Wound infection is without doubt the most troubling of all wound complications. Non healing wounds are a significant burden to healthcare systems, where it is estimated that 4-5% of the adult population has a problem wound at any one time (Guest el al, 2017). The development of a wound infection can have potentially serious complications for patients. As well as delaying healing, wounds can rapidly deteriorate and, if left untreated, patients are at risk of septicaemia and death (Newton, 2010). Accurate wound assessment is essential to detect early changes within the wound, surrounding skin, which may indicate a rise in bacterial levels. Infection is apparent when the sum of bacterial load and the virulence factors the bacteria produce are greater than the host’s immune defences, resulting in harm to the host. These are seen as the classic signs if infection (Swanson et al, 2014).

Topical antimicrobial silver has been used for hundreds of years in wound care. Topical antiseptics, such as silver, differ from antibiotics as they have multiple sites of antimicrobial action on target cells and therefore a low risk of bacterial resistance (Wounds international, 2012).

Advanced Medical Solutions has a new antimicrobial fibre dressing in the ActivHeal® range called  ActivHeal® Aquafiber Ag, which includes both a flat and ribbon format to address the clinical needs of patients. The dressing releases silver ions in the presence of wound exudate and is effective antimicrobial agent against a broad spectrum of microorganisms frequently associated with bacterial colonisation and infection of wounds, for up to 7 days. The case study will explore the management of the abscess wound using ActivHeal® Aquafiber Ag.

Initial assessment the wound measured the length of the full lower limb a long with the width of the limb and had a circumference of 28cm. The leg was covered with 100% sloughy tissue and high levels of exudate. The wound showed clinical signs of infection with erythema, heat, oedema, increased levels of exudate and oedema. The patient’s pain score using a visual analogue scale was 5. ActivHeal® Aquafiber Ag ribbon was applied as part of the treatment regime to reduce wound bioburden and manage exudate. The dressing was applied to the wound and covered with a secondary dressing. The dressing change was daily due to the high levels of exudate. The patient was also commenced on antibiotics.

The ActivHeal® Aquafiber Ag was selected to assist in reducing the risk of wound bioburden, absorb levels of exudate, maintain a moist wound environment, and promote healing. Significant progress was then noted in the wound, with the wound reducing in size and showing wound progression and a reduction in the clinical signs and symptoms of wound infection.

 

Wound at Week 1

 

Significant progress was noted in the wound, with the exudate levels significantly reducing, the wound reducing in size and showing wound progression and a reduction in the clinical signs and symptoms of infection. The wound still showed some signs and symptoms of infection,  erythema, heat, and oedema, but they had reduced along with the levels of exudate indicating that the bacterial bioburden was reducing. Exudate levels were now moderate however the peri wound skin was not macerated but remained inflamed. Due to the wound progression and reduction in clinical signs of infection the ActivHeal® Aquafiber Ag was discontinued and the patient was ready for discharge. The patient no longer required an antimicrobial dressing.

 

Guest, J. Ayoub, N. McIlwraith, T. et al (2017) Health economic burden that different wound types impose on the UK’s National Health Service. International Wound Journal. 14 (2): 32230. https://doi.org/10.1111/iwj.12603.
Newton, H. (2010) Reducing MRSA bacteraemias associated with wounds. Wounds UK 6 (1): 56-65.
Swanson, T. Grothier, L. Schultz, G. (2014) Wound Infection made easy. Wounds International. Available from: www.woundsinternational.com
Wounds International (2012) International consensus. Appropriate use of silver dressings in wounds. An expert working group consensus. London. Wounds International, 2012. Available to download from www.woundsinternational.com