Free to Read
Evaluating antimicrobial efficacy of new commercially available silver dressings
Marion H Cavanagh,
Robert E Burrell,
Patricia L Nadworny,
Marion H Cavanagh
MH Cavanagh, Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorRobert E Burrell
RE Burrell, PhD, Departments of Chemical and Materials Engineering and Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorCorresponding Author
Patricia L Nadworny
PL Nadworny, Departments of Chemical and Materials Engineering and Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
PL Nadworny, Department of Chemical and Materials Engineering, University of Alberta, W7-002 Electrical and Computer Engineering Research Facility, Edmonton, Alberta, Canada T6G 2V4E-mail:[email protected]Search for more papers by this authorMarion H Cavanagh,
Robert E Burrell,
Patricia L Nadworny,
Marion H Cavanagh
MH Cavanagh, Department of Chemical and Materials Engineering, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorRobert E Burrell
RE Burrell, PhD, Departments of Chemical and Materials Engineering and Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
Search for more papers by this authorCorresponding Author
Patricia L Nadworny
PL Nadworny, Departments of Chemical and Materials Engineering and Biomedical Engineering, University of Alberta, Edmonton, Alberta, Canada
PL Nadworny, Department of Chemical and Materials Engineering, University of Alberta, W7-002 Electrical and Computer Engineering Research Facility, Edmonton, Alberta, Canada T6G 2V4E-mail:[email protected]Search for more papers by this authorAbstract
Prevention and treatment of bacterial colonised/infected wounds are critical. Many commercially available silver dressings claim broad-spectrum bactericidal activity over days and are indicated for serious conditions including burns and ulcers. However, there is no peer-reviewed literature available for many newer dressings. This study compared the activity of some of these dressings. Six silver-containing dressings were compared using log reduction, silver release and corrected zone of inhibition assays. Only the nanocrystalline silver dressing was bactericidal against Staphylococcus aureus, and the only other dressing that produced any log reduction was a silver collagen matrix dressing. These two dressings and a silver alginate dressing produced zones of inhibition, although the collagen matrix and alginate dressings had decreasing zone sizes over time, and the latter liquefied after five transfers. The remaining dressings (two ionic silver foam dressings and a silver sulphate dressing) did not produce zones of inhibition. For the foam, alginate and collagen matrix dressings, antimicrobial activity was related to silver release. The silver sulphate dressing released large quantities of silver, but only through the dressing edges, as the wound-contacting surface appeared to be hydrophobic. The results of this study emphasise the importance of confirming product claims regarding silver dressing efficacy.
REFERENCES
- 1 Bowler P. The anaerobic and aerobic microbiology of wounds: a review. Wounds 1998; 10: 170–8.
- 2 Robson MC. Wound infection: a failure of wound healing caused by an imbalance of bacteria. Surg Clin N Am 1997; 77: 637–50.
- 3 Heggers JP, Haydon S, Ko F. Pseudomonas aeruginosa exotoxin A: its role in retardation of wound healing. J Burn Care Rehab 1992; 13: 512–8.
- 4 Mepilex Ag (homepage on the Internet). Sweden: Molnlycke Health Care LLC; © 2009. Mepilex Ag: the effective antimicrobial absorbent foam dressing; 2 pages. URL http://www.molnlycke.com/Files/Wound_Care/Productsheets/MepilexAg_PS.pdf [accessed on 3 February 2009].
- 5 Product Literature (homepage on the Internet). Ontario, Canada: Derma Sciences Inc.; © 2006. ALGICELL™Ag Silver Alginate Brochure; 4 pages. URL http://dermasciencesinc.com/editor/uploads/files/DermaSciences_ALGICELL_Ag.pdf [accessed on 3 February 2009].
- 6 Brochures and Literature (homepage on the Internet). IL, USA: Ferris Mfg. Corp.; © 2008. PolyMem®Silver: the world's only QuadraFoam®silver dressings; 4 pages. URL http://www.polymem.com/Silver.pdf?line_id=5 [accessed on 3 February 2009].
- 7 Biostep™ Ag Collagen Matrix Dressing Downloadable Materials (homepage on the Internet). Largo, Florida, USA: Smith and Nephew, Inc.; © 2008. Biostep Ag Product Insert; 4 pages. URL http://global.smith-nephew.com/cps/rde/xbcr/smithnephewls/Biostep_Ag_Patient_Insert_PI_02273-A.pdf [accessed on 3 February 2009].
- 8 Acticoat™ product range (homepage on the Internet). Largo, FL, USA: Smith and Nephew, Inc.; © 2008. Acticoat™product information; 2 pages. URL http://wound.smith-nephew.com/ca_en/Product.asp?NodeId=2722&Tab=1&Hide=True [accessed on 3 February 2009].
- 9 Gallant-Behm CL, Yin HQ, Liu SJ, Heggers JP, Langford RE, Olson ME, Hart DA, Burrell RE. Comparison of in vitro disc diffusion and time kill-kinetic assays for the evaluation of antimicrobial wound dressing efficacy. Wound Rep Reg 2005; 13: 412–21.
- 10 Wright JB, Lam K, Burrell RE. Wound management in an era of increasing bacterial antibiotic resistance: a role for topical silver treatment. Am J Infect Control 1998; 26: 572–7.
- 11 Wright JB, Hansen DL, Burrell RE. The comparative efficacy of two antimicrobial barrier dressings: in vitro examination of two controlled release silver dressings. Wounds 1998; 10: 179–88.
- 12 Moyer CA, Brentano L, Gravens DL, Margraf HW, Monafo WW. Treatment of large human burns with 0.5% silver nitrate solution. Arch Surg 1965; 90: 812–67.
- 13 Monafo WW, West MA. Current treatment recommendations for topical burn therapy. Drugs 1990; 40: 364–73.
- 14 Thomas S, McCubbin P. A comparison of the antimicrobial effects of four silver-containing dressings on three organisms. J Wound Care 2003; 12: 101–8.
- 15 Thomas S, McCubbin P. An in vitro analysis of the antimicrobial properties of 10 silver-containing dressings. J Wound Care 2003; 12: 305–8.
- 16 Wright JB, Lam K, Hansen D, Burrell RE. Efficacy of topical silver against fungal burn wound pathogens. Am J Infect Control 1999; 27: 344–50.
- 17 Yin HQ, Langford R, Burrell RE. Comparative evaluation of the antimicrobial activity of ACTICOAT antimicrobial barrier dressing. J Burn Care Rehabil 1999; 20: 195–200.
- 18 Wright JB, Lam K, Olson ME, Burrell RE. Is antimicrobial efficacy sufficient? A question concerning the benefits of new dressings. Wounds 2003; 15: 133–42.
- 19 Nadworny PL, Wang J, Tredget EE, Burrell RE. Anti-inflammatory activity of nanocrystalline silver in a porcine contact dermatitis model. Nanomedicine 2008; 4: 241–51.
- 20 Burrell RE, Heggers JP, Davis GJ, Wright JB. Efficacy of silver-coated dressings as bacterial barriers in a rodent burn sepsis model. Wounds 1999; 11: 64–71.
- 21 Tredget EE, Shankowsky HA, Groeneveld A, Burrell RE. A matched-pair, randomized study evaluating the efficacy and safety of Acticoat silver-coated dressing for the treatment of burn wounds. J Burn Care Rehabil 1998; 19: 531–7.
- 22 Doshi J, Karagama Y, Buckley D, Johnson I. Observational study of bone-anchored hearing aid infection rates using different post-operative dressings. J Laryngol Otol 2006; 120: 842–4.
- 23 Rustogi R, Mill J, Fraser JF, Kimble RM. The use of Acticoat in neonatal burns. Burns 2005; 31: 878–82.
- 24 Fan FF, Bard AJ. Chemical, electrochemical, gravimetric, and microscopic studies on antimicrobial silver films. J Phys Chem B 2002; 106: 279–87.
- 25 Blakely M, Weir D. The innovative use of Safetac soft silicone in conjunction with negative pressure wound therapy: three case studies. In: 20th Annual Symposium on Advanced Wound Care and the Wound Healing Society Meeting, 2007, Tampa, USA. URL http://www.molnlycke.net//Files/Wound_Care/Mepilex%20Ag%20PDFs/F6620%20Barrows%202008.pdf [accessed on 2 February 2009].
- 26 Meites H, Jett M, Gauthier S. The examination of antimicrobial soft silicone foam with regards to partial thickness burns. In: Third Congress of the World Union of Wound Healing Societies, 2008, Toronto, Canada. URL http://www.molnlycke.net//Files/Wound_Care/Mepilex%20Ag%20PDFs/F6620%20Meites%20et%20al%202008.pdf [accessed on 2 February 2009].
- 27 Nisbet TAS. Promoting complex wound healing through the utilization of an antimicrobial soft silicone foam dressing: solving the wound puzzle one piece at a time. In: 21st Annual Symposium on Advanced Wound Care and the Wound Healing Society Meeting, 2008, San Diego, USA. URL http://www.molnlycke.net//Files/Wound_Care/Mepilex%20Ag%20PDFs/F6620%20Nisbet%202008.pdf [accessed on 2 February 2009].
- 28 Barrows C. Enhancing patient outcomes – reducing the bottom dollar: the use of antimicrobial soft silicone foam dressings in home health. In: 21st Annual Symposium on Advanced Wound Care and the Wound Healing Society Meeting, 2008, San Diego, USA. URL http://www.molnlycke.net//Files/Wound_Care/Mepilex%20Ag%20PDFs/F6620%20Barrows%202008.pdf [accessed on 2 February 2009].
- 29 Timmins J. Management of a large haematoma with a new silver impregnated foam dressing. In: European Wound Management Association Conference, 2008, Lisbon, Portugal. URL http://www.molnlycke.net//Files/Wound_Care/Mepilex%20Ag%20PDFs/F6620%20Timmins%202008.pdf [accessed on 2 February 2009].
- 30 Schumann H, Apelqvist J, Schmidtchen A, Hansson C. Open, non-comparative, multicentre investigation exploring the tolerance of an absorbent foam dressing containing silver used in chronic wounds. In: European Wound Management Association Conference, 2007, Glasgow, UK. URL http://www.molnlycke.net//Files/Wound_Care/Mepilex%20Ag%20PDFs/F6620%20Schumann%20et%20al%202008.pdf [accessed on 2 February 2009].
- 31 Durante CM. Chronic wounds and local malpractice: an antimicrobial silver soft silicone foam can help solving the problem. In: Third Congress of the World Union of Wound Healing Societies, 2008, Toronto, Ontario, Canada. URL http://www.molnlycke.net//Files/Wound_Care/Mepilex%20Ag%20PDFs/F6620%20Durante%202008.pdf [accessed on 2 February 2009].
- 32 Taherinejad F, Hamberg K. Antimicrobial effect of a silver-containing foam dressing on a broad range of common wound pathogens. In: Third Congress of the World Union of Wound Healing Societies, 2008, Toronto, Ontario, Canada.
- 33 Varma AK, Bal A, Kumar H, Kesav R, Nair S. Efficacy of polyurethane foam dressing in debrided diabetic lower limb wounds. Wounds 2006; 18: 300–6.
- 34 Nadworny PL, Burrell RE. A review of assessment techniques for silver technology in wound care. Part 1: In vitro methods for assessing antimicrobial activity. J wound Technol 2008; 1: 6–13.
- 35 Allam RC, Partain R, Munson BA. A prospective, clinical in-market evaluation to assess the performance of a new collagen matrix dressing on facilitating granulation and epidermal migration, in a variety of wound types. 2007. URL http://global.smith-nephew.com/cps/rde/xbcr/smithnephewls/R._Allam_New_Collagen_Dressing_1.2_LOW.pdf [accessed on 3 February 2009].
- 36 Williams RL. Experience with novel porcine collagen matrix and silver used in long-term dressings. 2007. URL http://global.smith-nephew.com/cps/rde/xbcr/smithnephewls/R_Lewis-Long_Term_Dressings.pdf [accessed on 3 February 2009].
- 37 Williams RL. Novel porcine collagen matrix used to stimulate wound closure in arrested wounds. 2007. URL http://global.smith-nephew.com/cps/rde/xbcr/smithnephewls/R_Williams_Arrested_Wounds-8x4.pdf [accessed on 3 February 2009].
- 38 Williams RL. Clinical experience with a novel porcine collagen matrix to facilitate final closure of granulating wounds originally treated with negative pressure wound therapy. 2007. URL http://global.smith-nephew.com/cps/rde/xbcr/smithnephewls/R_Williams_Final_Closure-8x4-9_27.pdf.
- 39 Davis C, Dalbey C, Hill S. The successful use of a new adjunct therapy in a [sic] both acute and chronic wounds – a prospective, descriptive case series. 2007. URL http://global.smith-nephew.com/cps/rde/xbcr/smithnephewls/S_Hill-Succesful_use_of_adjunct-8x4.pdf [accessed on 3 February 2009].
- 40 Zhao X, Drlica K. Restricting the selection of antibiotic-resistant mutant bacteria: measurement and potential use of the mutant selection window. J Infect Dis 2002; 185: 561–5.
- 41 Li X-Z, Nikaido H, Williams KE. Silver-resistant mutants of Escherichia coli display active efflux of Ag+ and are deficient in porins. J Bacteriol 1997; 179: 6127–32.
- 42 Agathangelou C. Huge sacral pressure ulcer closed in four months using PolyMem Silver and PolyMem Wic Silver dressings. In: Third Congress of the World Union of Wound Healing Societies, 2008, Toronto, Canada. URL http://www.polymem.com/CaseStudies/MKL347_Huge_Sacral_PU_Healed_4_Months_Silver_REV0_0109.pdf??line_id=25 [accessed on 3 February 2009].
- 43 Hubbard M. Dramatic healing of three stalled venous hypertension ulcers in a bariatric patient using PolyMem Silver dressings under an Unna's boot. In: The WOCN Society's 39th Annual Conference, 2007, Salt Lake City, USA. URL http://www.polymem.com/CaseStudies/MKL296_3_Stalled_Venous_Wounds_in_Bariatric_Patient_Silver_Rev0_0108.pdf??line_id=24 [accessed on 3 February 2009].
- 44 Hubbard M. Pain relief and healing using PolyMem and PolyMem Silver dressings under compression for venous hypertension ulcers. In: 20th Annual Symposium on Advanced Wound Care, 2007, Tampa, USA. URL http://www.polymem.com/CaseStudies/MKL294_Venous_Hypertension_Pain_Relief_and_Healing_Compression_Hubbard_REV0_0308.pdf??line_id=22 [accessed on 3 February 2009].
- 45 Stamps J. Polymem Silver dressings successful in bringing quick closure to a chronic venous ulcer with an exposed tendon in a patient with arterial insufficiency. In: 20th Annual Symposium on Advanced Wound Care, 2007, Tampa, USA. URL http://www.polymem.com/CaseStudies/MKL285_Venous_Ulcer_with_Exposed_Tendon_Silver_REV3_1108.pdf??line_id=18 [accessed on 3 February 2009].
- 46 Thurs K. Chronic venous leg ulcer closed in only seven dressing changes using PolyMem Silver dressings. In: The WOCN Society's 39th Annual Conference, 2007, Salt Lake City, USA. URL http://www.polymem.com/CaseStudies/MKL283_Chronic_Leg_Ulcer_Silver_Thurs_REV2_1008.pdf??line_id=16 [accessed on 3 February 2009].
- 47 Caras J. Three malleolus wounds of two years' duration closed in four weeks using PolyMem Silver. In: 19th Annual Symposium on Advances in Skin and Wound Care, 2006, San Antonio, USA. URL: http://www.polymem.com/CaseStudies/MKL282_3_Malleolus_Wounds_Silver_REV2_0808.pdf??line_id=15 [accessed on 3 February 2009].
- 48 Benskin L. Maintaining tunnel tissue viability with PolyMem Silver QuadraFoam dressings during osteomyelitis treatment. In: 19th Annual Symposium on Advances in Skin and Wound Care, 2006, San Antonio, USA. URL http://www.polymem.com/CaseStudies/MKL215_Tunnel_Tissue_REV3_0808.pdf??line_id=10 [accessed on 3 February 2009].
- 49 Benskin L. Dramatic pain relief through the use of PolyMem QuadraFoam dressings on a deep axillary wound for entire course of healing. In: Third Congress of the World Union of Wound Healing Societies, 2008, Toronto, Canada. URL http://www.polymem.com/CaseStudies/MKL213_Axillary_Silver_REV3_0808.pdf??line_id=8 [accessed on 3 February 2009].
- 50 Benskin L. Activation of a stalled traumatic finger wound with PolyMem Silver QuadraFoam dressings. In: 19th Annual Symposium on Advances in Skin and Wound Care, 2006, San Antonio, USA. URL http://www.polymem.com/CaseStudies/MKL2090807_Stalled_Finger.pdf??line_id=7 [accessed on 3 February 2009].
- 51 Parsons D, Bowler PG, Myles V, Jones S. Silver antimicrobial dressings in wound management: a comparison of antibacterial, physical, and chemical characteristics. Wounds 2005; 17: 222–31.
- 52 Ip M, Lui SL, Poon VKM, Lung I, Burd A. Antimicrobial activities of silver dressings: an in vitro comparison. J Medical Microbiol 2006; 55: 59–63.
Citing Literature
