1.
Antimicrobial stewardship strategies in wound care: evidence to support the use of dialkylcarbamoyl chloride (DACC)- coated wound dressings.
Rippon, MG, Rogers, AA, Ousey, K
Journal of wound care. 2021;(4):284-296
Abstract
BACKGROUND Traditionally, infections are treated with antimicrobials (for example, antibiotics, antiseptics, etc), but antimicrobial resistance (AMR) has become one of the most serious health threats of the 21st century (before the emergence of COVID-19). Wounds can be a source of infection by allowing unconstrained entry of microorganisms into the body, including antimicrobial-resistant bacteria. The development of new antimicrobials (particularly antibiotics) is not keeping pace with the evolution of resistant microorganisms and novel ways of addressing this problem are urgently required. One such initiative has been the development of antimicrobial stewardship (AMS) programmes, which educate healthcare workers, and control the prescribing and targeting of antimicrobials to reduce the likelihood of AMR. Of great importance has been the European Wound Management Association (EWMA) in supporting AMS by providing practical recommendations for optimising antimicrobial therapy for the treatment of wound infection. The use of wound dressings that use a physical sequestration and retention approach rather than antimicrobial agents to reduce bacterial burden offers a novel approach that supports AMS. Bacterial-binding by dressings and their physical removal, rather than active killing, minimises their damage and hence prevents the release of damaging endotoxins. AIM: Our objective is to highlight AMS for the promotion of the judicious use of antimicrobials and to investigate how dialkylcarbamoyl chloride (DACC)-coated dressings can support AMS goals. METHOD MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar were searched to identify published articles describing data relating to AMS, and the use of a variety of wound dressings in the prevention and/or treatment of wound infections. The evidence supporting alternative wound dressings that can reduce bioburden and prevent and/or treat wound infection in a manner that does not kill or damage the microorganisms (for example, by actively binding and removing intact microorganisms from wounds) were then narratively reviewed. RESULTS The evidence reviewed here demonstrates that using bacterial-binding wound dressings that act in a physical manner (for example, DACC-coated dressings) as an alternative approach to preventing and/or treating infection in both acute and hard-to-heal wounds does not exacerbate AMR and supports AMS. CONCLUSION Some wound dressings work via a mechanism that promotes the binding and physical uptake, sequestration and removal of intact microorganisms from the wound bed (for example, a wound dressing that uses DACC technology to successfully prevent/reduce infection). They provide a valuable tool that aligns with the requirements of AMS (for example, reducing the use of antimicrobials in wound treatment regimens) by effectively reducing wound bioburden without inducing/selecting for resistant bacteria.
2.
The effect of Ringer's solution within a dressing to elicit pain relief.
Colegrave, M, Rippon, MG, Richardson, C
Journal of wound care. 2016;(4):184, 186-8, 190
Abstract
Clinical studies suggest that dressings containing Ringer's solution, such as the TenderWet and HydroClean families, provide relief from wound pain. This report reviews the available evidence and possible mechanisms for the relief of wound pain by these dressings. The ability of dressings containing Ringer's solution to provide pain relief is likely to be through providing a moist environment that is favourable for wound healing; furthermore, the dressing augments the protective barrier function by having additional fluid under the dressing, which covers exposed nerve endings and protects against friction damage. Ringer's solution will have a dilution effect and an influence on the pH of exudate. Diluting cytokines within the exudate would be expected to decrease inflammation in chronic wounds and reduce the influence of caustic components such as matrix metalloproteases (MMPs). Altering the pH of the wound bed could inactivate proteins and glycoproteins implicated in the pain response such as MMPs and sodium and calcium channels. The moist environment may also be better at recruiting leukocytes that release natural painkillers at areas of injury. These mechanisms are likely to act in combination to explain why dressings containing Ringer's solution can have analgesic effects.