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Silver dressing use 'unsupported'

  • 7 Comments

The NHS’s decision to use silver wound dressings despite doubts over their effectiveness is costing the service millions of pounds every year, experts have claimed.

An editorial in the Drug and Therapeutics Bulletin said the amount spent on the items had increased from £23m in 2005 to £25m in 2006-07 - a quarter of the total sum spent on all dressings that year.

While silver is known to have anti-microbial properties and is used in many types of dressings for wounds, ulcers and burns, the authors said evidence proving the beneficial effects of the item was scant, with the high cost “difficult to justify”.

“Silver dressings are expensive and there have been few high-quality clinical trials to establish whether they have advantages over other, cheaper alternatives,” they said.

Small-scale trials on effectiveness have so far failed to assess how well the dressings work over a long period, such as the 12 or more weeks it takes an ulcer to heal.

  • 7 Comments

Readers' comments (7)

  • In my experience I have found that a simple dressing with fucidin HC has been far more effective. A wider evidence base is required to justify such an expense.

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  • Martyn Butcher

    The issue of management of wound bio-burden is of concern to all professionals involved in wound care. Infection, and the local non-systemic condition of critical colonisation can have serious consequences for patient morbidity, mortality, subsequent wound healing outcomes and ultimately health economics. As the use of antibiotics has, (quite rightly) been restricted to reduce the risk of bacterial resistance, many clinicians have turned to topical antimicrobials to manage bioburden and prevent the development of wound infection in "at risk" individuals. These include silver, iodine, honey and PHMB-based products.

    However, we are now faced with the indisciminant use of antimicrobials in many circumstances. Some of this is the result of fear among clinicians that, should they not use antimicrobials and a patient develop an infection they may be seen as negligent. In other cases, clinicians are acting out of ignorance of the costs associated with the misuse of these products. Finally, (and in some ways more worrying) is the overt/covert manipulation of clinicians practice by some wound care manufacturers.

    Unfortunately, as with most of wound care there is little RCT-based evidence to support antimicrobials. However that does not mean they are not an important part of the clinicians armoury, it simply means that further research is needed and that clinicians need to use care to ensure their use is appropriate to each, individual clinical situation.

    Even when trials are performed (notably the recently published Vulcan trial on the use of silver-based products in leg ulcer treatment), we see poor trial design and inappropriate use of wound care products resulting in outcomes which are at best misleading and worst still place patients at risk in implemented in the general patient population.

    The tissue viability and wound care community is fully aware of this issue, and as a result a Best Practice Statement on the use of topical anti-microbials/antiseptics in wound management will be released in the next 2 months.

    Among other recommendations, this document will challenge clinicians over the use of long-term, and indiscriminant use of antimicrobial therapy; in general terms, 12 weeks of silver treatment is not only unsupported by both research findings and expert clinical opinion, but is contra-indicated by manufacturers.

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  • It is interesting that the previous writer talks about inappropriate use of antimicrobials when the first comment is from someone using a treatment (Fucidin HC) which has been virtually outlawed in every secondary care trust across the country due to it's role in the development of multi-resistant strains of staph!

    We really need some clear guidence on both antimicrobials and antibiotics in wound care. When this is available, we need the guts to challenge those who persist in outdated and potentially damaging healthcare practices.

    Not only is the inappropriate use of antimicrobials and antibiotics expensive, it will store-up many, many problems for us in the future

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  • I heard a tissue viability consultant explain, that silver based dressings might be effective in reducing the microbal colonisation in wounds, but if the dressings do not work within 1 week other treatment options should be considered and the use of silver dressings should be stopped. I thought this was a helpful comment and gave me more insight to critical anaylyse patients needs and to try treatment options which have been researched and demonstrated in practise.

    Guidence as the previous person mentioned comes only from a collaboration of health care professionals, who are willing to invest the time to fomulate a research based guideline and update this regularly and implement this in practise, so that nurses are educated to follow best practise.This also asks for surveillance so that patient outcomes are monitored and practise will be improved and patients outcome too.
    I hope there are many nurses out there who have this vision and are able to invest the time, which will enrich.

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  • If Fucidin HC has been outlawed in most secondry care settings in the country, why is it still available in some places in the country? And if Anonymous | 15-Apr-2010 3:21 pm has found it effective, maybe we need to find out why it is working for her without the claimed side effects. As we know, randomised controlled trials do not always give the whole picture, irrespective of the outcome.

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  • I find that Trimovate is very effective

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  • Richard White

    Martyn Butcher is absolutely correct! Used wisely, silver dressings can, and do, work effectively in managing bioburden. The 'two week' challenge is correct. The literature has plenty of helpful articles on this topic.

    Beware of so-called "experts" who pontificate on matters of wound care and have little or no experience in the field. There is evidence that the arbitrary removal of silver dressings from formularies can result in increased morbidity and mortality through septicaemia. Beware! The default position is not iodine!

    Richard White

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