Pertinent Insights On Antimicrobial Dressings And Infection Control

Start Page: 38
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Author(s): 
Clinical Editor: Kazu Suzuki, DPM, CWS

   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.

   Dr. Khan notes “very little evidence” for dressings in regard to preventing infection or slowing the progression of biofilm. He uses antimicrobial dressings more as a convenience factor. The seven-day dressings that release silver are mainstays for him as they allow the patient to keep a dressing on for seven days (under an Unna boot or a total contact cast). Dr. Khan says he will also employ these dressings if the patient doesn’t qualify for home health.

   “Otherwise, the goal is to maintain a moist wound healing environment and whichever dressing of the month you choose to obtain will be fine,” he says.

   Although Dr. Suzuki is a “big fan” of medical maggots (Monarch Labs), he does not use them routinely because of the acquisition cost, which patients must pay out of pocket.

Q:

What is your thought process in choosing antimicrobial dressings versus conventional dressings?

A:

Dr. Dinh cites “a great deal of confusion” regarding the role of antimicrobial dressings in treating and preventing infection in wounds. She notes that studies evaluating the use of such dressings are not standardized and the supportive evidence is meager. However, Dr. Dinh notes the use of these dressings may be appropriate in certain clinical situations.

   Dr. Suzuki also notes a lack of in-vivo clinical evidence to suggest that antimicrobial dressings reduce wound infection rates. However, he has witnessed many patients who developed wound infection after they switched from antimicrobial dressings (for example, Mepilex Ag) to a conventional dressing (regular Mepilex).

   Since one cannot completely sterilize any open wounds and since there are so many Staphylococcus aureus carriers among patients with wounds, he theorizes that it does make sense to use antimicrobial dressings. Although the cost of purchasing antimicrobial dressings can be an issue, Dr. Suzuki notes one might be able to justify a few dollars of additional cost per dressing, given that sepsis in the older patient populations can be devastating.

   Dr. Dinh says one must balance the benefits of antibacterial activity against the potential cellular toxicity to the healing host tissues. When deciding on an antimicrobial dressing, she advises considering the patient’s risk status, wound bioburden and the presence of biofilm. In patients who are immunocompromised, ischemic or have a history of resistant organisms, Dr. Dinh notes the use of antimicrobial dressings may be more important to reduce the risk of infection. Additionally, the degree of bioburden and the presence of a biofilm in chronic wounds can significantly delay the healing rates, and she says one should use antimicrobial dressings to promote wound closure.

   If a wound is colonized or infected, Dr. Fitzgerald will proceed with an antimicrobial dressing over a more conventional dressing to address this component of wound healing. He also uses these types of dressings in situations in which he believes the potential for contamination is significant.

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