II. Indications
-
Wound Critical Colonization
- Friable granulation tissue
- Malodorous Wounds
- Altered wound drainage
- Increased would pain
III. Preparations
-
Topical Antibiotics
- May decrease infection in minor contaminated wounds
- Do not decrease the risk of infection in clean wounds (surgical wounds)
- Risk fo Allergic Contact Dermatitis and antibiotics resistance
- Use only for short period and then transition to petroleum jelly or Vaseline Gauze
- Antimicrobial solutions
- Double Antibiotic Solution (DABS, Gentamycin and Neomycin)
- Applied 3-4 times per day
- Risk of Antibiotic Resistance
- Dakin's Solution (Bleach, Hydrogen Peroxide, betadine, Alcohol)
- Cytotoxic agents and typically only recommended for frank infection or necrosis
- Other agents are recommended after infection controlled
- Acetic acid (vinegar and saline)
- Effective for pseudomonas (but risk of tissue cytotoxicity)
- Hypochlorous acid (e.g. Puracyn Plus, Vashe)
- Naturally occuring agents released by White Blood Cells
- May use to soak wounds to remove biofilm, then remove, dry and apply bandage
- Double Antibiotic Solution (DABS, Gentamycin and Neomycin)
- Dressings
- Nanocrystalline Silver (e.g. Tegaderm Ag Mesh)
- Broad spectrum antimicrobial activity and decreases biofilms
- May stay in place for up to a week
- Not cytotoxic
- Cadexomer Iodine
- Time released Iodine 0.9%
- Highly absorptive gel
- May stay in place up to 2-3 days (turns yellow-white when time to change)
- Hydrofera Blue
- Bacteriostatic dyes
- Highly absorptive
- Leptospermum Honey (e.g. Medihoney)
- Antimicrobial activity, but avoid in critical colonization or infected wounds
- Debrides wounds
- Nanocrystalline Silver (e.g. Tegaderm Ag Mesh)
IV. References
- Quisberg (2017) Wound Care Update, Park Nicollet Conference, St Louis Park, MN (attended 9/15/2017)
