Silver Antimicrobial Dressings in Wound Management: A Comparison of Antibacterial, Physical, and Chemical Characteristics David Parsons, PhD; Philip G. Bowler, MPhil; Viv Myles, MSc; Samantha Jones, BSc WOUNDS 20051718}: Reprinted wih permission from WOUNDS: A Compendium of ClncolRecsearch ond Practice. Copyright® 2005 KIMP CorOriginal Research Silver Antimicrobial Dressings in Wound Management: A Comparison of Antibacte Physical, and Chemical Characteristics David Parsons, PhD; Philip G. Bowler, MPhil; Viv Myles, MSc; Samantha Jones, BSc From ConvalTec Ud, Flintshire, United Kingdom Abstract Silverconisining dressings are widely used fo assist with manogement of infected wounds and those at risk of infocton. Howover, such drossings have varied responses in clinical uso de to lechno- logical differences in the nature of thir siver content and releate and in propetoe ofthe dressings them solves. This study examines the relationship between siver content, rate of siver release, ond antibacterial ‘activity in a simulated wound fuid model agains! Staphylococcus aureus and Pscudemonas aeruginosa. The study oso looks at cther important measures for the elnieal performance of dressings inching li handling properlies cnd dressing pH. Seven proprietary silvercontoining dressings (AQUACEL® Ag (Hydrofiber; “nonwoven A"], Acticoat™ Absorbent [olginate; “nonwoven B”], SILVERCEL [alginate-car boxymethycellulose nylon blended fibers; “nonwoven C"], Conttet” Foam [nonadhesive; “foam A"), Poly. ‘Mem? Sitver (foam 8°], Urgotul $.Ag [‘gouze"], ancl SiaSorb® ["hydrogel"l] were assessed. No direct correlation between siver content, siver release, and antbacterial aciviy wos found, Dressings withthe highest silver content were nonwoven B ond nonwoven C, while the lowest levels were found in nonwoven ‘A and hydrogel. Nonwoven A, gauze, and nonwoven 8 ware mast effective against S. aureus and P. aeruginosa; however, her silver release rotes differed widely. Free Fuid absorption was greatest forthe 2 foam dressings and leas! for gauze. However, nonwoven A end nonwoven B showed the best fluid reter- tion under conditions of compression, whilo nonwoven A demonstated the lowest lavel of copillary wick ing. Dressing choice is « viol pat of the successful manogement of infected wounds and those wounds ot risk for infection. This study suggests that dressing selection should be based on the overall properties of the dressing clinicaly relevant to the wound type and condiion, Disclosure: All avhors ore potd employees of Corwalec li, Flnshice, United Kingdom. WOUNDS 2005;17(8}:222-237 ritieal colonization and infection of ( wounds present a dual problem for clini- cians. First, there is the possibility of delayed wound healing, particularly in the pres- ence of a compromised immune system or where the wound is grossly contaminated or poorly per- fused.’ Second, colonized and infected wounds are a potential source for cross-infection—a par ticular concern as the spread of antibiotic-resis- tant species continues. For patients, an infected ‘wound can have additional consequences includ- ing increased pain and discomfort, a delay in retum to normal activities, and the possibility of a life-threatening illness. For healthcare providers, there are increases in treatment costs and nursing time to consider. ‘Addeess correspondence to David Porsons, PhD, ConvaTee Wound Therapeutics Global Development Centre Deeside, Flintshire CHS 2NU United Kingdom Phone: 44 1244 584349; Email: dave.parsons@bms.com WOUNDS: A Compendium of Clinical Research and PracticeUntil recently, local wound infection has been a challenge with fow management options. How: ever, the advent of advanced wound dressings containing topical antimicrobial agents, such as silver, has provided a new approach to the con- trol of wound pathogens.* Silver has proven antimicrobial activity that includes antibiotic-resistant bacteria, such as methi- Cillin-tesistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Its role as an antimicrobial agent is particularly attractive, as it has a broad spectrum of antimicrobial activity** with minimal toxicity toward mammalian cells at ow concentrations” and has a less likely tendency than antibiotics to induce resistance due to its activi ty at multiple bacterial target sites" Topical creams or solutions containing silver (eg, silver sulfadiazine) have long been used as a main- stay of wound management in bum patients who are especially susceptible to infection.’ However, disadvantages to their use include staining the skin and toxicity.’ In addition, the need for frequent removal and reapplication of silver sulfadiazine due to the development of pseudoeschar is both time consuming for professionals and painful for patients®" A range of antimicrobial dressings con- taining silver either incorporated within or applied to the dressing are now available for clinical use." ‘This new class of dressings is designed to provide the antimicrobial activity of topical silver in a more convenient application. However, the dressings themselves differ considerably in the nature of their silver content and in their physical and chemical properties. This study compares the in-vitro antibacterial activity of 7 such dressings against 2 common wound pathogens, Staphylococcus aureus and Pseudomonas aeruginosa. The correlation between silver content and/or silver release from each dressing and its antibacterial effect is examined, and factors relating to the provision of an optimal environment for wound healing are compared to provide a basis for an overall assessment of the clinically valuable properties of each dressing, Methods This study assessed the characteristics of 7 pro- prietary silver-containing antimicrobial dressings: 3 PARSONS, ET AL. fibrous dressings—AQUACEL"* Ag (ConvaTec, Skillman, NJ, USA; referred to throughout this arti- cle as nonwoven A), Acticoat™ Absorbent (Smith & Nephew, London, UK; referred to throughout this, article as nonwoven B), and SILVERCEL™ Johnson & Johnson Wound Management, Somerville, NJ, USA; referred to throughout this article as nonwo- ven C); 2 foam dressings—Contreet® Foam (Colo- plast, Holtedam, Denmark; referred to throughout this article as foam A) and PolyMem® Silver (Ferris, Burr Ridge, Ill, USA; referred to throughout this, article as foam BY; a gauze dressing—Ungotul S.Ag. (Laboratoires Urgo, Chendve, France; referred to throughout this article as gauze); and a nonadhe- sive polymer hydrogel sheet—SilvaSorb® (AcryMed/Medline, Mundelein, Il, USA; referred to throughout this article as hydrogel). While all 7 dressings contain silver, they vary in their components and structures (Table 1). The dressings ranged in weight from 1.05 g to 693 g fora 10cm x 10cm piece. Bacteria. The dressings were tested against 2 common wound pathogens, namely Staphylo- coceus aureus NCIMB 9518 (gram positive) and Pseudomonas aeruginosa NCIMB 8626 (gram neg- ative) Measurement of antibacterial activity. Antibacterial activity was assessed in repeat-chal- lenge assays aver a period of 7 days for each of the 7 silver-containing dressings (SCD) and for a nonsilver-containing control dressing (NSCD, AQUACELY, ConvaTec). To best reproduce the clinical conditions in which these dressings are used while providing a consistent and reproducible environment across all the dressings tested, a simulated wound fluid was prepared consisting of 50% fetal calf serum (First Link [UK] Ltd, mycoplasma tested) and 50% maximum recovery diluent (MRD, LABM, UK; 0.1% w/v peptone [beef protein extract] and 0.9% w/v sodium chloride’. Bacteria were inoculated into simulated wound fluid (SWE) such that the final volume was 10 mL, and the population density was approximately 1 x 10° cfur/mL. Due to the higher free swell absorption capacity of the foam dressings, a20 mL volume was used to enable serial samples to be taken without distorting the dressings; however, to provide an equivalent bacterial challenge, the bacterial popula Vel. 17,No. 8 August 2005 223