 10% povidone iodine used on infected ulcerative wounds and minor burns. Iodoflex is used for the treatment of chronic exuding wounds such as leg ulcers, pressure ulcers and diabetic ulcers, particularly when infection is present or suspected. Inadine 5x5 0.33 Used for the prevention and treatment of infection in minor burns, minor trauma injuries, pressure ulcers, leg ulcers with low levels of exudate. Broad spectrum of antimicrobial activity with efficacy against microbacteria, fungi, protozoa and viruses. IODINE SENSITIVITY Absorption of iodine can occur. Rapidly de-activated by wound exude Antimicrobial Cont Iodoflex Paste 5g 4.13 Cadexomer dressing with iodine. For the treatment of chronic excuding wounds. IODOFLEX may be used on infected wounds. IODOFLEX is an effective deslougher with high absorption capacity, which has been shown to disrupt mature biofilms and cleanse the wound. Should not be used on dry necrotic tissue or on patients with a known sensitivity to any of its ingredients. Do not use on children, pregnant or lactating women, or on people with thyroid disorders or renal impairment. For details of precautions, contact supplier. Choose a suitable size of dressing for the wound (5g for wounds up to 6cm x 4cm, 10g for wounds up to 8cm x 6cm or 17g for wounds up to 10cm x 8cm). For wounds over 10cm x 8cm use multiples of the above. Clean wound and surrounding area with a gentle stream of water or saline. DO NOT DRY the wound surface. Remove carrier gauze on both sides of paste. Cut IODOFLEX dressing or mold to the shape of the wound. Cover the wound completely with an appropriate dressing. Any remaining IODOFLEX dressing should be discarded. IODOFLEX Can be used for up to 3 months in a single course of treatment. As long as the maximum daily and weekly application doses aren t exceeded. See usage guide for daily and weekly application limits. Page 17 of 2 4

Iodosorb Ointment 10g tube 4.62 Sterile antibacterial formulation of cadexomer iodine which when applied to the wound cleans it by absorbing fluids, removing exudate, slough and debris and forms a gel over the wound surface. Topical treatment for chronic exuding wounds. May be used on infected wounds. Can also be used under compression. Do not use on children, pregnant Apply Iodosorb ointment directly or breastfeeding women or people to the wound. with thyroid disorders or renal impairment. A change in colour indicates when iodosorb should be changed usually 2 to 3 times a week Each time the dressing is changed the remaining Iodosorb ointment should be gently washed from the wound with a suitable cleansing solution. (sterile water or saline) Page 18 of 2 4

Flaminal Hydro 15g tube 7.73 Flaminal Hydro is recommended for wounds that are low to moderately exuding. Flaminal is an antimicrobial Enzyme Alginogel that is recommended for any wound type. Flaminal Hydro will help aid autolytic debridement, Balance moisture in the wound, kill bacteria and reduce bioburden. It will help protect the wound edges and surrounding skin. Flaminal can also be used to pack cavity wounds. Do not use on or around the eyes. Apply a 5mm thickness of For cavity wounds use a Flaminal to the wound, Secondary syringe or contact local rep dressing will depend on exudate for nozzle adapters to levels. Change every 1-4 days as ensure easy application. long as the gel remains intact. Single patient use, can be recapped and used till expiry date Antimicrobial Cont Flaminal Forte 15g tube 7.73 Leukomed Sorbact (Hospital Only) 5cm x 7.2cm 1.66 8cm x 10cm 3.70 8cm x 15cm 5.24 10cm x 20cm 9.24 10cm x 25cm 11.55 10cm x 30cm 13.87 10cm x 35cm 16.17 Flaminal Forte is recommended for wounds that are moderate to heavily exuding. Flaminal is an antimicrobial Enzyme Alginogel that is recommended for any wound type. Flaminal Forte will help aid autolytic debridement, Balance moisture in the wound, kill bacteria and reduce bioburden. It will help protect the wound edges and surrounding skin. Flaminal can also be used to pack cavity wounds. Leukomed Sorbact helps to reduce the risk of infection by binding and removing bacteria and fungi from contaminated, colonised or infected wounds. The dressing comprises a waterproof adhesive film which provides protection against external contamination and an absorbent wound pad laminated to a green, acetate mesh coated with dialkyl carbamoyl chloride (DACC). Leukomed Sorbact can be used for all types of post-operative and traumatic wounds with up to and including moderate levels of exudate such as surgical incisions, lacerations, cuts, abrasions, dehisced wounds and minor burns. Do not use on or around the eyes. Do not use Leukomed Sorbact on patients with known sensitivity to the dressing components. If a reaction is observed, discontinue use and consult a doctor. Do not use Leukomed Sorbact in combination with ointments, creams as they decrease the binding of hydrophobic microorganisms. If swelling or movement is expected, avoid applying the film at tension as this may cause tension blisters to occur. Leukomed Sorbact is not intended to be cut. Apply a 5mm thickness of If the wound is exuding Flaminal to the wound, Secondary apply the Flaminal Forte dressing will depend on exudate directly on to the secondary levels. Change every 1-4 days as dressing then apply to the long as the gel remains intact. wound. Single patient use, can be recapped and used till expiry date 1. Clean the wound according to local protocol. 2. Remove Leukomed Sorbact from the pouch using an aseptic technique. 3. Remove the protective film on the bottom of the dressing and apply the dressing over the wound. Do not stretch the film during application. 4. It is important that the green Leukomed Sorbact fabric comes into direct contact with the wound area. 5. For reliable fixation, smooth the film securely to the skin, especially around the edges. 6. Carefully remove the application film, using the blue handling strip. Slowly pull it backwards, in parallel to the skin to avoid lifting of the dressing. 7. For gentle release, stretch the dressing to release adhesion. Pull one edge of the dressing parallel to the skin. Do not pull up or backwards. A 2cm overlap around the wound is advisable Page 19 of 2 4

Antimicrobial Cont Cutimed Sorbact Swabs (Community only) Cutimed Sorbact Round Swabs (Community only) Cutimed Sorbact Ribbon Gauzes (Community only) 4cm x 6cm 1.67 7cm x 9cm 2.78 5 round 3cm swabs 3.33 2cm x 50cm 4.08 5cm x 200cm (TVN only) 8.03 Cutimed Sorbact Swabs are designed for the effective binding and removal of bacteria and other microorganisms from contaminated, colonised or infected exuding wounds. Cutimed Sorbact Swabs can be used for all types of contaminated, colonised or infected exuding wounds (providing moisture is present), regardless of their aetiology. The dressings are made from acetate coated with DACC (dialkyl carbamoyl chloride), a strongly hydrophobic substance that achieves fast and effective binding of microorganisms. As above, but used for dressing small deep wounds As above, however the Cutimed Sorbact Ribbon is 100% cotton coated DACC. All types of deep or cavity wounds showing signs of infection. Suitable for fungal infection in the groin, in skin folds (e.g. under the breast) or between the digits. Do not use on dry wounds, for low to moderate levels of exudate please use Cutimed Sorbact Gel. Do not use Cutimed Sorbact in combination with ointments or creams as they will interfere with the dressings microbe binding effect 1. Clean the wound as usual 2. Direct wound contact is required for the effective binding of microorganisms. 3. In deep or cavity wounds, apply Cutimed Sorbact swabs or ribbon gauzes and leave a part of the dressing sticking out of the wound so it can easily be removed. In superficial wounds, apply a Cutimed Sorbact swab. 4. Depending on the amount of wound exudate, Cutimed Sorbact swabs, ribbon gauzes and round swabs can be combined with all types of absorbent secondary dressings such as foams or alginates. 5. If required, use a bandage, tape or a transparent film dressing for fixation. Dressing can be left in place for up to 7 days, however it is recommended that it is checked every 1-3 days. Cutimed Sorbact Gel (Community only) 7.5cm x 7.5cm 2.68 7.5cm x 15cm 4.52 A DACC-coated swab coated with an amorphous hydrogel.can be used for all types of dry, sloughy or low exuding wounds that are contaminated, colonised or infected. Avoid using Cutimed Sorbact gel if the patient has any known sensitivity to propylene glycol 1. Clean the wound as usual and apply Cutimed Sorbact gel gently onto the wound bed 2. Fold back any overlapping material in the direction of the wound 3. If desired, add remaining hydrogel from the pouch onto the applied dressing 4. Depending on the level of exudate, cover with a suitable secondary dressing Should be changed every 1-3 depending on wound condition Page 20 of 2 4

Silver dressings Dressings containing an antimicrobial agent that will kill or prevent growth and multiplication of bacteria If the wound does not respond within 2 weeks of antimicrobial therapy, it is not going to be effective and should be discontinued Antimicrobial Silver Name Sizes Costs Use Avoid Application Tips Kerracontact AG ( To be used under strict TVN supervision only ) 5 x 5cm 3.17 10 x 12.5cm 7.75 15 x 15cm 13.59 Indicated for the management of partial and full thickness wounds that are infected or have an increased risk of becoming infected, such as Pressure Ulcers, Diabetic Ulcers, Venous Leg Ulcers, First and Second Degree Burns, Grafts and Donor Sites. Utilises Oxysalt Technology which is proven to kill 99.999% of a broad spectrum of bacteria and destroy mature biofilms within 24 hours. Can be left in place for up to 7 days. Should not be used on patients with a known sensitivity to silver. Not compatible with oil-based products. Not compatible with MRI, ECG or EEG procedures- must be removed prior to and replaced following treatment. Cut to shape as neccesary Cover with a secondary dressing as approporiate for the degree of exudate or secure with surgical tape or bandage. Check dressing regularly and change depending on the amount of exudate and condition of the wound ensuring that a moist environment is maintained. If dressing adheres to the wound, moisten and soak prior to removal. Dressing can be worn for up to 7 days KerraContact Ag can be placed either way round and does not require moistening before application unless required. Normal Saline Name Sizes Costs Use Avoid Application Tips For irrigation of wounds Saline Clinipod 20ml x 25 amps 4.80 Page 21 of 2 4

Debridement Debridement Name Sizes Costs Use Avoid Application Tips Debrisoft 10x10cm 6.50 Debrisoft Lolly 5x2.7cm (dimensions of monofilament fibre head only). Core width is 1.9cm. 5.79 A debridement pad containing monofilament fibres which is used to remove debris; safely reaching uneven areas of the skin or wound bed. Debrisoft lifts debris, including biofilm, superficial slough and exudate, quickly. It binds this within the fibres, removing barriers to healing. Debrisoft is particularly suitable for shallow wounds and accessible areas of skin. Debrisoft is indicated for the debridement and cleansing of: Leg ulcers and other chronic wounds (e.g. pressure ulcers, diabetic foot ulcers) Hyperkeratosis and peri-wound skin Acute wounds (e.g. gravel rash, burns, dehisced surgical wounds) A debridement lolly containing monofilament fibres which is used to remove debris; safely reaching uneven areas of the skin or wound bed. Debrisoft lifts debris, including biofilm, superficial slough and exudate, quickly. It binds this within the fibres, removing barriers to healing. Debrisoft Lolly is particularly suitable for hard-to-reach areas e.g. cavity wounds, between digits and skin folds. It is indicated for the debridement and cleansing of: Leg ulcers and other chronic wounds (e.g. pressure ulcers, diabetic foot ulcers) Hyperkeratosis and peri-wound skin Acute wounds (e.g. gravel rash, burns, dehisced surgical wounds) Debrisoft must not be used as a wound dressing. Do not cut Debrisoft. Do not use if there is a known sensitivity to any components of the product (100% polyester). Debrisoft is for single use only. Debrisoft Lolly should never be introduced into wounds with an opening smaller than the size of the head. Core width of the Debrisoft Lolly head is 1.9cm. Debrisoft Lolly must not be used as a wound dressing. Do not cut Debrisoft Lolly. Debrisoft Lolly should not be used if there is a known sensitivity to any components of the product (100% polyester head, 100% polypropylene handle). Debrisoft Lolly is for single use only. Step 1. Fully moisten the soft, fleecy side of Debrisoft with 20 40ml (1 2 egg cups) of tap water or saline. Step 2. With gentle pressure, use the soft, fleecy side of the moistened Debrisoft in a circular motion (on wounds) or in long, sweeping strokes (on the skin). Step 3. Typically, a new Debrisoft is used for each separate wound/area of skin. Dispose of in normal clinical or household waste. Step 1. Fully moisten the head of the Debrisoft Lolly with 5 15ml (1 3 teaspoons) of tap water or saline. Step 2. With gentle pressure, use the moistened head of the Debrisoft Lolly, using forward/backward/rotational movements. Step 3. Typically, a new Debrisoft Lolly is used for each separate wound/area of skin. Dispose of in normal clinical or household waste. Wash off any emollients before using Debrisoft. Always use the soft, fleecy side and not the knitted, reverse side. Debrisoft is latex-free. Where very stubborn slough or hard necrosis is present, treatment by autolytic debridement, using dressings (e.g. ActiFormCool) prior to treatment with Debrisoft would be advised. In some cases, it may be necessary to use Debrisoft on more than one occasion. Larger areas may take longer to treat, depending on the amount of slough, debris or hyperkeratosis present. Wash off any emollients before using Debrisoft Lolly. Debrisoft Lolly is latex-free. Where very stubborn slough or hard necrosis is present, treatment by autolytic debridement prior to treatment with Debrisoft Lolly would be advised. In some cases, it may be necessary to use Debrisoft Lolly on more than one occasion. Larger areas may take longer to treat, depending on the amount of slough, debris or hyperkeratosis present. Page 22 of 2 4

Tubular Bandaging Name Sizes Costs Use Avoid Application Tips Tubular Bandaging Clinifast Beige Line (1 per pack) 17.5cm x 1m Blue Line (1 per pack) 7.5cm x 1m Blue Line (1 per pack) 7.5cm x 3m Blue Line (1 per pack) 7.5cm x 5m Green Line (1 per pack) 5cm x 1m Green Line (1 per pack) 5cm x 3m Green Line (1 per pack) 5cm x 5m Red Line (1 per pack) 3.5cm x 1m Yellow Line (6 per pack) 10.75cm x 1m Yellow Line (6 per pack) 10.75cm x 3m Yellow Line (6 per pack) 10.75cm x 5m 1.83 0.77 2.13 3.74 0.58 1.62 2.81 0.56 7.20 20.94 36.24 For use in the retention of dressings and underneath compression bandages to help prevent skin irritation. Refer to manufacturers guidelines Retention Bandaging Name Sizes Costs Use Avoid Application Tips Retention Bandage K-Lite 10x45cm 1.01 10x 5.25m 1.16 Light support used for dressing retention and for the prevention of chronic oedema Known allergies to any components. Is not to be used as a dressing on its own. Apply toe to knee as per manufacturers guidelines Page 23 of 2 4

Medicated Bandaging Medicated Bandaging Name Sizes Costs Use Avoid Application Tips Viscopaste 7.5cm x 6m 3.63 Zipzoc One size 3.13 Can be used as an adjunct to compression therapy in the management of leg ulcers, where venous insufficiency exists and in the treatment of chronic eczema/dermatitis where occlusion is indicated. Used for treatment of chronic leg ulcers. Where chronic venous insufficiency exists, the medicated stocking can be used as a primary contact layer under compression bandaging or hosiery. Any known sensitivty or allergy to components Any known sensitivty or allergy to components As per manufacturers guidelines As per manufacturers guidelines Pressure Relieving Pressure Relieving Name Sizes Costs Use Avoid Application Tips Aderma Dermal Heel pads (2 pair per pack) Aderma Dermal Pad Extra Large Heel (2 per pack) Aderma Dermal Pad Polymer (5 per pack) Aderma Dermal Pad Sacrum / Ankle Wrap (1 per pack) Aderma Dermal Pad Sheet (2 per pack) Aderma Dermal Pad Sheet (5 per pack) Aderma Dermal Pad Strip (5 per pack) Aderma Dermal Pad Strip (5 per pack) Heel 15.02 Extra Large 17.12 10 x 10 x 1.2cm Sheet 12.89 Sacrum / Ankle Wrap 16.87 20 x 20 x 0.3cm Sheet 17.16 10 x 10 x 0.3cm Sheet 4.30 50 x 2.5 x 0.3cm Strip 5.38 30 x 5 x 0.3cm Strip 6.45 For prevention of pressure ulcer on intact skin. For example patients where pillows or leg troughs may be difficult to use as the patient has contracture or over the spine where there is difficulty off loading the pressure for that area etc Not to be applied over broken skin or over dressed wounds. Refer to manafacturers guidelines 24