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Great Britain -- A new treatment protocol to reduce MRSA infections using an antimicrobial wound dressing ACTISORB* Silver 220 at open treatments sites is so successful that it has been made standard policy across the Doncaster and Bassetlaw NHS Hospitals Trust.(1)
The procedure was developed by two nurses, who were concerned at the level of MRSA infections at open treatment sites such as percutaneous endoscopic gastrostomies (PEG), tracheostomies, and central venous catheters. They carried out a small open study in nine patients with MRSA infected PEG sites. With good wound care, wrapping ACTISORB* Silver 220 around the wound entry site eradicated MRSA and the majority of wounds improved in one week. Since implementation of the peri-PEG skin policy, hospital admissions due to PEG problems have been markedly reduced with being people cared for in the community. (2,3)
Sisters Kathy Leak and Sue Johnson of Doncaster Wound Care Service say, Evidence shows that silver is a good antimicrobial agent. ACTISORB* Silver 220 was the logical choice as it is effective against MRSA and is the only dressing that does not deliver silver directly into the body, avoiding potential toxicity problems.
MRSA often lives completely harmlessly on the skin. However, when a patients immunity is low during illness intravenous catheters or PEG sites give bacteria access to the tissues, where failure to manage colonization can lead to serious infection problems and subsequent bacteremia. The key to dealing with MRSA is to prevent its spread by good hygiene. In wounds and other breaches in the skin, MRSA can cause infection. In such cases it is vital to implement standard wound care and nursing practices to control the problem. Early action can reduce morbidity.
Infection is common at PEG sites where a tube is placed through the wall of the abdomen to feed the patient. This can remain in place for a month or more. An examination of all inpatient PEG sites at Doncaster Royal Infirmary found that 90 percent had tissue maceration or overgranulation (2) an ideal breeding ground for MRSA and other bacteria. (4,5) The majority of the patients were from nursing homes, so the pilot study was carried out at one nursing home where swab tests revealed a high prevalence of MRSA.(3)
In all nine patients ACTISORB Silver 220 was applied around the tube at the wound entry site. All patients were swabbed at the first visit and then weekly until three clear swabs were obtained (according to infection control policy). As the dressing cannot be cut it is folded around the wound entry avoiding skin-tape on application. The dressing was changed as needed to manage exudates and rotated at each dressing change to ensure that all of the skin is covered. In every case a negative MRSA swab was obtained by week 3 and in 4 cases by week 1.(3)
ACTISORB* Silver 220 is clinically proven to manage bacterial infection and critically colonized wounds.(6) This silver charcoal dressing adsorbs toxins and other agents, which have an inhibitory effect on wound healing.(7) Its broad-spectrum antimicrobial activity is effective against 151 bacterial pathogens, including MRSA.(8) It has been shown in PEG sites to visibly reduce infection, MRSA colonisation and overgranulation of wound tissue.(2)
Leak remarks, As this simple economical method is non-invasive it could also be used as a preventative measure in those patients most at risk, including the immunosuppressed, diabetics and those with a history of infection problems.
MRSA is a form of the bacterium Staphylococcus aureus, which is resistant to methicillin, an antibiotic commonly used in its treatment. The antibacterial properties of silver have been known and applied for centuries.(9) The large body of research shows that it produces structural changes in bacterial cells and interacts with DNA to inactivate bacteria.(9)
*trademark of Johnson & Johnson.
1. Doncaster and Bassetlaw Hospitals NHS Trust. Policy for the Management of Peri-Percutaneous Endoscopic Gastrostomy Skin (PEG). 2004
2. Leak K. PEG site infections: a novel use for Actisorb Silver 220. British Journal of Community Nursing 2002; 7: 321 325.
3. Wound Care Service, Doncaster Royal Infirmary 2005.
4. White et al. Br J Nurs 2001; 10(9):563-78.
5. Hoiby et al. Antimicrob Agents Chemother 2000; 44(10):2855-7.
6. Morrison et al. The effect of a silver impregnated charcoal dressing on delayed-healing wounds: analysis of open, multicentre, observational studies. J&J UK data on file: presented at SAWC Las Vegas 2003.
7. Muller et al. Antimicrobial activity and endo-toxin binding capacity of Actisorb Silver 220. J Hosp Infect 2003;53(3):211-14.
8. Rennison et al. Antimicrobial Efficacy of Silver Impregnated Activated Charcoal Wound Dressing. J&J UK data on file: Presented at ETRS Amsterdam 2003.
9. Russell and Hugo. Antimicrobial Activity and Action of Silver. In: Progress in Medicinal Chemistry, vol 31; 1994.