Silver dressings for antimicrobial effect

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Advanced wound care with silver dressings

Silver dressings are the up-to-date wound care products intended to manage bioburden in acute and chronic wounds. The silver is used in various forms in the wound dressings. For Askina® Calgitrol®, the silver appears as a compound, a patented silver alginate that forms part of the dressing structure. The silver is then released into the wound in its ionic form (Ag+) which has been demonstrated to have a broad-spectrum antimicrobial effect.1)  and to  act as an antimicrobial barrier.

 

Recommended use of silver dressings

Silver dressings are recommended for acute or chronic wounds with, or at risk of, a high level of bioburden or local infection. The wound infection continuum that describes the stages of impact microbes have on a wound proposes silver dressings for wounds that present localized (overt or covert), spreading or systemic infection.2)

It follows that the greater role silver dressings play is to

  • reduce bioburden in infected or colonized wounds and to
  • act as an antimicrobial barrier for wounds at high risk of infection or re-infection4) and not to directly promote the healing of the wound.

Note: The use of silver dressings should also be combined with other aspects of standard wound care protocols such as a holistic assessment of the patient as well as the wound, the management of underlying comorbidities and appropriate wound bed preparation.5)

The two-week challenge

Antimicrobial dressings were recommended initially for a period of two weeks, to be followed by an extensive assessment of the wound and the patient to adapt further wound management.5)

These two weeks may be used to ‘challenge’ the efficacy of silver dressings.4)

If after two weeks

  • the wound has improved, but there are still signs of infection, it may be clinically legitimate to continue the application of silver dressings with further regular assessment
  • the wound has improved and there aren’t any signs or symptoms of wound infection, the treatment with silver dressing should be stopped
  • no improvement in the wound has been observed, the silver-dressing treatment should be stopped and an alternative treatment with a different antimicrobial agent considered.4)

 

Mode of action of Askina® Calgitrol®

How Askina® Calgitrol®  works7)

When exposed to exudate, the alginate matrix of Askina® Calgitrol® swells and softens, causing the silver and calcium alginate molecules to release silver ions (AG+) into the wound. A sustained release of these silver ions to the wound bed is ensured as Askina® Calgitrol® dressings retain a high concentration of silver ions within their molecular structure which is drawn little by little from within the dressing to be delivered gradually to the wound’s surface. An antimicrobial or antibacterial effect is reached within the first hour of application. The level of silver ion released to the wound is then maintained steadily throughout the entire use of the Askina® Calgitrol® dressing, avoiding an excess of silver which may cause staining of the wound or periwound area. Since the alginate matrix contains bonded water in its structure, wetting of the product prior to application is not necessary.8)  

Choosing silver dressing on the basis of patient and wound needs

Askina® Calgitrol®, and in general silver dressings, are available in different forms. The choice of dressing depends on the availability of the dressings in the clinical setting and of course on the needs of the wound and the patient, e.g. exudate level, wound depth, need for conformability, odor control, ease of removal and safety.4) 

Askina® Calgitrol®: one technology, three products

Askina® Calgitrol®: one technology, three products

The Askina® Calgitrol® range is available in three different forms which all have the same patented silver alginate matrix in common:

  • Askina® Calgitrol® Ag, an absorbent foam layer and a layer of silver alginate matrix
  • Askina® Calgitrol® THIN, a thin layer of silver alginate matrix
  • Askina® Calgitrol® Paste, an amorphous silver alginate matrix in paste form

Application recommendations

The three different silver dressings all work the same way (see above); they provide a sustained delivery of silver over several days, thus reducing the need for frequent dressing changes. The three dressings are easy to apply and intended to maintain a moist wound environment conducive to natural healing conditions. Each type of Askina® Calgitrol® is recommended for different wound characteristics.

Askina® Calgitrol® Paste - Highly conformable, not only for small tunnels and sinuses

Askina® Calgitrol® Paste – highly conformable, not only for small tunnels and sinuses 

Close contact between silver alginate matrix and the wound bed

Askina® Calgitrol® Paste is an amorphous silver alginate matrix in paste form. It is highly conformable and provides extremely close contact between the active ionic silver alginate matrix and the wound bed. Indeed, it was demonstrated that lack of conformability in the dressing may reduce antimicrobial activity and functionality of the dressing and that conformability and silver availability at the wound bed are crucial for maximizing the functionality of the dressing.10)

Askina® Calgitrol® Paste for small tunnels and sinuses

This high conformability may prevent the formation of pools of exudate where bacteria might flourish. The small 15g tube comes with a long cannula to facilitate the application of the paste into small tunnels, sinuses and awkward wound shapes.8)

Optimal conformability adapts to all kinds of wound shapes

Askina® Calgitrol® Paste® may also be used for other wounds such as deep cavity or difficult-to-dress wounds.

Regarding flat, superficial, low exuding wounds Askina® Calgitrol® Paste® may be spread on the entire surface of the wound bed by using a sterile glove or a sterile spatula. It must be covered with an appropriate secondary dressing depending on the amount of exudate.

Askina® Calgitrol® Paste® should be reapplied after each dressing change (daily or up to three days depending on wound condition) or if wound exudate leakage occurs through the secondary dressing.11) Askina® Calgitrol® Paste® is easy to remove by simple rinsing with sterile saline (0.9%) or Prontosan® Wound Irrigation Solution.11)

Indications

Askina® Calgitrol® Paste is indicated for the management of partial to full thickness wounds, stage I - IV pressure ulcers, venous, arterial and neuropathic ulcers, second degree burns and donor sites.11)

Askina® Calgitrol® AG – for flat superficial highly exuding wounds

Askina® Calgitrol® Ag – for flat superficial highly exuding wounds

Antimicrobial combined with exudate management

Askina® Calgitrol® Ag is a dressing that consists of an absorbent foam layer and the silver alginate matrix. The primary function of the polyurethane foam layer is to provide absorption for the wound exudate, so no need to cover with a secondary absorbing dressing.

In contact with wound exudate, the ionic silver alginate matrix forms a soft gel allowing the liberation of silver ions.

How to use Askina® Calgitrol® Ag

  • Select the appropriate dressing size to completely cover the wound surface, ensuring 2 to 3 cm excess beyond the edges of the wound. Askina® Calgitrol® Ag can be cut to size, if needed.
  • Place the dressing with the silver matrix (dark surface) facing the wound. If necessary, several dressings can be overlapped to cover very large wound areas. 
  • To secure Askina® Calgitrol® Ag cover it with an appropriate secondary dressing or secure with surgical tape or bandage.11) 

Fewer dressing changes

Askina® Calgitrol® Ag may be left in place for up to seven days or until the dressing is saturated with wound exudate.

Indications

Askina® Calgitrol® Ag is indicated for the management of exuding partial to full thickness wounds, stage I to IV pressure sores, venous ulcers, second degree burns and donor sites.

Askina® Calgitrol® THIN – also suitable for cavity wounds

Askina® Calgitrol® THIN – also suitable for cavity wounds 

Great adaptability

Askina® Calgitrol® THIN is a slim layer of silver alginate matrix.

In contact with wound exudate, the ionic silver alginate matrix forms a soft gel allowing the liberation of silver ions.

Askina® Calgitrol® THIN is recommended not only for shallow wounds but also suitable for deep cavity wounds.11) In addition, the thinness of the dressing allows to conform the dressing to irregularly shaped wounds or to wounds in awkward anatomical sites.8)

Both sides of Askina® Calgitrol® THIN are identical allowing ionic silver delivery to the wound bed from both dressing faces.

Shallow wounds

  • Select the appropriate Askina® Calgitrol® THIN size that will completely cover the wound surface, ensuring 2 to 3 cm excess beyond the edges of the wound.
  • Askina® Calgitrol® THIN can be cut to size, if needed, before removing the protective films.
  • If necessary, several dressings can be overlapped to cover very large wound areas.
  • As Askina® Calgitrol® THIN does not absorb wound exudate; it should be covered with an appropriate secondary dressing depending of the amount of exudate.

Deep cavity wounds

Pack Askina® Calgitrol® THIN into deep wounds and cover the wound with appropriate secondary dressing depending of the amount of exudate.

Fewer dressing changes

Askina® Calgitrol® THIN may be left in place for several days until the secondary dressing requires changing.

Indications

Askina® Calgitrol® THIN is indicated for the management of partial to full thickness wounds, stage 1 to IV pressure ulcers, venous ulcers, second degree burns and donor sites.

Case studies, Consensus document and explanation videos

Related documents:

Askina® Calgitrol® Made Easy Consensus Document

AMR increases patient morbidity, extends hospital stay, and increases treatment costs and mortality rates (Fletcher et al, 2020). In wound care, infection should be managed using topical antimicrobials containing agents that do not contribute to AMR, such as silver (Kramer et al, 2018; Edwards-Jones and Spruce, 2019). The Askina® Calgitrol® range has been designed to manage infection by delivering a controlled and sustained release of silver ions to the wound bed, and is suitable for use in a range of wounds, including common wound types such as venous leg ulcers (VLUs), pressure ulcers (PUs), diabetic foot ulcers (DFUs) and burns.

Askina® Calgitrol® Case Studies

Since the launch of our Askina® Calgitrol® range Paste, we have received reports of treatment successes on different ulcers (diabetic foot, leg and pressure), burns and acute wounds. We would like to share these with you in the form of a short photo storyboard.  

Videos to discover Askina® Calgitrol®

  • Discover the antimicrobial effects of silver ions and how Askina® Calgitrol® works.

  • How to use Askina® Calgitrol®

References:

1) Cutting K, White R, Edmonds M. The safety and efficacy of dressing with silver - addressing clinical concerns. Int Wound J 2007; 4(2): 177-84.

2) International Wound Infection Institute (IWII) Wound infection in clinical practice. Wounds International 2016

3) Figure adapted from Molecular Expressions Web site. Michael Davidson and the Florida State University Research Foundation. https://micro.magnet.fsu.edu/ Accessed January 2012. / Feng QL, Wu J, Chen GQ, Cui FZ, Kim TN, Kim JO. A mechanistic study of the antibacterial effect of silver ions on Escherichia coli and Staphylococcus aureus. J Biomed Mater Res. 2000;52(4):662-668.

4) International consensus. Appropriate use of silver dressings in wounds. An expert working group consensus. London: Wounds International, 2012. Available to download from: www.woundsinternational.com

5) Sibbald RG, Goodman L, Krasner DL, et al. Special considerations in Wound Bed Preparation 2011: An Update. Adv Skin Wound Care 2011; 415-36.

6) Best Practice Statement: The use of topical antiseptic/antimicrobial agents in wound management. 2nd edition. Wounds UK, London: 2011.

7) Review on Antimicrobial Resistance. Antimicrobial Resistance: Tackling a Crisis for the Health and Wealth of Nations. Review on AMR, Wellcome Trust, HM Government, 2014. Available at: http://bit.ly/1VOck4o (accessed 31.03.2017)

8) Opasanon S, Magnette A, Meuleneire F, Harding K. Askina® Calgitrol® Made Easy. Wounds International 2012; 3(1). Available from http://www.woundsinternational.com2012

9) Wounds International. Using Askina® Calgitrol® Paste for the treatment of diabetic foot infection: case studies. London: Wounds International 2013. Available from www.woundsinternational.com

10) Bowler P et al (2010) Dressing conformability and silver containing wound dressings. Wounds UK 6(2): 14–20

11) Instruction for use: Askina@ Calgitrol@ Ag, Askina@ Calgitrol@ THIN, Askina@ Calgitrol@ Paste

12) Trial C, Darbas H, Lavigne J-P, Sotto A, Simoneau G, Tillet Y, et al. Assessment of the antimicrobial effectiveness of a new silver alginate wound dressing: a RCT. J Wound Care. 2010 Jan;19(1):20–6.