Effect of a new silver dressing on chronic venous leg ulcers with signs of critical colonisation

Hyaluronic acid treatment versus standard of care in chronic wounds in a German setting: Cost-effectiveness analysis

Background and Aims

Chronic wounds are a major burden for worldwide health care systems. In the management of chronic wounds several strategies with innovative and active agents emerged in the past few years, such as hyaluronic acid containing wound dressings. Evidence comparing the cost-effectiveness of hyaluronan and standard of care dressings (hydrofiber with silver) is still missing. The aim of the study is thus, to assess the cost-effectiveness of hyaluronan versus standard of care dressings (hydrofiber with silver) in chronic wounds from a German statutory health insurance perspective.

Methods

A decision tree was modeled to quantify the cost and healing rate at 12 weeks for the hyaluronan and silver dressings strategies. Input parameters were collected literature-based, accounting for healing rates, dressing prices and prices for dressing changes and associated home care. Parameter uncertainty was accounted for by one-way and probabilistic sensitivity analysis.

Results

Hyaluronic acid showed a better healing rate (60.68%) and noticeable lower cost (749.80 Euro) compared to standard of care (silver containing) dressings (59.62%; 883.05 Euro), resulting in an Incremental Cost Effectiveness Ratio of -12,570.57. The hyaluronan approach is hence a dominant strategy in chronic wound management. Sensitivity analysis confirmed these results, giving a range of 60%- 70% of cost-effective scenarios.

Conclusions

Hyaluronic acid dressings showed to be a clinical more effective strategy at significantly lower cost in chronic wounds compared to standard of care (hydrofiber with silver).

A preliminary clinical trial comparing wet silver dressings versus wet-to-dry povidone-iodine dressings for wound healing in pemphigus vulgaris patients

There is insufficient evidence concerning the efficacy of wet silver-containing dressings for wound healing in pemphigus vulgaris (PV). In this randomized, controlled clinical trial, 58 patients with PV skin erosions (10%-70% body surface area) were assigned to receive either wet silver-containing dressings (n = 28) or wet to dry povidone-iodine dressings as a control (n = 30). The patients in the treatment group demonstrated a significant improvement in the number of dressing changes, wound healing time, and duration of hospital stay compared with the control group. Patients treated with wet silver dressings had significantly lower NRS pain scores and reported better subjective satisfaction compared with the control group. The only adverse reactions were an occasional abnormal discharge or infection, but there was no difference between the two groups. In our study the wet silver-containing dressings were safe and effective for the treatment of wound healing in PV patients.

Reduction in Central Line-Associated Bloodstream Infections Correlated With the Introduction of a Novel Silver-Plated Dressing for Central Venous Catheters and Maintained for 6 Years

OBJECTIVE

To assess a novel silver-plated dressing (SD) for central venous catheters in comparison to chlorhexidine gluconate-impregnated sponge (CHGIS) dressings in preventing central line-associated bloodstream infections (CLABSIs) in adult intensive care unit (ICU) patients.

DESIGN

Retrospective cohort study.

SETTING

Tampa General Hospital, an academic medical tertiary care center.

PATIENTS

All adult ICU patients of an academic medical tertiary care center from January 2009 to December 2010.

MEASUREMENTS AND MAIN RESULTS

A total of 3189 patient records were studied from 7 different ICUs during the 2-year period. Patients received either CHGIS dressings (January 2009-December 2009) or SDs (January 2010-December 2010). Primary outcomes measured were CLABSI rates per 1000 catheter days and ICU length of stay. There were 30 696 catheter days with CHGIS dressings and 31 319 catheter days with SDs. There was a statistically significant decrease in the rate of CLABSI per 1000 catheter days in the SD group, from 2.38 to 1.28 ( P = .001), with an absolute risk reduction of 1.1. There was a significantly lower incidence in the rate of CLABSI per 1000 catheter days in the SD group (incidence rate ratio [IRR] = 0.54, 95% confidence interval [CI]: 0.36-0.80). The relative risk of CLABSI in the SD group was 0.502 (95% CI: 0.340-0.730; P < .001). If SDs are used on all catheters, the decreased rate of CLABSIs observed would calculate to a cost savings of US$4070 to US$39 600 per 1000 catheter days. After successful implementation of the SD, we observed significant reductions in CLABSI rates and a sustained reduction in the subsequent 6 years.

CONCLUSION

Use of SDs is associated with a significant decrease in CLABSI rates in adult ICU patients compared to CHGIS dressings, with an estimated cost savings of US$4070 to US$39 600 per 1000 catheter days.

Review and update on new horizon in the management of venous ulcers

Chronic venous ulcers (CVUs) contribute to functional deficits and are a source of significant morbidity among the affected population. In addition, they directly impact the quality of life of patients and are a significant economic burden on the health care system. In this review, we critically evaluate the current strategies for treating CVUs that have emerged within the last decade and outlined a suggested algorithm for treating patients with this difficult condition.

The effect of honey-coated bandages compared with silver-coated bandages on treatment of malignant wounds-a randomized study

Malignant wounds (MWs) occur in 5-10% of all cancer patients. Malodor and exudation are the most common side effects. The aim was to determine the influence of honey-coated compared with silver-coated bandages on treatment of MWs. Patients were randomly selected to enter either group A (honey-coated bandages) or group B (silver-coated bandages). Parameters were the following: wound size, cleanliness, malodor, exudation, and wound pain. Digital photographs, visual analog scales (VAS), and wound morphology registration were used for measurement at baseline and following the 4-week intervention. Sixty-nine patients with MWs and advanced cancer, aged 47-90 (median 65.6), were included. No statistically significant difference was noted between the groups with respect to wound size, degree of cleanliness, exudation, malodor, and wound pain. There was a median decrease in wound size of 15 cm² and 8 cm² in group A and B, respectively (p = 0.63). Based on post-intervention pooled data from the groups, improvement was seen in 62% of the participants with respect to wound size and in 58% (n = 69) with respect to cleanliness. The VAS score for malodor (p = 0.007) and exudation (p < 0.0001) improved significantly post-intervention. Patients with reduced wound size had a median survival time of 387 days compared with 134 days in patients with no wound reduction (p = 0.003). The use of honey-coated and silver-coated bandages improved the outcome of MWs. No differences were found between the two regimens. Both types of bandages are recommended for use by patients with MWs containing tumor debris and necrosis.

The use of silver nylon in preventing surgical site infections following colon and rectal surgery

BACKGROUND

Patients who undergo colorectal surgery have up to a 30% chance of developing a surgical site infection postoperatively. Silverlon is a silver nylon dressing designed to prevent surgical site infections, but only anecdotal evidence has previously supported its efficacy.

OBJECTIVE

The aim of this study was to evaluate the effect of silver nylon dressings in patients undergoing colorectal surgery.

DESIGN

We performed a prospective, randomized, controlled trial comparing a silver nylon dressing with gauze dressings in patients undergoing elective colorectal surgery.

SETTING

The study was performed at a university-based, tertiary referral center.

PATIENTS

We studied patients undergoing elective colorectal surgery with an abdominal skin incision of at least 3 cm.

INTERVENTION

Patients were randomly assigned to receive either a silver nylon or a gauze dressing.

MAIN OUTCOME MEASURES

The primary end point was surgical site infection occurring within 30 days of surgery.

RESULTS

One hundred ten patients were enrolled in the study and were randomly assigned to 1 of 2 treatment groups. After a 30-day follow-up period, the incidence of surgical site infection was lower in the silver nylon group compared with the control group (13% vs 33%, P = .011). Twenty-five patients in the study developed superficial surgical site infections, 5 in the silver nylon group and 14 in the control group (P = .021). Two patients in the study group developed deep wound infections compared with 4 in the control group (P = .438). Multivariate analysis revealed that patients in the control group had a 3-fold increase in risk of infection compared with patients in the silver nylon group (P = .013).

LIMITATIONS

A limitation of this study is that the members of the surgical team were not blinded to the treatment groups.

CONCLUSION

Silver nylon is safe and effective in preventing surgical site infection following colorectal surgery.

Platelet gel in the treatment of severe scleroderma skin ulcers

Systemic sclerosis (SSc) is characterized by microvascular damage and fibrosis of the skin and internal organs. Non-healing skin ulcers, mainly non-venous leg ulcers, represent one of the most challenging complications. Platelet gel (PG) is a hemocomponent containing numerous growth factors, potentially useful for tissue reparation. This pilot open study aimed to evaluate the effect of PG in 12 SSc patients with skin ulcers resistant to conventional therapies from at least 6 months. PG was applied in the wound bed twice weekly for 2 weeks, then once a week for 12 weeks; in all cases, the ongoing treatments remained unchanged at the time of PG applications. Skin ulcers were evaluated at 0, 12 and 24 weeks; the patient's quality of life was also evaluated using the visual analogical scale (VAS) and the health assessment questionnaire (HAQ). During the 6-month follow-up, the skin ulcers consistently improved in 10/12 patients, with complete healing in 4. At the last evaluation, wound size reduced from 23.4 ± 14.9 SD to 2.3 ± 2.2 SD cm(2) (p < 0.0001). Patient's quality of life markedly improved: VAS decreased from 87.08 ± 13.5 to 57.9 ± 12.6; p < 0.0001 and HAQ from 0.73 ± 0.43 to 0.57 ± 0.22; p < 0.0001. PG may represent a novel therapeutic option for SSc skin ulcers refractory to conventional treatments.

Use of a new silver barrier dressing, ALLEVYN Ag in exuding chronic wounds

Recognising and managing wounds at risk of infection is vital in wound management. ALLEVYN Ag dressings have been designed to manage exudate in chronic wounds that are at risk of infection; are displaying signs of local infection; or where a suspected increase in bacterial colonisation is delaying healing. They combine an absorbent silver sulfadiazine containing hydrocellular foam layer, with a perforated wound contact layer and highly breathable top film. The results presented are from a multi-centre clinical evaluation of 126 patients conducted to assess the performance of ALLEVYN Ag (Adhesive, Non Adhesive and Sacrum dressings) in a range of indications. Clinicians rated the dressings as acceptable for use in various wound types in 88% of patients. The majority of clinical signs of infection reduced between the initial and the final assessment. The condition of wound tissue and surrounding skin was observed to improve, and there was significant evidence of a reduction in the level of exudate from initial to final assessment (p < 0.001). Clinicians rated ALLEVYN Ag as satisfying or exceeding expectations in over 90% of patients. The evaluation showed the dressings to offer real benefits to patients and clinicians across multiple indications when used in conjunction with local protocols.

Evaluation of a new silver foam dressing in patients with critically colonised venous leg ulcers

OBJECTIVE

To evaluate the performance (efficacy and safety) of an absorbent dressing impregnated with silver salts (UrgoCell Silver) in the management of leg ulcers with clinical signs of critical colonisation.

METHOD

This was a prospective multicentre non-comparative phase III clinical trial. Patients were assessed weekly for up to four weeks. Assessment included clinical assessment of critical colonisation (severe spontaneous pain between dressing changes, erythema, oedema, malodour and heavy exudate), wound area tracing and photography. Acceptability was documented by the nursing staff when dressings were changed between two weekly evaluations.

RESULTS

Forty-five leg ulcers were included. At baseline the mean number of clinical signs of critical colonisation per ulcer was 3.6 +/- 0.7, which decreased to 1.2 +/- 1.2 at the end of the fourth week of follow-up (an average reduction of 2.3 +/- 1.3, p < 0.001). Oedema, malodour, erythema and spontaneous pain disappeared at the fourth week in 80%, 70%, 69% and 65% of the treated ulcers respectively. Compared with baseline, the mean reduction in ulcer area was 35.0 +/- 58.0% (median 33%, p < 0.001) after the four weeks treatment. Granulation tissue covered a mean 77% of the ulcer surface area at four weeks, compared with 41% at baseline. Only three local events were documented: contact dermatitis, a burning sensation and erythema.

CONCLUSION

The results suggest that the test dressing had a favourable influence on the wound prognosis, and was well tolerated and accepted in the treatment of venous leg ulcers with clinical signs of critical colonisation.

Silver dressings: their role in wound management

Dressings have a part to play in the management of wounds; whether they are sutured or open, usually chronic wounds of many aetiologies which are healing by secondary intention. They traditionally provide a moist wound environment, but this property has been extended through simple to complex, active dressings which can handle excessive exudate, aid in debridement, and promote disorganised, stalled healing. The control of infection remains a major challenge. Inappropriate antibiotic use risks allergy, toxicity and most importantly resistance, which is much reduced by the use of topical antiseptics (such as povidone iodine and chlorhexidine). The definition of what is an antimicrobial and the recognition of infection has proven difficult. Although silver has been recognised for centuries to inhibit infection its use in wound care is relatively recent. Evidence of the efficacy of the growing number of silver dressings in clinical trials, judged by the criteria of the Cochrane Collaboration, is lacking, but there are good indications for the use of silver dressings, to remove or reduce an increasing bioburden in burns and open wounds healing by secondary intention, or to act as a barrier against cross contamination of resistant organisms such as MRSA. More laboratory, and clinical data in particular, are needed to prove the value of the many silver dressings which are now available. Some confusion persists over the measurement of toxicity and antibacterial activity but all dressings provide an antibacterial action, involving several methods of delivery. Nanocrystalline technology appears to give the highest, sustained release of silver to a wound without clear risk of toxicity.