WUK_Collarte amended.indd

White (2015) suggests that in conjunction with appropriate compression therapy, when a venous leg ulcer (VLU) is infected, there are four main criteria that a dressing will need to meet. It has to: Provide sustained broad spectrum antibacterial action Be efficacious against biofilm Be efficacious in the presence of exudate Be safe. Along with other topical antimicrobial agents, dressings that contain elemental silver or a silverreleasing compound have been developed for the management of infected wounds. However, their use sparked much debate about their efficacy (Vermeulenet al, 2007; Storm-Versloot et al, 2010) safety and cost-effectiveness (Michaels et al, 2009). A lack of understanding about the mode of action of silver dressings may have led to their inappropriate use; for example, continued use after the infection had cleared or as prophylaxis against infection, thereby increasing local wound dressing costs. In addition, not all silver dressings are the same; this can make choosing the correct dressing difficult. Silver can either coat the dressing, be incorporated into the structure of the dressing, or both. It is present in dressings in the following forms (International Consensus, 2012): Elemental silver such as silver metal, nanocrystalline silver An inorganic compound such as silver oxide, silver sulphadiazine (SSD, an antibiotic) An organic complex such as silver-zinc allantoinate, silver alginate. Silver ions bind to the cell membrane and disrupt the cell wall causing it to leak, or they bind to proteins and interfere with energy production, enzyme function and cell replication. They are active against a broad range of bacteria, fungi and viruses including methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycinresistant Enterococci (VRE) (International Consensus, 2012).