Pertinent Insights On Antimicrobial Dressings And Infection Control
Dr. Suzuki is participating in a trial on a hypochlorous acid solution (Vashe Wound Therapy, Puricore) for wound irrigation and as an ultrasound debridement medium. As he notes, hypochlorous acid (weak acid, HClO) smells like a bleach but it is a tissue-friendly solution that is naturally synthesized within human neutrophils to kill bacteria. Since it is pH-balanced for human use, he says Vashe is not irritating or toxic to granulation tissues or mucosal membranes. He calls Vashe Wound Therapy “a neat method to add another layer of attack to combat wound surface bacteria and biofilms.”
Do you use sterile gloves when you take care of lower extremity wounds?
Drs. Suzuki and Khan see no reason to use sterilized gloves. Noting that human skin is never sterile and lower extremity wounds are inherently contaminated with bacteria, Dr. Suzuki says sterile gloves are also “vastly more expensive” in comparison to regular rubber gloves.
Dr. Khan cites studies demonstrating no difference in infection rate in wounds using sterile versus non-sterile gloves, sterile versus non-sterile dressings or sterile saline versus tap water.2-4 He recognizes the goal is to stay as clean as possible and one can prevent cross-contamination by frequent switching of gloves after debridement of the wound, cleansing and application of a new dressing.
Dr. Khan often switches gloves three or four times during a single dressing change as does Dr. Suzuki.
Dr. Dinh and Dr. Fitzgerald do not use sterile gloves for ulcer debridement or application of clean (not sterile) dressings in the office or inpatient hospital setting. However, both will use sterile gloves to apply bioengineered alternative tissues. Dr. Fitzgerald also uses sterile gloves when performing procedures such as a percutaneous tendo-Achilles lengthening.
What kind of antimicrobial dressings do you use?
Dr. Suzuki routinely uses silver-containing antimicrobial dressings in the shape of foams (Mepilex Ag, Molnlycke) and calcium alginate or hydrofiber (Silvercel, Systagenix and Aquacel Ag, Convatec). Thus far, he has only seen one case of possible allergic reaction to silver dressings and he believes such allergies are pretty rare. Dr. Suzuki also uses medical-grade sterile honey gel (Medihoney, Derma Sciences), an antimicrobial and osmotic debriding agent.
Dr. Suzuki has also started using a new product, Cutimed Sorbact WCL (BSN Medical), a non-adherent contact layer dressing coated with dialkyl carbamoyl chloride, a fatty acid derivative that binds to bacteria cell walls and prevents bacterial growth. He notes the product is not metallic, is inexpensive and it is not linked to any allergic reaction or bacterial resistance.
For Dr. Fitzgerald, the use of antimicrobial dressings depends somewhat on the wound type and location. In the context of a potentially infected or colonized wound, he will often utilize some sort of silver-impregnated dressing in conjunction with other modalities such as alginates, depending on the degree of drainage.
Dr. Dinh uses antimicrobial dressings in certain clinical situations. These include reducing the bioburden in preparation for applying an advanced bioengineered skin substitute or in the infected ischemic wound in which systemic antibiotics may not provide adequate tissue concentrations as a result of poor tissue perfusion. In those instances, she usually selects silver containing dressings, povidone-iodine or cadexomer-iodine preparations. In addition to decreasing the bacterial bioburden, she says such dressings have demonstrated effectiveness against methicillin resistant Staphylococcus aureus in vitro.