Clinical Management of Infected Wounds: Antimicrobial Innovations
Thursday, February 29, 2024
NSWOCC & WOC Institute Continuing Education Webinar: "Clinical Management of Infected Wounds: Antimicrobial Innovations"
Objectives:
• Review the damage cascade for infected wounds
• Identify initial clinical interventions
• Differentiate use of topical antimicrobial agents
• Describe the antimicrobial actions of Anasept® Antimicrobial Solution and Gel, and Silverlon® Antimicrobial Dressings
Presented by:
Theresa Wilson, RN, BSN, CWON, FACCWS, DAPWCA
In partnership with MedTech Solutions Group
Clarifications to the Q&A by Theresa Wilson:
While I received many great questions during and after the presentation entitled “(Clinical Management of Infected Wounds: Antimicrobial Innovations),” many of the questions involved the use and outcomes associated with silver, Silverlon, and the effects on biofilm in chronic wounds, as well as comparative information between Silverlon and Cadexomer Iodine. So, I wanted to provide everyone with additional information, which I hope will be helpful to you when making a care decision for your patients with chronic wounds.
The standard of care for the removal and control of biofilm worldwide is active debridement and the incorporation of advanced antimicrobial solutions and dressings to eliminate the recurrence. Due to the development of the EPS matrix, which provides a protective barrier to antimicrobials, the best way to ensure optimal removal of biofilms is an initial debridement to remove this barrier so the antimicrobials can be effective, and the biofilm infection is eradicated. The use of topical and parenteral antimicrobial therapy without wound debridement have had limited impact on decreasing biofilm infection, which remains a major problem in wound care. Current claims to manage wound biofilm infection rely on limited early-stage data. In most cases, the data originate from limited experimental systems that lack host immune defense. (Sen, Chandan K. Ph.D.; Roy, Sashwati Ph.D.; Mathew-Steiner, Shomita S. Ph.D.; Gordillo, Gayle M. M.D.. Biofilm Management in Wound Care. Plastic and Reconstructive Surgery 148(2):p 275e-288e, August 2021. | DOI: 10.1097/PRS.0000000000008142)
While many wound care companies want to make the statement that their products kill biofilm, the scientific evidence is simply not there. In a systematic review involving 640 articles, (Schwarzer, S., James, G. A., Goeres, D., Bjarnsholt, T., Vickery, K., Percival, S. L., ... & Malone, M. (2020). The efficacy of topical agents used in wounds for managing chronic biofilm infections: A systematic review. Journal of Infection, 80(3), 261-270.), revealed a huge disparity in the laboratory studies. In vitro testing accounted for 90% of all studies with these demonstrating a minimum biofilm eradication concentration that is unable to validate real-world utilization and outcomes. There is insufficient human in vivo evidence to definitively recommend any topical agent over another for the treatment of chronic wound biofilms.
To make a comparison between silver and cadexomer iodine for the treatment of biofilms would involve a head-to-head, in vivo clinical study design including a mature biofilm, and qualitative and quantitative diagnostics – which currently doesn’t exist in a reputable and worldwide accepted protocol . There are multiple in vitro studies that demonstrate both silver and cadexomer iodine dressings exerted an antimicrobial effect against target species biofilms in several studies.
So, the BEST recommendations I can provide for the eradication and control of biofilms is to begin with extensive debridement, followed by the selection and application of true antimicrobial dressings which sustain microbial control for the longest period, and, at the highest rate of delivery – which Silverlon dressings have been conclusively proven to provide, (Barillo DJ, Croutch CR, Barillo AR, Reid F, Singer A. Safety evaluation of silver-ion dressings in a porcine model of deep dermal wounds: A GLP study. Toxicol Lett. 2020 Feb 1;319:111-118. doi: 10.1016/j.toxlet.2019.10.023. Epub 2019 Nov 9. PMID: 31715245.).
If you are using a cadexomer iodine dressing and are experiencing good results – keep using it! If you are using it and the wound continues to stall – change to Silverlon – and vice versa. Don’t continue to use a therapeutic modality that is not producing the results you want and expect. Alternating therapies is another good way to stimulate an active healing response. But remember – DEBRIDE first!!
