II. Indications

  1. Wound Critical Colonization
    1. Friable granulation tissue
    2. Malodorous Wounds
    3. Altered wound drainage
    4. Increased would pain

III. Preparations

  1. Topical Antibiotics
    1. See Topical Antibiotic
    2. May decrease infection in minor contaminated wounds
    3. Do not decrease the risk of infection in clean wounds (surgical wounds)
    4. Risk fo Allergic Contact Dermatitis and antibiotics resistance
    5. Use only for short period and then transition to petroleum jelly or Vaseline Gauze
  2. Antimicrobial Solutions
    1. Double Antibiotic Solution (DABS, Gentamycin and Neomycin)
      1. Applied 3-4 times per day
      2. Risk of Antibiotic Resistance
    2. Dakin's Solution (Bleach, Hydrogen Peroxide, Betadine, Alcohol)
      1. Cytotoxic agents and typically only recommended for frank infection or necrosis
      2. Other agents are recommended after infection controlled
    3. Acetic acid (vinegar and saline)
      1. Effective for Pseudomonas (but risk of tissue cytotoxicity)
    4. Hypochlorous acid (e.g. Puracyn Plus, Vashe)
      1. Naturally occuring agents released by White Blood Cells
      2. May use to soak wounds to remove biofilm, then remove, dry and apply bandage
    5. Leptospermum Honey (e.g. Medihoney, Activon Tulle Honey, Dynarex L-Mesitran)
      1. Gamma-irradiated products
      2. Antimicrobial activity, but avoid in critical colonization or infected wounds
      3. Debrides wounds
  3. Dressings
    1. Calcium Alginate Gel (e.g. Dermaginate, Tegaderm Alginate)
      1. Kills active biofilms and prevents their growth
    2. Nanocrystalline Silver Impregnated Films (e.g. Tegaderm Ag Mesh, Aquacel Ag, Silvercel, Mepilex Ag)
      1. Broad spectrum antimicrobial activity and decreases biofilms
      2. May stay in place for up to a week (change more often if heavy exudate)
      3. Not cytotoxic
    3. Cadexomer Iodine (e.g. Iodoflex, Inadine)
      1. Time released Iodine 0.9%
      2. Highly absorptive gel
      3. May stay in place up to 2-3 days (turns yellow-white when time to change)
      4. Kills active biofilms and prevents their growth
      5. Contraindicated in Iodine allergy, renal dysfunction, Thyroid dysfunction and extensive burns
    4. Hydrofera Blue
      1. Bacteriostatic dyes
      2. Highly absorptive
    5. Surfactant (e.g. Plurogel)
      1. Prevents biofilm development and promotes antibiotic efficacy
      2. Start with daily application

IV. References

  1. Quisberg (2017) Wound Care Update, Park Nicollet Conference, St Louis Park, MN (attended 9/15/2017)

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