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When to use a silver dressing?

When to use a silver dressing?

Silver dressings play two roles in managing wounds, and they should be used for these specific purposes:

  • reducing the bioburden in acute or chronic wounds that are infected or where microorganisms are preventing the wound from healing; and
  • acting as an antimicrobial barrier for acute or chronic wounds when there is a high risk of infection or re-infection.1

Remember: Antimicrobial dressings are used as part of standard wound care practice, which includes:

How to use a silver dressing:

When you’re treating an infected wound, international best practice recommends using the ‘clean and cover’ approach.2 This approach involves two steps:

  1. Cleanse and debride the wound. This will remove some, but not all, of the biofilm. It also creates a window of opportunity for the antimicrobials to act effectively.
  2. Cover the wound with an antimicrobial (e.g. silver) dressing.3

The'two-week challenge’

When you use antimicrobial dressings, best practice recommends that you use a ‘two-week challenge’, where you use the dressing on the wound for a two-week period. This will give you enough time to find out if the silver dressing is having the desired effect.3 The chart below shows an example of a decision tree you can follow at the end of the two-week period.1

Decision tree after the two-week challenge

If... Then...

the wound improves after two weeks, but there are still signs of infection…

… you can continue to use the silver dressings. Make sure to also assess the wound regularly.

the wound improves after two weeks, and there are no signs of infection…

...you can stop using the silver dressing and switch to another moist wound healing dressing, such as a foam or gelling fibre dressing.

the wound doesn’t improve after two weeks…

...you can consider switching to another antimicrobial agent, using a systemic antibiotic and/or assess your patient for possible comorbidities that haven’t been treated.

How to select the right silver dressing?

There are many types of silver dressings, and they all have different properties, such as:

  • dressing material;
  • silver release profile (i.e. how the dressing releases the silver into the wound);
  • absorption and retention capacity (i.e. how well the dressing absorbs and keeps wound exudate); and
  • conformability (i.e. how well the dressing conforms to the wound bed).

Your main goal with using silver dressings should either be to treat an infection or prevent re-infection. One of the keys to treating infection in chronic wounds is managing biofilm.4 That’s why it’s important to choose a silver dressing with properties that can manage biofilm effectively.

Here are three tips that can guide you in finding the right dressing to treat your patient:

Tip #1: Look for a dressing that conforms to the wound bed

New research shows that biofilm can be found both in the wound bed surface and in the tissue below the wound bed. By choosing a silver dressing that fills the gap between the wound bed and the dressing, you can create a less favourable environment for biofilm to develop.5

If you want to learn more about biofilm, go to our section on this topic

Tip #2: Look for a dressing that absorbs and retains exudate

Managing wound exudate is another important step in treating wound infection. You want a dressing that can absorb exudate quickly and keep it within the dressing. This will prevent any exudate from leaking on to the surrounding skin. If you’re using the dressing together with a compression bandage, you should also make sure that the silver dressing can retain exudate when under compression.

Tip #3: Look for a dressing that can manage biofilm

Managing biofilm is an important part of treating an infected wound. This is because biofilm are present in most chronic wounds. They are also the leading cause of delayed wound healing.4 To manage biofilm, you can use the ‘clean and cover’ approach, where you first debride the wound, and then cover it with an antimicrobial (e.g. silver) dressing.     

Learn more about managing biofilm: Download this 5-step chart

Take-away tips for using silver dressings4

  • Always conduct a holistic assessment of the patient, wound, and environment before deciding whether to use a silver dressing.
  • If the wound is infected, follow the two-week challenge.
  • Choose the silver dressing based on the needs of your patient and their wound. Consider the wound’s exudate level and depth, the dressing’s conformability and how easy it will be to remove.
  • Use silver dressings as a part of the ‘clean and cover
  • Document your decisions in the patient’s healthcare records.
  • Conduct regular reviews to see how the dressing is performing.

References

References
  1. Appropriate use of silver dressings in wounds. An expert working group consensus. London: Wounds International, 2012.
  2. Dissemond et al. Evidence for silver in wound care – meta-analysis of clinical studies from 2000-2015. JDDG 2017; 15(5)_524-35.
  3. International Wound Infection Institute (IIWI). Wound infection in clinical practice. Wounds International. 2016.
  4. Keast, David H. et al. Managing the gap to promote healing in chronic wounds – an international consensus. Wounds International 2020. Vol 11, issue 3.
  5. Schultz G, Bjarnsholt T, James GA, Leaper DJ, McBain AJ, Malone M, et al. Consensus guidelines for the identification and treatment of biofilms in chronic nonhealing wounds. Wound Repair and Regeneration. 2017;25(5):744-57.

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