Should You Use Antimicrobial Dressings On Clean, Uninfected Wounds?

Author(s): 
Thomas Campbell, DPM, Qeena Woodard, DPM, FACFAS, and Stephanie Wu, DPM, MSc, FACFAS

Why The Efficacy Of Antimicrobial Dressings May Not Justify Their Cost

Finally, one must consider the cost of the antimicrobial dressings. Healthcare is already one of the most expensive industries worldwide. The medical device market and wound care market are no exceptions.

   In 2012, the U.S. Wound Registry evaluated the average cost of therapy for patients undergoing treatment of wounds in the United States.28 To accomplish this study, researchers looked at five years of data from 59 hospital outpatient wound centers throughout 18 states, which involved 5,240 patients with 7,099 wounds. After accounting for physician fees, procedure costs and cost of operation, researchers found the average cost to heal a wound ranged from $3,927 to $9,358. The study did not involve inpatient costs or the costs of non-healing wounds so the average costs are most likely much higher with the costs of non-healing wounds rising in linear fashion. This once again questions the usefulness of antimicrobial dressings in comparison to their cost.

   One example of this is the provocative 2010 article published in the popular British newspaper, The Telegraph, which cited the waste of millions of pounds by British National Health Services (NHS) on silver impregnated dressings amid doubts over their effectiveness.29 The article was based on a large clinical trial comparing silver-containing dressings with non-medicated dressings in venous leg ulcer treatment that found no evidence to justify the use of the more expensive silver dressings in routine, uninfected venous leg ulcer care. The authors of the study concluded that silver dressings offered no real clinical advantage or improvement in wound healing and patient quality of life, but are significantly more expensive.

   The article provoked reactions not only within the United Kingdom but internationally as well. Other news media around the world broadcasted the news and patients reportedly refused silver dressings because they read in popular press that silver does not work.

   While quality published studies on the cost-effectiveness of antimicrobial dressings are currently lacking, it is well known that antimicrobial wound dressings cost more than those without antimicrobial properties. The antimicrobial dressing segment is a significant portion of the medical device market and consequently, marketing and promotional issues can occasionally obscure the evidence that clinicians need to have in order to make informed decisions about the appropriate treatment for their patients.22 The higher cost associated with antimicrobial dressings does not seem justifiable considering the general lack of clinical evidence.

Case Study: Chronic Wound Healing Without Antimicrobial Dressings

A 54-year-old male presented with a chronic wound at the dorsum of his left foot following incision and drainage secondary to an abscess on the second metatarsophalangeal joint.30

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