Odor Absorbent Dressings - Restore Odor Control Dressing, CarboFlex Odor Control Dressing

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Odor Absorbent Dressings

Today's new generation of bandages and dressings are designed not only to treat a wide array of wounds, but also to help heal hurting budgets. By warding off tricky infections, requiring less changes, even helping wounds to heal more effectively, new bandage and dressing choices make sense for patients, caregivers and hospitals alike.

One trend in wound care that's quickly gaining momentum is the use of ionic silver. Because ionic silver delivers broad-spectrum antimicrobial properties against even stubborn bacteria like Methicillin resistant Staphylococcus aureus (MRSA), and is activated by wound exudate, a number of vendors are incorporating silver into their bandage and dressing offerings.

Antibiotic resistant infections such as MRSA are becoming more of a threat every day, both to patient and caregiver health, as well as the health of the hospital's bottom line. Open wounds provide an ideal vessel for cross-contamination of MRSA and there fore require special treatment to appropriately manage infection.

"There is a good deal of attention being paid to the potential of silver in the wound care arena," said Eric Shapiro, vice president of marketing, Kinetic Concepts Inc. (KCI), San Antonio, TX. "Ionic silver has shown to be an effective barrier to bacterial penetration and may help reduce infection in chronic, acute, traumatic, sub acute, and dehisced wounds, diabetic ulcers, pressure ulcers, flaps, grafts and partial thickness bums. The clinical and anecdotal evidence in favor of silver continues to build."

In response, KCI recently launched a silver-based dressing as an adjunct to its V.A.C. localized negative-pressure wound therapy system. The V.A.C. GranuFoam Silver Dressing helps provide a protective barrier to reduce aerobic, anaerobic, gram-negative and gram-positive bacteria, yeast and fungi, and may help reduce infections in wounds. The dressing also helps provide continuous antimicrobial activity through the sustained release of silver ions.

The V.A.C. GranuFoam Silver Dressing provides direct and complete contact where the pores come in direct contact with the wound, eliminating the need for additional silver dressing layers that may inhibit negative pressure and granulation, explained Shapiro. Micro-bonded metallic silver is uniformly distributed throughout the dressing, providing continuous delivery of silver even after sizing to treat different wound types.

Odor Control Dressing

Another example of silver in action is the Acticoat line of dressings from Smith & Nephew Wound Management (Largo, FL). Acticoat features a nanocrystalline silver that provides broad-spectrum antimicrobial activity for up to seven days through a sustained release formula. Because of the extremely small size of the nanocrystalline silver molecules, Acticoat silver is able to quickly absorb into the dressing and deliver an extremely high concentration of ionic silver creating an effective barrier that kills a broad range of pathogens.

Acticoat owes its sustained release formula to the fact that it contains both positively charged silver ions (Ag+) along with a "reserve" of neutral silver ions (Ag). When first applied, the positively charged ions in Acticoat seek out the negatively charged bacteria, attaching to and essentially killing the bacteria. Over the life of the dressing application, as the Ag+ gets absorbed, the Ag neutrals convert to Ag+ ions and continue the cycle of bacteria kill.

"Acticoat essentially has a back up plan. And that's what allows it to maintain not only a high kill rate, but a sustained kill over time," said Carl Liebert, group product manager, infection control, Smith & Nephew Wound Management.

Acticoat is available in five versions to treat various types of wounds, including an Acticoat Moisture Control with an absorbent foam pad. The company positions its Acticoat 3 dressing for use on surgical site incisions and first-and second-degree burns, particularly for patients more susceptible to infections, as an added barrier of prevention.

3M (St. Paul, MN) has added a silver option to its transparent line of waterproof Tegaderm film dressings. Tegaderm Ag Mesh Dressing with Silver is fast-acting and provides a seven-day anti-microbial barrier for a variety of wounds, especially those that have stalled or are slow to heal, including pressure, venous and neuropathic (diabetic) ulcers, surgical wounds, second-degree burns, traumatic wounds, donor sites and abrasions. This gauze-like porous material may be used as a primary dressing with absorbent wound fillers or packed into tunnels or undermined areas.

Medline Industries (Mundelein, IL), recently introduced Optifoam AG. The dressing combines absorbent foam with antimicrobial silver. "The introduction of Optifoam AG rounds out Medline's line of antimicrobial dressings that includes a complete range of dressings that will incorporate antimicrobial silver for all types of wounds regardless of the location, depth, or drainage level," said Jonathan Primer, president, Medline Dermal Management Systems Division.

Optifoam AG incorporates Medline's Silvasorb targeted release silver technology into a line of highly absorptive foams. The dressing is designed to meet the challenge of contaminated wounds with moderate to heavy exduate. Optifoam AG is a potent and fast acting antimicrobial dressing that handles higher levels of wound exudate compared to other foam dressings.

Silver dressings vary widely in the amount of silver they actually deliver. For example, Smith & Nephew's Acticoat dressings deliver between 70 and 100 parts per million (ppm) of silver, while Medline's Silvasorb targeted silver delivers between 1 and 2 ppm of silver. Some contend that a high concentration of silver is needed to combat more aggressive strains of MRSA, while others cite evidence proving that concentrations well below 1 part per million are effective against the microorganisms commonly encountered in the clinical setting.

Proponents of low-silver formulas also contend that silver at high concentrations has been shown to harm new cell growth. Others warn that lower levels of silver may promote bacterial resistance to silver. There are a number of studies showing successful results with a variety of silver dressings used in specific clincal settings. While silver will no doubt continue to play an important role in wound care, clearly, more research is needed to help clinicians target their dressing selections to the right applications. For more information on the use of silver in dressings, try searching the Wound Ostomy. "Another way to help protect patients from hospital-acquired infections such as MRSA is to use dressings that provide a bacteria proof layer," said Rachel Savage, associate brand manager, Molnlycke Health Care (Norcross, GA).

Molnlycke Health Care introduces its Mepore Pro self-adhesive absorbent dressing to the U.S. market this month. The all-in-one dressing is made of a soft, non-woven polyester with a bacteria-proof, vapor-permeable film backing that protects the wound from outside contaminants.

Dressings that stay the course Minimizing dressing changes with longer-lasting dressings is beneficial for a number of reasons. Too many dressing changes can be hard on the patient, slow the wound healing process and eat up caregivers' time.

"Many facilities opt to use cost-efficient, all-in-one dressings for post-surgical use, cuts and abrasions that are proven to reduce the most costly part of dressing changes: precious nursing time," said Savage. "Also, by allowing dressings to stay in place for a longer amount of time, the wounds underneath are allowed to heal undisturbed."

Designed for post-surgical wounds, cuts or abrasions, Molnlycke's Mepore Pro can be left on for up to three days. The dressing is highly breathable, but also shower-proof. It features a water-based adhesive that is gentle to skin.

To help reduce pain at dressing changes, Medline launched Gentleheal, super-absorbent, silicone faced, foam dressings. Gentleheal's soft silicone wound contact layer, called Sensil, helps minimize pain for the patient and reduces trauma to the wound. Gentleheal can even be repositioned. Inside the dressing, channels containing super-absorptive granules take in exudate, pulling it up and away from the wound bed. This Exulock technology prevents wound fluid from reentering the wound and also stops the lateral migration of exudate dramatically reducing the risk of maceration.

"The combination of superior exudate management combined with soft silicone facing promotes longer wear time and decreased dressing changes," said Primer.

"Patients view pain as the worst aspect of their chronic wound. They rank pain control as more important than healing," Primer added. "Additionally, pain has been shown to be a primary reason for why patients fail to attend clinic visits."

Medline also recently introduced its Exuderm Odor Shield, the first odor-control hydro-polymer dressing. Exuderm Odor Shield gets its odor absorbing properties from the same material used in the home deodorizer, Febreze. Designed for light to moderately draining wounds, Exuderm absorbs odor as it absorbs wound exudate, making dressing changes more pleasant for caregivers and patients.

"Controlling odor also ranks high among patient concerns," said Primer. "Wound odor carries a social stigma and often contributes to depression."

Smith & Nephew's Acticoat dressings are available in a version that last up to three days (Acticoat 3), as well as the Acticoat 7 version that contains an added layer of silver and absorptive material for seven days of antimicrobial protection.

"With Acticoat 7 the patient's care interval is less frequent. This helps improve the quality of life for the patient. But also it frees up more time to the caregivers," said Smith & Nephew's Liebert. "Caregivers these days are reviewed much more stringently by the governing bodies, both state and national, such as JCAHO. Simply managing the paperwork takes a lot of time." Liebert adds, "If one is caring for the patient more efficiently it enables them to ensure that guidelines are followed, and that they are responding as necessary."

The transparent, conformable film of 3M's Tegaderm product allows visualization of the covered area for easy monitoring with less dressing changes; while a waterproof, viral and bacterial barrier protects patients and health care workers. Tegaderm is now available in an easy-to-use roll option. Tegaderm Roll comes in 2", 4" and 6" roll widths x 11 yd length, allowing customization of shape and size to fit any site. It can be used in a variety of ways including protection of at-risk skin from friction, sheer and body fluids; waterproof fixation of primary dressings, such as gauze, alginates, foams, etc.; fixation of medical devices (drainage tubes, catheter tubing, etc.); and reinforcing the edges of a dressing or "framing".

Cost containment

Some of the more advanced dressing choices may initially seem pricey, but when it comes to wound care it pays to look at the long-term picture.

For example, silver dressings generally carry a higher price tag than standard dressings, but the antimicrobial benefits achieved may significantly outweigh the per-dressing premium. If you can prevent spread of infection or heal a wound faster, the savings can be significant.

"Infections complicate the treatment of chronic hard-to-heal wounds and impede the healing process. Controlling or preventing infections is essential in order for the healing process to progress normally, to produce favorable patient outcomes and to alleviate some of the cost strain shouldered by the healthcare system," said KCI's Shapiro.

Smith & Nephew's Liebert asks buyers to weigh the acquisition cost of product against the total treatment cost for delivery of the wound care. "It's hard sometimes to see beyond today's acquisition costs, and really think what is the most cost-effective practice down the line. Use of efficacious and fiscally sensible products is the most effective way of ensuring that value is received."

Reimbursement issues may also play a part in dressing choices. For example, Savage noted that Molnlycke's Mepore Pro is categorized as a composite dressing under Centers for Medicare and Medicaid Services (CMS) reimbursement, which allows for up to three dressing changes per week at reimbursement around $3.00.

Savage described a possible scenario for cost comparisons in which a customer may save up to 50 percent using the all in-one dressing Mepore Pro over tape and gauze. The equation factors the actual cost of the dressing materials, the number of changes required per week and nursing time for dressing changes. Using an average cost of $0.40 per Mepore Pro dressing changed 3 x per week, compared to gauze and tape at $0.04 and $0.08 respectively, changed every day, the Mepore Pro dressing already comes out a winner at $1.20 for the week versus $1.68 for the week.

Taking into account nursing time involved in the extra, and more difficult, dressing changes associated with gauze and tape, brings the total for gauze and tape to about $25 per week versus about $12 per week for the all-in-one, longer-lasting adhesive bandage.

3M's Tegaderm Roll can serve as an economical alternative to the use of sterile transparent dressing in applications where a sterile dressing is not required. Because it can be customized to any length, it eliminates the need to carry a large assortment of different sized dressings, and its easy-to-use delivery system helps reduce application waste. Tegaderm is reimbursed by CMS as a transparent film dressing.

Key to keeping costs in check when it comes to wound care is choosing the right dressing for the right application.

Smith & Nephew touts its Iodosorb product as a "front-line defense" against infection in wounds with a high level of exudate. These multi purpose dressings absorb exudate, deslough messy wounds and control infection. Both Iodosorb gel and Iodoflex dressings contain a unique cadexomer Iodine formed into spherical, highly absorbent microbeads that deliver 0.9% elemental iodine, a safe toxicity level well below that of commonly used betadine. The dressing provides sustained release for up to three days.

While Iodosorb and Iodoflex have been manufactured and distributed worldwide by Smith & Nephew for over a decade, they were previously being distributed in the U.S. by HEALTHPOINT. As of April 2006, Smith & Nephew now exclusively distributes the products.

An added bonus for caregivers, Iodosorb changes color as it releases iodine, changing from a dark brown color to a lighter color throughout the life of the dressing. That way, a nurse can quickly assess whether a dressing change is in order.

"Many wounds are still being cared for in more traditional methods," concluded Liebert. "Utilization of advanced wound care technology is a dynamic that enables effective barrier protection against infection while assisting in the overall reduction of healthcare delivery costs. The point of view one takes--today or tomorrow, or weeks from now is the critical factor pertaining to minimizing the cost of wound care overall."

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