Transcript The Role of Topical Silver Preparations in Wound Healing

The Role of Topical Silver
Preparations in Wound Healing
Nancy Tomaselli
Wound, Ostomy and Continence Nurses Society
July/August 2006
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 This article reviews the effects of
silver on wound bioburden and its
role in the management of complex
wounds.
 Many wounds healing by secondary
intention become indolent, resulting
in pain and suffering to the patient
and increased healthcare costs.
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 Wound bioburden impedes healing and
compromises the effectiveness of
advanced wound care therapies.
 Identifying bioburden as the cause of
indolent wound healing is difficult because
many affected wounds do not exhibit
classic signs of infection and, therefore, go
untreated
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History
 1900s:
colloidal silver was used to treat indolent wounds
 1920s:
the US Food and Drug Administration accepted
colloidal silver as a wound treatment.
 1940s:
research on medical applications of silver
declined.
 1968:
35 years later, is still the leading topical
agent for the treatment of burns
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Wound Bed Preparation
 Silver preparations may not be
effective if the steps to optimize the
wound bed are not addressed before
initiating therapy.
 optimize the wound bed to ensure
unimpeded tissue repair and
regeneration.
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Wound Bed Preparation
 Specificinterventions required to achieve this
goal include debridement,elimination of
bacterial burden, establishing a moisture
balance, eliminating edema, correcting
causativefactors, and addressing local and
systemic factors.
 Silver agents contribute to wound bed preparation by controlling the bacterial bioburden
 silver preparationsshould be used as a component of a total wound bed preparationplan if
they are to be effective
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Levels of Bacterial Contamination
The first level of bacterial
involvement is contamination
The second level of bacterial
involvement is colonization
The third level of bacterial
involvement is critical colonization
The fourth level of bacterial
involvement is infection
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Levels of Bacterial Contamination
 Contamination
All chronic wounds are contaminated,but this level
of bacterial presence does not interfere with tissue
repair and is therefore considered normal
 colonization
organisms attach to the wound bed and begin to
multiply, but no accompanying host response and
no interferencewith wound healing
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Levels of Bacterial Contamination
 critical colonization
1. Bacteria that generate more potent toxins are
more virulent and are associated with greater
tissue damage.
2. its presence does not typically produce the
redness,heat, swelling, and pain that are
traditionally
 infection
Concentrations of 105 of bacteria per gram of
tissue indicate a clinical infection.
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Antimicrobial Benefits of
Topical Silver Preparations
 One of the reasons for the renewed interest in
the use of silver preparations is the increasing
incidence of bacterial resistance and the
recognition that antibiotics should be reserved
for invasive infections.
 Low levels of silver can prevent replication and
cause the death of microorganisms
 Silver resulting in antimicrobial activity against
a broad range of aerobic, anaerobic, Gramnegative, and Gram-positive bacteria, yeast,
filamentous fungi, and viruses
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Antimicrobial Performance
of Silver Dressings
 Silver is effective against superficial
pathogens, but it may not inhibit bacteria
that have penetrated a signifi-cant distance
into the wound bed
 silver is indicated for mild wound infections,
but not cellulitis. Antimicrobial silver
preparations can be used to help decrease
the bacterial count when colonization or
critical colonization is suspected.
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Differences in Various Types
of Silver Preparations
 All silver-based dressings contain the
same active ingredient, the silver cation,
but use different methods for creating
and incorporating a reservoir for the
release of the silver cation.
 There are differences in the composition
of the dressings that affect their
performance in terms of maintaining
moisture or managing exudate.
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Differences in Various Types
of Silver Preparations
 The use of saline should be avoided
because it will reduce the release of ionic
silver. Papain-urea debriding ointment is
inactivated by silver salts and should not be
used in combination with antimicrobial
silver dressings
 Maintenance debridement is needed to
remove both bacterial debris and exudate.
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Differences in Various Types
of Silver Preparations
 More silver is not necessarily better
because excessive concentrations
may delay healing if the silver attacks
host cells
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Differences in Various Types
of Silver Preparations
 Providing the patient, family, and care
providers with a greater understanding of
the treatment plan will encourage their
participation in wound management and
ensure appropriate application of silver
products.
 Education includes appropriate wound care
techniques, signs and symptoms of
infection, and when to contact a healthcare
professional.
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Antimicrobial Silver Dressings
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Antimicrobial Silver Dressings
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Disadvantages of Antimicrobial
Topical Silver Preparations
 Although silver may reduce the amount
of exotoxins being produced, it does not
reverse the adverse effects of existing
exotoxins.
 Gram-negative bacteria are destroyed,
endotoxins are released
 Concern associated with the overuse of
silver and the consequent emergence of
bacterial resistance is being raised
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Conclusion
 To ensure positive results with
advanced wound therapies, bioburden
must be reduced.
 Topical silver preparations provide
excellent antimicrobial protection that
reduces wound bioburden and may
enhance wound closure.
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