The effectiveness of silver‐releasing dressings in the management of non‐healing chronic wounds: a meta‐analysis

Lo, Sherman; Chang, Ching‐Jui; Hu, Wen‐Yu; Hayter, Mark; Chang, Yu-Ting

doi:10.1111/j.1365-2702.2008.02534.x

Cited by 80 publications

(59 citation statements)

References 22 publications

(26 reference statements)

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“…These findings are broadly in agreement with those from relevant systematic reviews. [216][217][218] Only one systematic review considered infection-related outcomes 218 despite silver-impregnated dressings being indicated for use in infected wounds. 238 This scoping review considered the reporting of infection-related variables and found considerable variation at baseline and in terms of outcome definition.…”

Section: Discussionmentioning

confidence: 99%

“…215 Most evidence from systematic reviews does not suggest a benefit of using silver compared with other types of dressings in terms of healing venous leg ulcers. [216][217][218] However, the current evidence is based on group-level data and it is possible that true treatment effects can be concealed when important patient-level prognostic factors are not controlled for. A more powerful analysis based on IPD may be more informative and therefore aid clinical decision-making.…”

Section: Introductionmentioning

confidence: 99%

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Wounds research for patient benefit: a 5-year programme of research

Cullum

Buckley

Dumville

et al. 2016

Programme Grants Appl Res

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BackgroundComplex wounds are those that heal by secondary intention and include lower-limb ulcers, pressure ulcers and some surgical wounds. The care of people with complex wounds is costly, with care mainly being delivered by community nurses. There is a lack of current, high-quality data regarding the numbers and types of people affected, care received and outcomes achieved.ObjectivesTo (1) assess how high-quality data about complex wounds can be captured effectively for use in both service planning and research while ensuring integration with current clinical data collection systems and minimal impact on staff time; (2) investigate whether or not a clinical register of people with complex wounds could give valid estimates of treatment effects, thus reducing dependence on large-scale randomised controlled trials (RCTs); (3) identify the most important research questions and outcomes for people with complex wounds from the perspectives of patients, carers and health-care professionals; (4) evaluate the potential contributions to decision-making of individual patient data meta-analysis and mixed treatment comparison meta-analysis; and (5) complete and update systematic reviews in topic areas of high priority.MethodsTo meet objectives 1 and 2 we conducted a prevalence survey and developed and piloted a longitudinal disease register. A consultative, deliberative method and in-depth interviews were undertaken to address objective 3. To address objectives 4 and 5 we conducted systematic reviews including mixed treatment comparison meta-analysis.ResultsFrom the prevalence survey we estimated the point prevalence of all complex wounds to be 1.47 per 1000 people (95% confidence interval 1.38 to 1.56 per 1000 people). Pressure ulcers and venous leg ulcers were the most common type of complex wound. A total of 195 people with a complex wound were recruited to a complex wounds register pilot. We established the feasibility of correctly identifying, extracting and transferring routine NHS data into the register; however, participant recruitment, data collection and tracking individual wounds in people with multiple wounds were challenging. Most patients and health professionals regarded healing of the wound as the primary treatment goal. Patients were greatly troubled by the social consequences of having a complex wound. Complex wounds are frequently a consequence of, and are themselves, a long-term condition but treatment is usually focused on healing the wound. Consultative, deliberative research agenda setting on pressure ulcer prevention and treatment with patients, carers and clinicians yielded 960 treatment uncertainties and a top 12 list of research priorities. Of 167 RCTs of complex wound treatments in a systematic review of study quality, 41% did not specify a primary outcome and the overall quality of the conduct and reporting of the research was poor. Mixed-treatment comparison meta-analysis in areas of high priority identified that matrix hydrocolloid dressings had the highest probability (70%) of being the most effective dressing for diabetic foot ulcers, whereas a hyaluronan fleece dressing had the highest probability (35%) of being the most effective dressing for venous ulcers; however, the quality of this evidence was low and uncertainty is high.ConclusionsComplex wounds are common and costly with a poor evidence base for many frequent clinical decisions. There is little routine clinical data collection in community nursing. A prospective complex wounds register has the potential to both assist clinical decision-making and provide important research evidence but would be challenging to implement without investment in information technology in NHS community services. Future work should focus on developing insights into typical wound healing trajectories, identifying factors that are prognostic for healing and assessing the cost-effectiveness of selected wound treatments.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Wounds research for patient benefit: a 5-year programme of research

Cullum

Buckley

Dumville

et al. 2016

Programme Grants Appl Res

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“…The wound dressings are applied to the wounds and compared to non-silver dressings. The outcome concerning wound healing or reduction in wound area and depth, infection, odor, wound exudates, pain, and quality of life [88][89][90][91]. Some of these criteria are subjective (arbitrary scale) and it is hard to imagine how these measurements can be used to analyze the efficiency of silver dressings.…”

Section: Medical Coatings Containing Silver or Silver Nanoparticlesmentioning

confidence: 99%

New Strategies in the Development of Antimicrobial Coatings: The Example of Increasing Usage of Silver and Silver Nanoparticles

2011

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Bacterial infection from medical devices is a major problem and accounts for an increasing number of deaths as well as high medical costs. Many different strategies have been developed to decrease the incidence of medical device related infection. One way to prevent infection is by modifying the surface of the devices in such a way that no bacterial adhesion can occur. This requires modification of the complete surface with, mostly, hydrophilic polymeric surface coatings. These materials are designed to be non-fouling, meaning that protein adsorption and subsequent microbial adhesion are minimized. Incorporation of antimicrobial agents in the bulk material or as a surface coating has been considered a viable alternative for systemic application of antibiotics. However, the manifestation of more and more multi-drug resistant bacterial strains restrains the use of antibiotics in a preventive strategy. The application of silver nanoparticles on the surface of medical devices has been used to prevent bacterial adhesion and subsequent biofilm formation. The nanoparticles are either deposited directly on the device surface, or applied in a polymeric surface coating. The silver is slowly released from the surface, thereby killing the bacteria present near the surface. In the last decade there has been a surplus of studies applying the concept of silver nanoparticles as an antimicrobial agent on a range of different medical devices. The main problem however is that the exact antimicrobial mechanism of silver remains unclear. Additionally, the antimicrobial efficacy of silver on OPEN ACCESSPolymers 2011, 3 341 medical devices varies to a great extent. Here we will review existing antimicrobial coating strategies and discuss the use of silver or silver nanoparticles on surfaces that are designed to prevent medical device related infections.

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“…There is conflicting evidence about the therapeutic benefits of silver dressings in wound healing: while several systematic reviews have identified positive effects, [24][25][26][27] others have failed to establish any association. 12,28,29 Many studies analysed in these reviews included endpoints relating to healing.…”

Section: Introductionmentioning

confidence: 99%

Silver-containing foam dressings with Safetac: a review of the scientific and clinical data

Davies

McCarty

Hamberg³

2017

J Wound Care

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Phil Davies has more than 25 years of experience of working in healthcare-related industries. During that time, he has authored and contributed to numerous peer-reviewed journal articles and conference presentations (oral and poster) relating to wound care and other areas of healthcare. Phil was awarded a BSc (Hons) Medical Cell Biology and Biochemistry by the University of Liverpool (United Kingdom) in 1989.Sara McCarty was awarded her BSc (Hons) in biomedical sciences in 2008 by the University of Chester, UK. Since then, Sara has gained research experience in the field of wound healing. As a medical writer, she has also authored and contributed to a number of peer-reviewed journal articles and conference presentations. In 2014, she was awarded a PhD in the role and control of matrix metalloproteases in cutaneous wound healing.Kristina Hamberg has over 10 years of experience of working with the design and development of wound care products, particularly those with antimicrobial properties. During that time, she has become an expert within the areas of microbiology and test method development, as well as infection prevention. Kristina was awarded her MSc in food science in 1997 from the University of Kalmar, Sweden, and in 2002 she was awarded a PhD for microbiological evaluation of novel technologies for food preservation by Chalmers Technical University, Gothenburg, Sweden.How to cite this document: Davies, P., McCarty, S., Hamberg, K. Silver-containing foam dressings with Safetac: a review of the scientific and clinical data. J Wound Care 2017; 26: 6 (Suppl. 1), S1-S32. Conclusion S24 References S27Downloaded from magonlinelibrary.com by 054

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The effectiveness of silver‐releasing dressings in the management of non‐healing chronic wounds: a meta‐analysis

Abstract: The results of this study provide objective data on the effectiveness of silver-related dressing when applied to non-healing chronic wounds.

Cited by 80 publications

References 22 publications

Wounds research for patient benefit: a 5-year programme of research

Wounds research for patient benefit: a 5-year programme of research

New Strategies in the Development of Antimicrobial Coatings: The Example of Increasing Usage of Silver and Silver Nanoparticles

Silver-containing foam dressings with Safetac: a review of the scientific and clinical data

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