Key Considerations For Utilizing Silver Dressings
In wounds with low bacterial counts, Poon and Burd noted that high silver cation-releasing products can actually bind to the fibroblasts and epithelial host cells, causing delayed wound healing.7 Innes, et. al., studied the effects of silver on wounds with low bacterial counts and found a delay in epithelialized wounds such as skin graft donor sites.3 The authors compared Acticoat versus absorbent polyurethane foam on skin graft donor sites (a clean, superficial and epithelializing wound bed). These findings did not support the use of Acticoat as a skin graft donor site dressing. Other Pertinent Pointers On Using Silver Products Although some studies show the deleterious effects of silver on wounds, the impact of silver depends on not only the type of wound bed but also the amount of silver that is being released in the wound. For example, in an infected deep wound, one would need to utilize a silver product with a large amount of silver cation release compared to a clean superficial wound with fragile neo-epithelialization. In regard to the delivery of silver in wounds, Thomas and McCubbin found that Contreet H (Coloplast) was effective after an extended period of time due to the fact that it is a hydrocolloid. This product contains an undisclosed silver complex that is activated by the uptake of wound fluid.4 This illustrates the importance of proper use of wound care products in specific wound types. The dressing vehicle is mainly dependent on the wound bed’s characteristics. For example, one should not use a silver impregnated alginate dressing on a dry, non-exudative wound. The dressing delivery mechanism will affect the overall performance of the product in terms of its ability to control moisture maintenance or exudate management in the wound.2 There are some important considerations when clinicians are looking to apply these silver dressings on wounds. For example, the product information guides for Acticoat and Silverlon (Argentum Medical) state that one should use sterile water (not saline) on their respective products. The chloride ion in normal saline reacts with the pure metallic silver coating of the Silverlon product to form silver chloride crystals, reducing the release of ionic silver (Ag+, the form necessary for the antimicrobial properties of silver).8 Smith and Nephew reinforces this same concept with Acticoat.9 In addition, the company also suggests not using papain-urea debriding agents, which tend to be inactivated by the silver salts of the Acticoat.10 Driver discusses these points in presenting the clinical role of silver dressings.1 In Conclusion Silver dressings do not “cure” infections. However, when clinicians employ these dressings proactively, they can inhibit the progression of bacterial penetration and be effective against MRSA and most other superficial wound pathogens.1 There is a great benefit to the proper utilization of silver products in the hospital setting, especially between surgical debridements. The use of antimicrobial prophylaxis is important in reducing the wound’s microbial load as it can help facilitate wound healing.7 For example, patients who are surgically unstable or awaiting their next debridement would be excellent candidates for the use of silver products in their respective wound beds. Dr. Friedman is a PGY-II resident at the Washington Hospital Center in Washington, D.C. Dr. Bass is a PGY-III resident at the Washington Hospital Center in Washington, D.C. Dr. Steinberg (pictured) is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C. For related articles, see “What You Should Know About Using Silver Products In Wound Care” in the November 2004 issue of Podiatry Today.