Pertinent Insights On Antimicrobial Dressings And Infection Control
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.
What is your thought process in choosing antimicrobial dressings versus conventional dressings?
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.
Dr. Khan notes that cost and the ability to obtain dressings play large roles in what he can use in the inner city clinics. He tries to obtain antimicrobial dressings to help patients keep dressings on longer and reduce the overall time and costs associated with daily dressing changes by nurses, but he says it has become an issue of availability. If Dr. Khan can trust the patient to use a conventional dressing or if he or she qualifies for home health, he will ask for daily dressing changes to maintain a moist wound healing environment.
“Either way, the old adage of ‘It’s not what you put onto a wound but what you take off the wound’ will allow it to heal,” says Dr. Khan.