Surgical Site Management: Choosing an Antimicrobial Dressing

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Surgical Site Management

Surgical site management in the post-operative time frame is paramount in preventing infection and wound dehiscence. It is essential to use practical knowledge in good wound cleansing and skin care and in providing moisture balance in surgical site wound care management.1

Dressing changes require an aseptic technique for post-operative wounds within 48 hours. However, initial surgical dressings are normally to remain in place for 48 to 72 hours, and others up to seven days, because tissue layers during this period are not completely healed and cannot withstand external forces. The epidermis will then resurface, forming a barrier to pathogens and contaminants.1

Antimicrobial and antibacterial advanced wound care dressings help provide bacterial balance and reduce the risk of infection in partial- and full-thickness wounds. Pairing these bacteria-reducing agents with sponges, woven gauze, film dressings, and other absorptive dressing technologies can also provide an optimal moist environment, moving wounds toward a healing trajectory. Antimicrobial and antibacterial dressings generate a lower concentration of sustained-release agents to the wound, thereby avoiding toxicity to host cells.2

The advanced wound care dressing market has expanded into an abundant selection of antimicrobial and antibacterial technology products that are available in a variety of delivery systems, shapes, thicknesses, and sizes.

Mechanisms of Action

Antimicrobial dressings can provide a variety of features, depending on their format. Features of these dressings may include2:

  • Absorbency
  • Antimicrobial effects up to 48 hours, three days, and seven days, sustained-release formula
  • Bacterial binding, bacterial trapping, bacterial barrier
  • Bactericidal action, broad spectrum
  • Bacteriostatic action
  • Dressing formats: alginates, hydrocolloids, gelling fiber, collagen, contact layer, composite, gauze, hydrogel, foam, super absorbent polymers, and wound fillers
  • Fungicidal, virucidal, sporicidal, microbicidal action
  • Impregnated dressing formats
  • Moisture vapor permeability, transparent film dressing format
  • Odor control: charcoal
  • Silicone-based adhesive format

Antimicrobial dressings should not be used on patients with sensitivities to silver or iodine, and silver dressings are prohibited during magnetic resonance imaging. Follow your facility policy and procedures in patients undergoing hyperbaric oxygen therapy treatments.

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Advanced Wound Care Dressings With Antimicrobial Properties

Silver
Silver can be used in dressing technology as a coating or an impregnated dressing. Silver forms include:

  1. Elemental silver: nanocrystalline silver
  2. Inorganic compound: silver oxide, silver phosphate, silver chloride, silver sulfate, and silver sulfadiazine
  3. Organic compound: silver alginate, ionic silver-impregnated sodium carboxymethylcellulose

Iodine
Iodine is widely used in wound care management, but it continues to be controversial because of perceived issues of toxicity. Commonly used iodine compounded products include: povidone-iodine (PVP-1), which is a chemical complex of polyvinylpyrrolidone; and cadexomer iodine, which is an iodine and polysaccharide complex.3

Polyhexamethylene Biguanide
Polyhexamethylene biguanide (PHMB) reduces bacterial penetration, resists colonization, and provides protection against gram–negative organisms, gram-positive organisms, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus species (VRE), and fungi-yeast microorganisms.4

Dialkylcarbomoyl Chloride
Dialkylcarbomoyl chloride (DACC)–coated dressings irreversibly bind bacteria at the wound surface that are then removed when the dressing is changed.5

Methylene Blue
Methylene blue has a strong affinity for dead cells. It is an organic antimicrobial cationic dye that focuses on gram-negative bacteria and fungi and attaches to protein-rich exudate and infectious debris. Methylene blue helps decrease hypergranulation, reduces antimicrobial burden, and has a drying effect.6

Gentian Violet
Gentian violet is an antibacterial, antifungal, and antihelminthic agent that is highly effective against gram-positive microbes, specifically S. aureus. Gentian violet can impact bacterial colonization and proinflammatory mediators.7

Honey
Honey has been used for centuries as an antimicrobial and anti-inflammatory agent. Manuka honey and Cameroonian honey influence Pseudomonas aeruginosa, MRSA, and VRE.8

Conclusion

Antimicrobial and antibacterial dressings utilized in the appropriate wound environment can help accelerate wound healing and provide bacterial balance. Various dressing technologies and product features open up a larger selection for wound care management options. Practical knowledge of dressing categories with antimicrobial or antibacterial agents is key in choosing the appropriate treatment, optimizing wound outcomes.

October is Surgical Wound Management Month

References
1. National Institute for Health and Care Excellence (NICE). Surgical Site Infections: Prevention and Treatment. Evidence update June 2013. https://www.nice.org.uk/guidance/ng125. August 19, 2020 update.
2. WoundSource. Product Category Dressings: Antimicrobial/Antibacterial Dressings. https://www.woundsource.com/product-category/dressings/antimicrobialanti.... Accessed August 9, 2020.
3. Lawrence J. A povidone iodine medicated dressing. J Wound Care. 1998; 7(7): 332-336.
4. Cazzaniga A, Serralta V, Davis S, Orr R, Eaglstein W, Mertz PM. The effect of an antimicrobial gauze dressing impregnated with 0.2% polyhexamethylene biguanide (PHMB) as a barrier to prevent Pseudomonas aeruginosa wound invasion. Wounds. 2002;14(5):169-176.
5. Totty JP, Bua N, Smith GE, et al. Dialkylcarbamoyl chloride (DACC)-coated dressings in the management and prevention of wound infection: a systematic review. J Wound Care. 2017;26(3):107-114. doi:10.12968/jowc.2017.26.3.107
6. Stoff B, MacKelfresh J, Fried L, Cohen C, Arbiser JL. A nonsteroidal alternative to impetiginized eczema in the emergency room. J Am Acad Dermatol. 2010;63(3):537-539.
7. Maley A, Arbiser J. Gentian violet: a 19th century drug re-emerges in the 21st century. Exp Dermatol. 2013;22(12):775-780.
8. Boateng JS, Diunase K. Comparing the antibacterial and functional properties of Cameroonian and Manuka honeys for potential wound healing-have we come full cycle in dealing with antibiotic resistance? Molecules. 2015;20(9):16068-16084.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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