nhs fife woundcare guidelines · wound care consumes a significant amount of resources in terms of...

Area Drug and Therapeutics Committee

NHS Fife Wound Formulary Updated Sept 2018

Wound Formulary And Wound Management Guidelines

2017 Updated September 2018

Developed by the NHS Fife Wound and Skin Care Forum (WSCF) Group

Approved: December 2016 Updated Sept 2018 For review: February 2020 Approved by NHS Fife ADTC 2016



Contents Introduc on 2

Wound Defini on 4

Cavity Wounds, Packing and Probing 4

Necro c Wounds & Comprehensive wound assessment 5

Factors to consider when planning holi wound care 7

Characteris of ideal dressings & Ordering products 8

Guide to selec on of wound dressings 9 Overgranula on 10

STAR – Skin Tear Classifica on System 11

Bacterial burden and management of infec on 12

Wound cleansing guidelines 14

MONOGRAPHS FOR DRESSINGS

o Barrier film 17

o Non adherent dressings 17

o Hydrocolloid dressings 18

o Foam dressings 19

o Hydrofibre dressings 20

o Hydrogel dressings 21

o Alginate dressings 22

o Deodorising dressings 23

o Silicone dressings 24

o Silicone Foam 25

o Super Absorbent Dressings 26

SPECIALISED DRESSINGS

Guidance for use of Specialised dressings and therapies 27

Ropper Ladder 28 o Silver containing Dressings 29

o Prontosan Preparation 29

o Cutimed Range 30

o Honey Preparations 30

o Iodine containing Dressings 32

o Antimicrobial Alginate Gel 32

o Pain Management Dressings 33

o Foam/Fibre Dressings - Heavily Exuding Wounds 33

o Debridement product 33

o Tulle Dressings 34

o Technology Lipidocolloid (TLC) 34

o Specialist Plastic Surgery 36

o Larvae Therapy 37

o Negative Pressure Wound Therapy 37

o Wound Drainage Bags 38

Glossary of Wound Terms 39

Reading list / Resources 40

Related Policies 42

Appendix 1 – Wound Assessment Charts 43

Appendix 2 – Wound Conversion Charts 46

1



Introduction

Wound care consumes a significant amount of resources in terms of wound management products and professional time. The range of wound care products currently available can be bewildering and choosing the most appropriate dressing difficult. There is no such thing as the perfect dressing, so the choice is usually a compromise, trying to achieve the optimum environment to encourage the best outcomes in the shortest time. The dressing selected will invariably change as the wound healing proceeds, adding to the number of decisions necessary.

The introduction of non-medical prescribing has increased both responsibility and accountability in wound management. Prescribers must therefore ensure that the choice of dressing is based on a full and accurate assessment of all the factors which may influence healing, and not just the wound itself.

These guidelines aim to assist practitioners in the assessment and management of wounds. They encourage rational, Price-effective prescribing of dressings and other materials used in wound care. Demonstrating the use of evidence based treatments, and allowing practitioners to disseminate and share best practice, will promote seamless care across all sectors.

On most of the pages containing information on dressings, a 1st and 2nd choice is given. Where possible, the 1st choice dressing should be used, however there may be reasons that this is not appropriate, therefore the 2nd choice dressing may be used. Staff must be able to give a rationale for choosing a dressing out with the main pages of the guidelines and this should be documented in the patients’ notes. Other dressings, treatment choices are within the specialised dressing pages. Dressing prices (Scottish Drug Tariff, SDT January 2017) have been added to make practitioners aware of Price. More expensive dressings may still be Price effective if used in the correct manner. Practitioners are advised to contact their local Tissue Viability nurse or Podiatrist for further advice, if they have a good rationale for not using the choice of dressing given.

These guidelines are based on a selection of up to date research and clinical expertise of group members. We do accept that opinions vary and point out that these guidelines are not intended to be a definitive textbook, therefore a further reading list is included.

Disclaimer

Guideline users should be mindful that, as with any clinical guideline, recommendations may not be appropriate for use in all circumstances. Clearly, a limitation of any guideline is that it simplifies clinical decision making processes and recommendations.

Decisions to adopt any particular recommendations must be made by the practitioner in the light of available resources, local services, policies and protocols. The particular patient’s circumstances and wishes including consent for treatment and medical photography, available personnel and equipment, clinical experience of the practitioner and knowledge of most recent research findings must all be considered and decisions clearly documented in the patient’s notes.

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Acknowledgements

The NHS Fife Wound and Skin Care Forum would like to thank the Glasgow Wound Guidelines Group, for allowing us to use some of their work, particularly in the teaching area of the Fife Guidelines. We would also like to thank Ruth Ropper, Tissue Viability Nurse in Lothian for her permission to use the Ropper Lothian Ladder for wound infection.

We would also acknowledge the contribution of both NHS Fife Community Services and NHS Fife Acute Services Division staff in the development of these Guidelines.

NHS Fife Wound and Skin Care Forum (WSCF) Guideline Group

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NAME POSITION

Jane Nicoll Lead Tissue Viability Nurse, ASD (Chairperson)

Anne Barns District Charge Nurse, Path House, Kirkcaldy

Andy Cameron Senior Procurement Officer

Julia Chalmers District Charge Nurse, Balmullo Health Centre

Lynn Coyne Plastic Surgery Specialist Nurse, ASD

Antonia De Angelis Tissue Viability Nurse, ASD and Community

Katrina Deas Clinical Practice Development Officer

Fiona Dick Charge Nurse, Ward 13 VHK

Kevin Finnegan Assistant Procurement Administrator

Fiona Graham Highly Specialist Podiatrist

Tanya Hardy Senior Staff Nurse, Plastic Surgery, ASD

Joanne Koczubik Plastic Surgery Nurse, ASD

Deborah McCallum Clinical Nurse Practitioner, Plastic Surgery, ASD

Heather McKellar Senior Charge Nurse in OPD, Adamson Hospital

Gillian Meldrum Highly Specialist Podiatrist

Gillian Preston Tissue Viability Nurse, ASD

Leesa Radcliffe Community Tissue Viability Nurse, West Fife

Yvonne Robson Senior Charge Nurse, OPD, QMH

Susan Roemmele Staff Nurse, Dermatology Department, QMH

Islay Roy Plastic Surgery Nurse, ASD

Lesley Shiels Tissue Viability Nurse, Community East Fife

Mary Thomson Senior Prescribing Support Nurse

Caroline Turnbull Plastic Surgery Nurse, ASD

Catherine Ward Staff Nurse, Ward 10 VHK

Karen Whatton Senior Prescribing Support Nurse

Anne Wilson Vascular Nurse and Senior Prescribing Support Nurse



Wound Definition

For the purposes of these guidelines, the following definitions apply - A simple wound is one where there is damage to the epidermal layer of the skin, including

discolouration due to pressure damage.

A complex /chronic wound is one which heals by granulating from the base up and requires contraction and scar tissue to close. Debridement of slough and necrotic tissue may be necessary.

It is important to note that the term chronic suggests longevity; however, many wounds e.g. diabetic foot or rheumatoid lesions may be termed chronic at the onset. A more accurate term for a chronic /complex wound would be a compromised wound. It is the underlying host response to the wound, which will determine to a great extent its ability to heal.

Cavity Wounds

Providing a single definition for a cavity wound is challenging as they vary in aetiology, size, depth and position. They may present with additional challenging features such as sinus formation, fistulae, undermining or bridging (Wounds UK, Cavity Wounds Quick Guide, 2016)

For the purposes of these guidelines, the following definitions apply – A wound extending beneath the layers of the dermis, potentially exposing structures such as

fascia, tendon, muscle or bone.

A wound requiring more than a simple flat dressing – wounds that require a ‘filler’ dressing.

A wound deeper than 2cm.

Packing and Probing wounds

Guidance has been requested on how best to pack a wound and how to probe a wound to measure wound depth. A literature search was conducted; unfortunately there is no evidence to support robust guidance. However the consensus of the Fife Wound and Skin Care Forum Group is as follows:

Clinicians must use their clinical judgment when deciding to pack or probe a wound.

To gauge depth use a soft cotton tipped swab to gently probe, taking care not to damage tissue or structures.

Podiatrists, please seek local advice regarding probe type.

To pack a wound with a hydrogel or alginate gel, half fill the cavity and apply secondary dressing.

To pack a wound with dressing material, the end of the wound must be established to avoid dressing material being lost within the wound, it may be more appropriate to use a gel.

Pack dressing material loosely

Clearly document how many pieces of dressing material have been inserted and removed from the wound.

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Necrotic tissue

Necrotic tissue is a layer of dead tissue which can be brown/ black and or waxy in colour and is caused by an inadequate blood supply or infection. It may be soft or hard on the surface. The skin can remain intact and the necrosis can be of varying depth and it may produce an offensive smell.

Nursing staff must be cautious before attempting to remove necrotic tissue from a wound; this includes autolytic debridement with the use of hydrogels and dressing products. A full, holistic assessment of the patient must be undertaken first to ascertain any intrinsic or extrinsic factors which may cause complications if removal of necrotic tissue is initiated or necessary.

Necrosis should not be routinely removed in an ischemic area. This may cause significant

deterioration in the area.

Necrosis should not be routinely removed and at the end of life in the absence of any systemic

or local signs of infection unless required for symptomatic relief.

For example: debridement may be necessary e.g. wound is beginning to break down, a

collection of fluid is evident below the necrosis and when malodour or infection is an issue, this

must be discussed with the relevant clinicians before you attempt any form of necrotic tissue

removal.

Specialist advice should be sought when considering sharp debridement of a wound.

Mechanical or surgical removal such as sharps debridement of tissue should only be performed

by specialist practitioners.

Further information:

Guidelines For Practice, Effective Debridement in a Changing NHS – a UK Consensus, Wounds UK 2013. Available form: www.wounds-uk.com

Healthcare Improvement Scotland (2010) Tissue Viability Scottish Wound Assessment and Action Guide. ..\20100728_Wound_Assessment_Tool_Guide_Final SWAG.pdf

Comprehensive Wound Assessment

Recognised good practice is to assess a wound using a validated wound assessment chart (see page 43)

Compromised wound healing is usually a result of the patients underlying disease processes, ability to initiate an inflammatory response and fight infection. Intrinsic factors must therefore be taken into account whilst planning wound care.

Extrinsic factors at the wound bed (slough, necrotic tissue, biochemical and bacterial burden or damage to underlying structures, e.g. tendon) may inhibit the healing process and wound bed preparation must be carried out to promote proliferation and epithelialisation. (See web site below).

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http://www.wounds-uk.com/



The condition of the surrounding skin must be considered when recognising if there are signs of infection, tracking or undermining of the wound. Consideration must be made as to whether adhesive or non-adhesive dressings should be used dependent on the vulnerability of the surrounding skin.

Address patient issues to establish if the patient/carer can be empowered to assist in their own wound care. It is important to determine if they have the ability to cope psychologically with the presence of a wound. It is important to recognise the need for adequate pain control / analgesia and this must be reviewed regularly.

It is not always possible to heal wounds due to the patients underlying aetiology (e.g. in fungating tumours or advanced disease). In this instance palliative care may be the aim, with management of symptoms in a way that is acceptable to the patient.

There should be an awareness in the non-healing compromised wound that further referral to the appropriate specialty may be required, e.g. vascular, dermatology, podiatry, plastic surgery or tissue viability.

Assessment tools have been developed by the National Association of Tissue Viability Nurses (Scotland) and the Scottish Wound Assessment and Action Guide can be accessed on-line:

..\20100728_Wound_Assessment_Tool_Guide_Final SWAG.pdf

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Factors to Consider when Planning Holistic Wound Care

7

Patient Issues (Relating to wound and personal)

Pain Odour

Exudate Anxiety

Low Self Esteem Poor Mobility

Social Isolation Loss of employment/income

Feeling vulnerable Need to be included with their management

Compromised blood flow Oedema

Diabetes Poor nutrition

Connective tissue disorders Smoking

Malignancy Alcohol misuse

Drug treatment /radiotherapy Systemic infection

Redness Maceration

Dry / Flaky Oedematous

Nodular Fragile

Undermining Tracking

Condition of margins Suppleness

Healthy granulation Exposed tendon or bone

Epithelialisation Bacterial Burden

Wet / Dry Slough Biochemical imbalance

Type & Colour of exudate Depth, presence of sinus or fistulae

Necrosis Precise anatomical position

Inability to access food Poor economic status Reduced mobility Inability to communicate preference Socially isolated

Poor appetite Underlying disease process Medication Depression

Difficulty in swallowing Stroke Neuromuscular disorders Underlying malignancy

Inability to absorb adequate nutrients Gastro-intestinal disorders Malabsorption syndrome Paralytic ileus

Vomiting and diarrhoea Small or large bowel resection

Increase metabolic demand Trauma Sepsis Recent surgery



Characteristics of Ideal Dressings

1. Provide the optimum environment for wound healing - a moist environment - at the wound/dressing interface.

2. Allow gaseous exchange of oxygen, carbon dioxide and water vapour.

3. Provide thermal insulation - wound healing is temperature dependent.

4. Impermeable to micro-organisms (in both directions).

5. Free from particulate contaminants.

6. Non-adherent (many products are described as non-adherent but are low adherent).

7. Safe to use (non-toxic, non-sensitising, non-allergenic).

8. Acceptable to the patient.

9. High absorption characteristics (for exuding wounds).

10. Price effective.

11. Carrier for medicaments, e.g. antiseptics.

12. Capable of standardisation and evaluation.

13. Provide mechanical protection.

14. Conformable and mouldable (especially over sacrum, heels and elbows).

It is generally recognised that modern wound dressings are capable of being left on the wound bed for up to seven days, however this is dependent on exudate levels and whether there is infection present within the wound, therefore check with the instructions given within the box of dressings for further information.

Ordering Dressings

The most Price effective ordering route for both hospital and community is via the Area Distribution Centre/National Distribution Centre (ADC/NDC).

All dressings listed on the general pages of the Wound Management Guidelines are available on Drug Tariff. To order an item that is not on formulary, an Exception form must be completed and submitted to the Senior Prescribing Support Nurses ([email protected])

http://www.fifeadtc.scot.nhs.uk/formulary/woundcare-formulary/woundcare-catheter-product-request-and- exception-form.aspx

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http://www.fifeadtc.scot.nhs.uk/formulary/woundcare-formulary/woundcare-catheter-product-request-and-

Fife Health & Social Care

Partnership Supporting the people of Fife together

IS THE WOUND?

OBJECTIVES: To protect and

promote new tissue growth.

OBJECTIVES: Encourage

angiogenesis and promote granulation tissue.

OBJECTIVES: To debride slough,

manage exudate levels.

OBJECTIVES: To rehydrate eschar. NB: Depending on overall aims, it may not be appropriate to break necrosis

down, e.g. palliative or vascular wounds.

OBJECTIVES: To reduce bacterial load in wounds. NB: If spreading infection (e.g. cellulitis), systemic

antibiotics will be required.

Developed by NHS Fife Wound & Skincare Forum (WSCF) January 2017. Review Date January 2020 updated July 2018 For further information on dressings, refer to Wound Formulary.

EXUDATE LEVELS EXUDATE LEVELS EXUDATE LEVELS EXUDATE LEVELS

LOW MED - HIGH

EXUDATE LEVELS

LOW MED - HIGH

Infected Necrotic Sloughy Granulating Epithelialising

NHS ASSESS THE WOUND

Non-adherent Non-adherent dressing dressing with

OR absorbent pad

Thin Hydro- OR

colloid Foam adhesive/ Non adhesive

FORMULARY DRESSINGS

1st CHOICE 1st CHOICE

365 Island NA Ultra plus

Kliniderm

2nd CHOICE

Mepilex Lite/

AllevynGentle

Border Lite

2nd CHOICE

Tegaderm Foam/

Tegaderm Foam

adhesive

Antimicrobial

impregnated

dressing &

non adherent

dressing.

Antimicrobial

or silver

impregnated

dressing

plus

absorbent

secondary

dressing

FORMULARY DRESSINGS

1st CHOICE

Inadine &

non adherent pad

2nd CHOICE

Actilite and

non adherent

pad

1st CHOICE

Urgotul SSD

& Kliniderm

2nd CHOICE

Refer to

Infected Wound

section of

Wound Guidelines

(Ropper Ladder)

Hydrogel and

non-adherent

dressing with

pad

OR

Hydrocolloid

Foam dressing

Consider.

hydrogel if

necrosis still

needs broken

down.

FORMULARY DRESSINGS

1st CHOICE 1st CHOICE

Comfeel Plus Aquacel Extra &

Ulcer Kliniderm

2nd CHOICE 2nd CHOICE

Purilon gel & *Aquacel Foam

Tegaderm Foam adhesive/

non adhesive

Hydrofibre

Hydrogel dressing &

absorbent pad

Non-adherent OR with pad or

foam Foam dressing

FORMULARY DRESSINGS

1st CHOICE

Purilon gel &

Mepilex Lite

2nd CHOICE

Purilon gel &

Tegaderm Foam/

Tegaderm Foam

adhesive

1st CHOICE

Aquacel Foam*

2nd CHOICE Tegaderm Foam/

Tegaderm Foam

adhesive (if

infection

suspected, refer to

Infected Wound

section).

Non-adherent

dressing

OR

Foam dressing

Non-adherent dressing with

absorbent pad

OR

Foam dressing

FORMULARY DRESSINGS

1st CHOICE

365 Island

dressing

2nd CHOICE

Tegaderm Foam/

Tegaderm Foam

adhesive

1st CHOICE

Aquacel Extra

plus Kliniderm

2nd CHOICE

Tegaderm Foam/

Tegaderm Foam

adhesive

LOW MED - HIGH LOW MED - HIGH LOW MED - HIGH

REMEMBER: A full holistic assessment of the patient

must be carried out.

Overgranulation

An essential aspect of secondary intention wound healing is the proliferation of granulation tissue, (McGrath, 2011). Granulation incorporates a dense network of blood vessels and newly growing capillaries with an irregular upper layer created by the capillaries looping together on the wound surface. This is what gives the appearance of red lumps or granules on the wound surface. When granulation ‘over grows’ beyond the surface of the wound, this is known as overgranulation, or hypergranulation. It is clinically recognised by a soft, fleshy, friable, often shiny appearance which is raised above the level of the surrounding skin. The wound will not continue to heal as the presence of this tissue will prevent the migration of epithelial tissue across the wound bed.

The exact cause of overgranulation is unknown, (Russell 2000). It is thought to be the consequence of a reaction to foreign bodies, infection/bio burden, mechanical trauma or allergies and hypersensitivities.

The research to date to support treatment options for overgranulation is limited, (McGrath, 2011). Reported treatments attempt to treat the causative factor, and focus on reducing bacteria present, applying pressure, using non occlusive dressings and the use of steroid therapies.

It is essential that the clinician can identify the causative factor of the overgranulation, in order to make informed clinical decisions on an effective treatment. A number of treatment options exist, and for this reason, the advice of an appropriate specialist should be sought, e.g. local Tissue Viability Nurse or Plastics Nurse.

References McGrath A (2011) Overcoming the challenge of overgranulation. Wounds UK 7(1): 42-49 Russell L (2000) Understanding physiology of wound healing and how dressings help. British Journal of Nursing 9(1): 10-21 Stephen – Haynes J. Wound Care Alliance UK: Achieving effective outcomes in patients with overgranulation

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Bacterial Burden and Management of Infection

Bacterial burden and virulence are important factors in assessing the wound for infection. Host resistance is a major determinant in the body’s ability to fight infection and initiate an inflammatory response. This may be illustrated in the following equation:

Infection = dose x virulence

host resistance

Bacterial Burden Continuum

Wound Swabs for Microbiology

Wound infection is recognised by the presence of clinical signs of infection rather than the isolation of bacteria from a wound swab. A wound swab should only be taken when there is concern regarding infection. They should not be taken as part of “routine practice”. Taking a wound swab will give a qualitative picture of bacteria present on the wound surface. These are most commonly colonising bacteria and not responsible for infection. (Refer to The Adapted Ropper Lothian Ladder). N.B. Do not confuse signs of inflammation with infection

For diabetic foot wounds consult local podiatrist for advice at an early stage as signs of infection may be masked.

Organisms most commonly associated with soft tissue infections are S.aureus, and Group A, B, C, and G Streptococcus. The clinical presentation should be reviewed alongside the swab result to ensure the most appropriate treatment is prescribed.

Swabbing for culture and sensitivity is only recommended before antibiotics are commenced or to confirm that the antibiotics commenced are appropriate. If a patient fails to respond to antibiotics within 72hours, then consider re-swabbing or seek further Medical advice

The Price incurred for each Wound Swab is in excess of £35.88.

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Bacterial Load Definition Wound Dressing

Contaminated Presence of non replicating bacteria in the wound

Topical antimicrobial and antibiotics not recommended.

Colonised Replicating bacteria adhering to the wound, with no detrimental effect to wound healing

As above.

Critically colonised Presence of bacteria at the wound bed, which compromises healing but does not result in infection

Topical antimicrobial dressings can be used. In general, a two week treatment is advised. If no improvement in wound after this time, seek advice from local wound care specialist

Infection Invasion and multiplication of micro-organisms in body tissues with overt host response

If there is clinical evidence of invasive infection systemic antibiotics are required. Prescribe systemic antibiotic therapy in conjunction with appropriate dressing.



The wound bed must be cleansed prior to swabbing so as to avoid sampling slough or necrotic tissue that may only reveal surface organisms which are not causing underlying infection. Critically colonised or infected wounds can be treated with antimicrobial dressings but when significant infection is present systemic antibiotics should be commenced.

Procedure for taking a Wound Swab

Irrigate the wound with Sodium Chloride 0.9% solution.

Swab the edge of the wound adjacent to the good tissue which is inflamed. It is the organism infecting the good tissue which will be the major pathogen. This would normally tend to be nearer the edge of the wound as the tissue in the centre is more often necrotic.

The swab should be rotated between the fingers to ensure that all sides of the swab make contact with the wound.

Infected wound below, swab area as directed by arrows

13

Example of most suitable areas to swab



Wound Cleansing Guidelines

To Clean or Not To Clean?

There is no single correct way to clean a wound or the surrounding skin, although there are a number

of important considerations

Does the wound really need cleansing?

What is the safest method that causes no ill effect and maintains the wound temperature?

What is acceptable to the patient?

Simple wound cleansing procedure (e.g. suture lines, superficial breaks)

Gentle skin washing with warm tap water (e.g. showering).

A minimalist approach is recommended to reduce interference at the wound bed.

Dry surrounding skin with non woven gauze to allow adherence of wound dressing.

Compromised / complex wound cleansing procedure

Aims:

Remove excess exudate, debris or old dressing materials.

Minimize pain and trauma.

Prevent infection.

Procedure

1 Explain procedure and rationale to patient.

2 Wash hands thoroughly as per hand hygiene policy prior to and following procedure.

3 Dressing packs are not always necessary.

4 Requirements: non woven swabs, clean surface, non-sterile gloves.

5 Remove dressing as per manufacturer’s instructions.

6 Assess wound type and carry out appropriate irrigation procedure (see pages 11 and 12).

7 Dry surrounding area with non woven swabs.

8 Do not touch surface of wound with swabs.

9 Apply new dressing.

Further guidance available, wound cleansing flowchart: www.tissueviabilityscotland.org

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http://www.tissueviabilityscotland.org/



Wound Cleansing Guidelines

Infection Control Manual can be accessed via:

Intranet / Subjects / Infection Control / Infection Control Manual http://intranet.fife.scot.nhs.uk/subjects/index.cfm?fuseaction=service.display&pageid=7A5F5BB2-5056-8C6F- C03F5A9FA592A31A&subjectid=6C965E0A-DB7D-B17A-04E54EAC6A42E839&objectid=6BE801F1-5056-8C6F-C0E12BB07758F462

15

Preparation Procedure Rationale

Gentle showering of wound area during routine social hygiene

Run shower for three minutes. Ensures free flowing warm clean water.

Gently irrigate wound with warm water using shower head. Ensures safe removal of exudate, loose slough and wound dressing residue.

In healthcare premises, shower should be cleaned with general purpose neutral detergent/cream cleanser before and after use.

Maintains clean working environment.

In the home care setting patients own household cleaner should be used to clean the shower and/or bath before and after the procedure. Refer to Infection Control Manual.

Bucket lined with polythene bag for lower limbs

Gently wash limb. Dry skin surrounding wound prior to application of new dressing. Avoid direct contact with wound bed.

Ensures safe removal of exudate, loose slough and wound dressing residue. It incorporates social hygiene into wound management procedure.

In healthcare premises, bucket should be cleaned with general purpose neutral detergent and warm water, rinsed and dried. Buckets should be stored dry and inverted. Patients own household cleaner should be used in home care setting. Refer to Infection Control Manual.

Maintains clean working environment.

http://intranet.fife.scot.nhs.uk/subjects/index.cfm?fuseaction=service.display&pageid=7A5F5BB2-5056-8C6F-



With Sodium Chloride 0.9% Solution - Hospital and Primary Care = Irripod 20mls

Warm Sodium Chloride 0.9% solution pods by running under hot water Does not require alcohol swab to wipe pod prior to use Available on prescription

Irrigate wound area with Sodium Chloride 0.9% solution to remove surface exudate and loose slough or dressing residue.

To maintain optimum temperature for healing.

If slough is not easily removed by irrigation, further hydration with wound dressing products will be necessary.

FOR COMPROMISED WOUNDS ONLY Use soak of Prontosan® Solution with gauze swabs for 10

minutes at dressing change, then discard. Deeper cleansing of wound and biofilm removal

N.B. Prontosan should not be routinely used. It is for use in compromised wounds. For example, chronic or infected wounds

16

Dressing Size (Pack Size) SDT Price – July 2018(Each)

Irripod® 20ml (25) 23p

Prontosan® 40ml (24) 350ml

60p £4.86



Barrier Film

Sureprep® No Sting Barrier Film Sorbaderm® Cream

Description Sureprep® No Sting Barrier Film provides long lasting skin protection for up to 72 hours. Sorbaderm® Cream provides long lasting protection from bodily fluids whilst moisturising the skin

Indications

Intended to be used as a primary barrier and moisturiser against irritation from bodily fluids e.g. from urine and/or faeces. The no sting film acts as a protective barrier against adhesive wound dressings and surgical tapes, provides peri-wound protection from exudate damage and provides protection from damage caused by friction and shear. It is suitable for use in neonates.

Method of Use

Both film and cream should be applied to clean, dry skin. Sureprep® No Sting Barrier film should be applied in a uniform coating over the entire treatment area when using the foam applicator. If using the spray, hold the nozzle 10 - 15cm from the treatment area and apply a smooth, even coat. Allow to dry for 60 seconds before applying any adhesive dressings or surgical tapes. Reapply at least every 48 - 72 hrs (or more frequently if required) Sorbaderm® Cream should be applied in small amounts, gently smoothing into the skin over the affected area and allowed to dry for 30 seconds before applying any dressing

N.B. If the after feel of the skin is oily, then too much has been applied.

Non-adherent Dressings

N-A® Ultra

Description A primary wound contact layer consisting of a knitted viscose rayon sheet with a silicone coating.

Indications Provides moisture retention or rehydration, thermal insulation and low-adherence. A secondary dressing is required to dress more heavily exuding wounds.

Method Of Use

Apply directly to the wound surface. Secondary dressings are required to retain dressing in position.

Frequency of changing the dressings depends on exudate/ strike through

Dressing Size (Pack Size) SDT Price - July 2018 (Each)

N-A® Ultra 9.5cm x 9.5cm (40) 9.5cm x 19cm (25)

£0.35 £0.67

17


Sureprep® No Sting Barrier Film 1ml foam applicator (25) £0.77 3ml foam applicator (25) £1.32 28ml spray bottle (1) £5.00

Sorbaderm® Cream 2g sachet (20) £0.18 28g (1) £2.20 92g tube (1) £3.20



Hydrocolloid Dressings

First Choice: Comfeel® Plus Transparent/Comfeel® Plus Ulcer Second Choice: Duoderm® Extra thin

Comfeel® Plus Transparent Duoderm® Extra Thin

Description A hydrocolloid dressing is a micro granular suspension of various natural or synthetic polymers, e.g. gelatin or pectin, in an adhesive matrix. The dressings are interactive with wound exudate - by slowly absorbing fluid. They physically change to form a gel, which may be cohesive, and/or hydrophilic.

Comfeel® Plus Ulcer Absorbent hydrocolloid dressing with added alginate for absorption, a vapour-permeable film backing with beveled edge to reduce rucking. There is a 1cm grid printed on backing to aid wound measurement.

Indications Aids debridement in wounds covered with black necrotic tissue, suitable for softening eschar and promoting granulation. Suitable for low to moderately exuding wounds. May also be used prophylactically on areas prone to breakdown and as a secondary dressing.

Method Of Use Apply dressing of sufficient size to provide at least 2cm overlap onto intact skin. Smooth dressing into place - warmth of the hand improves initial adhesion. For best results aim to leave dressing in place for at least 3 days. Dressings may be left in place for up to 7 days in low exuding wounds.

N.B. Owing to the occlusive nature of their backing hydrocolloids are not considered suitable for the treatment of clinically infected or very heavily exuding wounds.


Comfeel® Plus Transparent 5cm x 7cm (10) 5cm x 25cm (5)

9cm x 14cm (10) 10cm x 10cm (10) 15cm x 15cm (10) 20cm x 20cm (5)

£0.68 £2.61 £2.46 £1.29 £3.37 £3.44

Comfeel® Plus Ulcer 10cm x 10cm (10) 15cm x 15cm (10) 20cm x 20cm (5) 4cm x 6cm (10)

£2.48 £5.31 £7.64 £0.97

Duoderm® Extra Thin 5cm x 10cm (10) £0.78

7.5cm x 7.5cm (5) £0.81 9cm x 15cm (10) £1.80 9cm x 25cm (10) £2.87 9cm x 35cm (10) £4.02

10cm x 10cm (10) £1.34 15cm x 15cm (10) £2.90

18



Foam Dressings

Tegaderm® Foam / Tegaderm® Foam Adhesive Tegaderm® Foam Adhesive - Heel only

Description Highly absorbent polyurethane foam dressing with semipermeable film backing layer. Foam dressings in general provide thermal insulation, do not shed fibres or particles and can be cut or shaped to fit the wound (non-adhesive). They help to maintain a moist environment at the surface of the wound and are gas permeable and non adherent. Should be used on moderate to highly exuding wounds.

Tegaderm® Foam / Tegaderm® Foam Adhesive Tegaderm Foam is suitable for use in moderate to highly exuding wounds. Tegaderm Foam Adhesive is suitable for low to highly exuding wounds. Can be used on clean granulating wounds or as a secondary dressing in sloughy or necrotic wounds, can be used under compression. Adhesive version is beneficial for patients wishing to bathe or shower. Dressing should be renewed when exudate has reached within 1cm of the edges of the dressing. The dressing may be left in place for 3 - 7 days depending on the level of exudate.

Tegaderm® Foam Adhesive - Heel only A highly absorbent polyurethane foam dressing with semipermeable film backing layer and adhesive border. Comprises of four layers for high fluid absorption.

19


Tegaderm® Foam 8.8cm x 8.8cm (10) £2.25 10cm x 10cm (10) £2.20 20cm x 20cm (5) £5.97 10cm x 20cm (5) £3.74 10cm x 60cm (Roll) £12.64

Tegaderm® Foam Adhesive 6.9cm x 7.6cm (10) £1.47 10cm x 11cm (10) £2.39

14.3cm x 14.3cm (10) £3.57 14.3cm x 15.6cm (5) £4.28

Tegaderm® Foam - Heel 13.9cm x 13.9cm (5) £4.25



Hydrofibre Dressings

Aquacel® Extra/ Aquacel®

Description A soft, non woven pad composed of hydrocolloid fibres. This interacts with wound exudate and forms a soft gel which is easy to remove with little or no damage to healing tissue.

Indications Used in the management of moderate to heavily exuding wounds. Can be used in acute and chronic wounds, e.g. abrasions, lacerations, leg ulcers, pressure sores. Infection is not a contraindication to use.

Method Of Use Apply directly to the wound surface. Irrigation facilitates removal. Secondary dressing is required. May be left in place for up to seven days – depending on the level of exudate.

NB If “packing” a wound with Aquacel® Extra, always leave a small piece outside of the wound to facilitate removal. Also record the number of pieces of used. (See wound chart).

Hydrofibre Foam Dressing

Aquacel® Foam

Aquacel® foam dressings have a soft absorbent pad, an Aquacel contact layer, a gentle silicone adhesive and a waterproof/ bacteria barrier. It can be used on a variety of moderate to heavily exuding wounds.


Aquacel® Foam Non Adhesive 5cm x 5cm (10) £1.36 10cm x 10cm (10) £2.58 15cm x 15cm (5) £4.33 15cm x 20cm (5) £5.92 20cm x 20cm (5) £7.07

Aquacel® Foam Adhesive 8cm x 8 cm (10) £1.42 10cm x 10cm (10) £2.18

12.5cm x 12.5cm (10) £2.70 17.5cm x 17.5cm (10) £5.40

21cm x 21cm (5) £7.91 25cm x 30cm (5) £10.24

20

Dressing Size (Pack Size) SDT Price - July2018 (Each)

Aquacel® Extra 5cm x 5cm (10) £1.02 10cm x 10cm (10) £2.42 15cm x 15cm (5) £4.56

Aquacel® 1cm x 45cm Ribbon (5) £1.88 2cm x 45cm Ribbon (5) £2.50



Hydrogel Dressings

First choice : Purilon®Gel

Description An amorphous gel with high water content, containing Calcium Alginate (Purilon®)

Indications Hydrogels facilitate autolysis by rehydrating necrotic tissue and effecting debridement. They provide a moist environment which promotes healing. They are non-adherent and do not harm viable tissue or surrounding skin. Bacterial colonisation of the wound is not a contraindication to the use of a hydrogel.

Method of Use Apply the gel directly into the wound. A secondary moisture - retentive dressing is required e.g. Hydrogel should be changed when the cover dressing leaks. Intervals should not exceed 3 days when used on sloughy or necrotic wounds or 7 days if used on clean granulating wounds.

N.B. When using in cavity wounds only half fill the cavity. Due to the effective debridement of necrotic tissue, a wound being treated with gel may appear larger at first dressing change, however, this is a natural step in the healing process.

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Purilon® Sterile 8g tube (10) Sterile 15g tube (10)

£1.77 £2.31



Alginate Dressings

Kaltostat®

Description The basic elements of alginates are extracted from brown seaweed (Phaeophyceae). Their clinical composition means that they are highly absorbent and biodegradable. Alginates vary in composition (calcium/sodium salts of alginic acid) and in the arrangement of fibres.

Indications Alginate dressings are suitable for moderate to heavily exuding wounds. They form a gel on contact with the wound exudate, and are effective at absorbing exudate, debriding slough and encouraging granulation tissue. Where bleeding is involved, Kaltostat® may be considered as a haemostatic agent.

Method Of Use Apply to the wound surface/cavity, secondary dressing required to secure. Frequency of change will depend on level of exudate.


Kaltostat® 5cm x 5cm (10) £0.97 7.5cm x 12cm (10) £2.12 10cm x 20cm (10) £4.15 15cm x 25cm (10) £7.14

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Deodourising Dressings

First choice : Clinisorb®

Second choice : CarboFlex®

Clinisorb®

Description Clinisorb® is an activated charcoal cloth dressing, produced by carbonising and activating woven viscose rayon that is sandwiched between two layers of a nylon and viscose rayon blend. Clinisorb® has the optimum combination of microporous activity and activated charcoal cloth weight, for significantly reducing odour by attracting and permanently trapping bacteria. It is non-adhesive and contained in a sterile peel pack.

Indications Clinisorb® can be used to manage malodourous wounds such as fungating breast lesions, pressure ulcers, leg ulcers and diabetic foot ulcers.

Method Of Use Clinisorb® can be used as a primary or secondary dressing and its soft, flexible construction can be cut to fit practically any wound. Even unusually shaped fungating wounds on curved body sites can be easily dressed. Clinisorb® is highly effective wet or dry, can be used either side down, and can be left in place for up to one week.

CarboFlex®

Description A sterile non-adhesive dressing consisting of five layers - film layer, absorbent padding, activated charcoal cloth, film layer and absorbent wound contact layer containing Kaltostat® and Aquacel®.

Indications For use in the management of malodourous acute and chronic wounds. May be used as a primary dressing for shallow wounds or as a secondary dressing over wound fillers with deeper wounds.

Method Of Use This dressing must not be cut to size or shape. The fibrous surface is placed directly on to the wound. This may be left undisturbed for up to three days depending on the level of exudate.


Clinisorb® 10cm x 10cm (10) 10cm x 20cm (10) 15cm x 25cm (10)

£1.92 £2.56 £4.12

CarboFlex® 8cm x 15cm (5) Oval 10cm x 10cm (10) 15cm x 20cm (5)

£3.92 £3.27 £7.44

23



Silicone Dressings

Mepitel® One

Description A sterile transparent soft silicone wound contact layer, which is non adherent to a moist wound bed.

Indications For use in a wide range of painful, chronic and traumatic wounds and wounds with compromised or fragile surrounding skin. The soft silicone adheres gently to the surrounding skin and ensures removal with minimal trauma and pain. Mepitel®One prevents the outer dressing sticking to the wound. The porous structure of Mepitel® One allows exudate to pass to an outer absorbent dressing.

Method Of Use Apply directly to the wound or wound bed. It can be cut to size or shape of wound if desired. Requires a secondary dressing which can be changed independently as the Mepitel® One can remain in place for up to 10 days. Mepitel® One may offer advantages when primary dressings are required to stay in place for longer periods, since it is adhesive on one surface only.

Mepilex® Lite

Description A thin absorbent foam dressing with soft silicone contact layer and film backing

Indications For use on non to low exuding wounds. May also be used as a protective dressing on compromised or fragile skin.

Method of Use Apply directly to wound or wound bed. Mepilex® Lite can be easily cut to fit an individual wound and makes it ideal for difficult to dress wounds, such as armpits, breast etc.


Mepilex® Lite 6cm x 8.5cm (5) £1.82 10cm x 10cm (5) £2.17 15cm x 15cm (5) £4.22 20cm x 50cm (5) £26.66

24

Dressing Size (Pack Size) SDT Price - July2018(Each)

Mepitel® One 6cm x 7cm (5) 9cm x 10cm (5) 13cm x 15cm (5) 24cm x 27.5cm (5)

£1.22 £2.41 £4.98

£14.25



Silicone Foam Dressings

Allevyn® Gentle / Alleyvn ®Gentle Border Description An absorbent hydrocelluar pad sandwiched between a perforated soft gel adhesive wound contact layer and highly permeable waterproof outer film. Alleyvn ®Gentle Border benefits from an easy application and removal of the dressing with the ability to reposition through an

adhesive technology based on the soft silicone gel in the dressing.

Indications Designed for a wide range of moderate to highly exuding wounds e.g. leg, foot and pressure ulcers, traumatic wounds and secondary healing wounds.

Method of Use

During the early stages of wound management, Allevyn Gentle Border dressings should be inspected

frequently. Where the product is used on infected wounds, the infection should be inspected and treated

as per local clinical protocol.

Dressings can be left in place for up to 7 days depending on the condition of the wound and the

surrounding skin or until exudate is visible and approaches to within 1.5cm of the edge of the dressing pad,

whichever is sooner. If required, Allevyn®Gentle can be cut.

Contraindications

Do not use Allevyn® Gentle Border dressings with oxidising agents such as hypochlorite solutions (e.g.

Eusol or Hydrogen peroxide, as these can break down the absorbent polyurethane component of the

dressing. If reddening or sensitisation occurs discontinue use.


Allevyn® Gentle Border 7.5cm x 7.5cm (10) £1.52 10cm x 10cm (10) £2.23

12.5cm x 12.5cm (10) £2.73 15cm x 15cm (10) £4.08

17.5cm x 17.5cm (10) £5.38 10cm x 20cm (10) £3.59

Allevyn® Gentle 5cm x 5cm (10) £1.29 10cm x 10cm (10) £2.55 15cm x 15cm (10) £4.28 10cm x 20cm (10) £4.10 20cm x 20cm (10) £6.84

Allevyn® Gentle Border Sacrum 16.8cm x 17.1cm (10) £4.04 21.6cm x 23cm (10) £5.71

Allevyn® Gentle Border Lite 5cm x 5cm (10) £0.91 7.5cm x 7.5 cm (10) £1.41 10cm x 10cm (10) £2.20 15cm x 15cm (10) £3.88

5.5cm x 12cm (10) £1.88 8cm x 15cm (10) £3.49

10cm x 20cm (10) £3.51

25



Super Absorbent Dressings

Kliniderm®

Description Super absorbent secondary dressing compromising of four layers: a hydrophilic wound contact layer, a distribution layer, a super absorbent inner core and a fluid repellent wound contact layer

Indications Moderate to heavily exuding wounds. May be used under compression

Indications Not to be used on dry wounds, heavy bleeding wounds and surgical implantation. The dressing must not be cut.

Eclypse®

Description Super absorbent secondary dressing

Indications Moderate to heavily exuding wounds

Indications Not to be used on arterial bleeds or heavily bleeding wounds. If a wound has a potential to dry out, a non adherent wound contact layer should be applied beforehand. Do not cut dressing.


Kliniderm® 10cm x 10cm (50) £0.49 10cm x 15cm (10) £0.69 20cm x 20cm (15) £0.99 20cm x 30cm (10) £1.49

Eclypse® 15cm x 15 cm (20) £0.98 20cm x 30 cm (20) £2.16 60cm x 40cm (10) £8.21

26



Specialised Dressings & Therapies

Antimicrobial Dressings

Antimicrobials are agents which kill or inhibit the growth and division of micro-organisms. Commonly used in wound management are honey, iodine and silver.

There is no robust clinical evidence that dressings containing antimicrobials (e.g. silver, iodine or honey) are more effective than undedicated dressings for the prevention of wound infections.

Indiscriminate use of topical antimicrobial dressings should also be discouraged because of concerns over bacterial resistance and toxicity.

You may be asked by your local pharmacist, GP Practice or Wound Specialist Nurse to give a rationale for using these products. Please use the following tips to aid your selection.

10 Top Tips when using Antimicrobial Dressings

SILVER DRESSINGS

Some silver products oxidise in contact with air GENERAL POINTS Is the wound clinically infected

o Check for signs of infection o Don’t confuse normal signs of

inflammation with infection

Systemic antibiotics are indicated in cases of overt wound infection where classical signs are evident

Check the correct antimicrobial is chosen according to the wound exudate levels

If no improvement in wound after two weeks, review wound and antimicrobial choice

Check cautions as stated in manufacturer instructions, and BNF when using antimicrobial preparations.

and this may be displayed as a brown/black discolouration on the wound bed and/or surrounding skin

HONEY PRODUCTS

Patients may experience pain due to osmotic effects of dressing on wound (e.g. “drawing sensation”). Monitor pain levels, consider simple analgesia and only remove if the dressing is not tolerated.

Wound exudate may increase when using honey ointments and therefore use an appropriate absorbent secondary dressing.

IODINE PREPARATIONS These products are rapidly deactivated by wound

exudate therefore consider other antimicrobials for moderate – highly exudating wounds

All iodine products change from orange/brown to white when iodine is inactive/”used up”.

Please see Ropper Lothian Ladder on next page for further guidance

27

Initiation of these products should be on the advice of the relevant specialist e.g. Acute or Community Tissue Viability Nurse, Podiatry, Vascular, Plastic

Surgery or Dermatology Service.



Stage 4 – Treatment

If systemic signs only, consider other source of infection

Swab wound using standardised method

Consider taking blood cultures prior to starting antibiotics

Start broad spectrum systemic antibiotics* while awaiting culture results

Consider combination therapy with topical antimicrobials** e.g. in PVD, diabetes

Monitor wound progress, review wound at 2 weeks and stop topical antimicrobials when signs of infection cease

Once topical antimicrobial stopped continue with correct dressing regime for

wound/tissue type

The Adapted Ropper Lothian Ladder

Guidelines for identifying infected wounds and when to start & stop using topical antimicrobial dressings

2

Each stage builds on the previous signs noted

Stage 4: Overt signs of local infection and signs of systemic infection: may lead to sepsis if not treated Spreading cellulitis

Pus/abscess

Patient systemically unwell

e.g. confusion

Pyrexia

Raised white cell count/CRP

Malodour of wound

Stage 3: Overt signs of local infection: evidence of surrounding tissue involvement, wound deteriorating

Localised cellulitis

Discoloured or bleeding granulation tissue

Pain in or around wound

Exudate: thick, haemopurulent or purulent

and/or high volumes

Localised oedema

Malodour

Stage 2: Increasing signs of infection (Critical colonisation): healing not progressing normally

Exudate – high volumes

Malodour

Pain in or around wound

Discolouration of granulation tissue

Slough/Necrosis

Stage 1: Few subtle signs: healing progressing normally

Exudate – low to moderate volume

Pain – minimal

Odour – minimal

Slough/necrosis – minimal

START


Swab wound using standardized method

Drain any local collections of pus/fluid

Consider combination therapy with broad spectrum systemic antibiotics* and topical antimicrobials**

Monitor wound progress, review wound at 2 weeks and stop topical antimicrobials when signs of infection cease

Once topical antimicrobial stopped continue with correct dressing regime for wound/tissue type

If no progress after two weeks and/or signs of systemic infection move to Stage 4


Select topical antimicrobial**

Monitor wound progress, review wound 1-2 weeks

If no improvement:

i. Consider swabbing wound using standardised method

ii. Consider alternative topical antimicrobial**

If improved stop topical antimicrobials when signs of infection cease

Once topical antimicrobial stopped continue with correct dressing regime for wound/tissue type

If no progress after two weeks and/or increasing signs of systemic infection move to Stage 3


Promote moist wound healing using correct dressing regime for wound/tissue type & exudate level

Monitor wound progress, if no improvement in 1-2 weeks reassess wound

and dressing choice

Check underlying aetiology of wound, if required refer to appropriate specialist e.g. vascular, diabetic podiatry, tissue viability, lymphoedema etc.

If no progress after a further 1-2 weeks and/or increasing signs of infection/critical colonisation move to Stage 2

This guidance should be used along with clinical judgment in complex patients; in particular patients with diabetic wounds, vascular problems and immuno compromised patients may require topical antimicrobials for prophylaxis as well as treatment. *Systemic Antibiotics – Follow NHS Fife Antibiotic Guidance for the Treatment of Community Managed Infections Sept 2010. **Topical Antimicrobial – NHS Fife Joint Wound

Formulary 2010. Topical antimicrobials can include honey, iodine, silver, PHMB, DACC and enzymatic products. Contact TVN team for more info if required.

References::European Wound Management Association (2005) Position Document: Identifying criteria for wound infection, MEP, London European Wound Management Association (2006) Position Document: Management of wound infection, MEP, London Best Practice Statement: Use of topical antiseptic/antimicrobial agents in wound management, Wounds UK, Aberdeen (2010) Good Practice Recommendation for Antimicrobial Use in Frail Elderly 2013

Adapted & reproduced with permission of R. Ropper, TVN CNS NHS

Lothian



Specialised Dressings & Therapies

Silver Containing Dressings

Aquacel® Ag+ Ribbon Aquacel® Ag+ Extra Urgotul®SSD

Aquacel® Ag+ Ribbon/Extra

Description

Aquacel®Ag+ Ribbon is a versatile primary dressing. The combination of Hydrofiber® Technology with ionic silver (Ag+), enhanced with anti – biofilm technology, produces a dressing that is highly absorbent and has favourable gelling characteristics with the aid of broad-spectrum antimicrobial activity

Indications For use in moderate to highly exuding chronic and acute wounds where there is infection or an increased risk of infection. Also suitable for cavity wounds

Contraindications Should not be used on patients who are sensitive to, or have had an allergic reaction to silver or sodium carboxymethycellulose.

Urgo®SSD Description A non adherent, non occlusive, antibacterial contact layer. The contact layer is a polyester mesh impregnated with hydrocolloid petroleum jelly and silver sulphadiazine particles.

Indications For use on non to lightly exuding wounds with signs of infection. Can be combined with an absorbent layer for heavily exuding wounds. Can also be used in cavity wounds.

Contraindications Do not use on patients with a known sensitivity to any components of the dressing. Caution: Do not use on patients undergoing MRI scans. Avoid contact with electrodes or conductive gels

during electronic measurement procedures.


Aquacel® Ag+ Ribbon 1cm x 45cm (5) 2cm x 45cm (5)

£3.14 £4.80

Aquacel ® Ag+ Extra 5cm x 5cm (5) 10cm x 10cm (5) 15cm x 15cm (5) 2cm x 30cm (5) 4cm x 10cm (5) 4cm x 20cm (5) 4cm x 30cm (5)

£1.98 £4.71 £8.88

£22.02 £2.87 £3.74 £5.60

Urgotul® SSD 10cm x 12cm (10) 15cm x 20cm (10)

£3.17 £8.99

29

Initiation of these products should be on the advice of the relevant specialist practitioner and follow local policies for use.



Prontosan Solution

Prontosan solution is a wound irrigation solution containing betaine, a gentle surfactant that penetrates, disturbs and removes Biofilm and wound debris, and PHMB to help control bacteria levels on the wound.

Dressing Size (Pack Size) SDT Price - July 2018(Each)

Prontosan Solution 40ml ampoule (24) 350ml bottle

£0.60 £4.86

Prontosan Wound Gel

Prontosan Wound Gel contains betaine, is a gentle surfactant that penetrates, disturbs and removes biofilm and wound debris, it also contains PHMB to help control bacterial levels on the wound.


Prontosan Wound Gel 30g 50g

£6.50 £11.90

Cutimed® Sorbact Cutimed® Sorbact dressings are coated with a fatty acid derivative (DACC) which give them highly hydrophobic properties. In the moist environment of an infected wound, bacteria are attracted to the dressing and become bound to it. The bacteria cannot multiply and are removed with the dressing.

Cutimed®Sorbact Hydroactive is a Semipermeable polyurethane film which contains Bacteria-binding

Sorbact® acetate mesh

N.B. Using the dressing in combination with cream/ointments impairs the effect of the DACC.


Cutimed® Sorbact Ribbon

Cutimed® Sorbact Swab

Cutimed®Sorbact Hydroactive

2cm x 50cm (20) 5cm x 200cm (10) 4cm x 6cm (5)

unfolded 11cm x 16cm 7cm x 9cm (5) unfolded 17cm x 27cm 7cm x 8.5cm (10) 14cm x 14cm (10) 19cm x 19cm (10) 14cm x 24cm (10) 24cm x 24cm (10)

£4.11 £8.10 £1.68

£2.80

£3.75 £5.47

£10.29 £8.76

£15.60

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Honey Preparations

Honey provides a moist healing environment with antibacterial and deodorizing properties as well as autolytic and osmotic debriding actions. It can be used on a variety of acute and chronic wounds.

Medihoney® Products

For use in acute and chronic wounds: leg/foot ulcers, pressure ulcers, sloughy wounds, necrotic wounds, infected wounds, malodorous wounds, donor and recipient graft sites, and burns, diabetic wounds and surgical wounds.

Activon®Products

Activon®(ointment) is ideal for debriding necrotic tissue. Ideal for topping up dressings where the honey is washed away or for using directly into cavities. Can be washed out using normal saline solution.

Actilite® Actilite® is a light viscose net dressing coated with antibacterial Manuka honey & Manuka oil. The dressing is designed to protect a wound, promote healing and allow the passage of exudate. The antibacterial effect of Actilite has been enhanced by combining high grade antibacterial Manuka oil with Manuka honey.

The combination of Manuka honey and Manuka oil has been demonstrated in-vitro to be effective against a number of major wound infecting organisms including MRSA and VRE.


Medihoney® Antibacterial Honey Apinate

Medihoney® Tulle

5cm x 5cm (10) 10cm x 10cm (5)

5cm x 5cm (5) 10cm x 10cm (5)

£2.01 £3.42 £1.71 £3.00

Medihoney ® Antibacterial Medical Honey Activon®Medical Grade Manuka Honey

20g tube (5)

25g tube (12)

ADC only £9.00

Prescription only £2.77

Actilite® 5cm x 5cm (10) 10cm x 10cm (10) 10cm x 20cm (10)

£0.71 £1.23 £2.38

31

Initiation of these products should be on the advice of the relevant specialist practitioner and local policies should be followed.



Iodine Dressings

CAUTION: Care must be taken when these dressings are used for patients with Thyroid or Renal Patients.

Inadine® A sterile low-adherent fabric dressing impregnated with 10% povidone iodine in a water soluble slow release base. Povidone iodine is a potent antibacterial agent with a broad spectrum of activity It is used as a primary wound dressing providing prophylactic treatment against infections in superficial wounds and minor skin injuries. The dressing should be changed daily or when the orange/ brown colour turns to white.

lodoflex® Iodoflex is a sterile Cadexomer Iodine paste containing Iodine in an inert base. The sachet consists of the paste sandwiched in protective gauze. Used for the topical treatment of a variety of chronic and acute wounds. When applied to the wound lodoflex® cleans and reduces' bacteria at the wound surface and is particularly useful in highly exuding wounds.

Remove the protective gauze on both sides of the paste, lodoflex® can then be moulded into shape and applied to the wound surface. An appropriate secondary dressing can then be applied. The dressing should be changed every 72 hours.

N.B. Maximum single application is 50g; weekly maximum must not exceed 150g; treatment duration should not exceed three months.

Antimicrobial Alginate Gel

Flaminal®

Flaminal® is an antimicrobial alginate gel, indicated for a variety of wounds. It maintains a moist wound environment, helps debride and restore bacterial balance. It comes in two preparations, Flaminal® Forte for medium to heavily exuding wounds, and Flaminal® Hydro for low to moderately exuding wounds.


Flaminal® Forte 15g (5) 50g (5)

£7.79 £25.78

Flaminal® Hydro 15g (5) 50g (5)

£7.79 £25.78

N.B. Flaminal® preparations are intended for single patient use, but can be used for multiple applications on the same patient, as this will make the product more Price effective.

32


Inadine® 5cm x 5cm (25) 9.5cm x 9.5cm (10)

33p 49p

Iodoflex® 5g (5) 10g (3) 17g (2)

£4.19 £8.37

£13.25



Pain Management Dressing

ActiFormCool®

A transparent, non-adhesive high water content hydrogel, formed around a supporting blue polyethylene matrix. It can be particularly useful for painful wounds, e.g. leg ulcers and diabetic ulcers.


ActiFormCool® 5cm x 6.5cm (5) £1.83 10cm x 10cm (5) £2.68 10cm x 15cm (5) £3.86 20cm x 20cm (5) £8.08

Foam/Fibre Dressing For Heavily Exuding Wounds

Allevyn® Life

A dressing which is a multi-layered design incorporating hydrocellular foam with a hyper-absorber lock away core. It has a highly waterproof outer film and incorporates a mesh screen on the pad which allows the levels of exudate to be visible. This indicates when the dressing should be changed.

Cutimed® Sorbion Sachet XL

A specially shaped Hydration Response Technology dressing for large, difficult to dress sites such as lower leg. Hypoallergenic primary dressing that absorbs and binds exudate. Can be used under compression.

Dressing Size (Pack Size) SDT Price – July2018(Each)

Cutimed® Sorbion Sachet XL 45cm x25cm (10) £15.27

33


Alleyvn® LIfe 10cm x 10.3cm (10) £1.72 12.9cm x 12.9cm (10) £2.53 15.4cm x 15.4cm (10) £3.09

21cm x 21cm (10) £6.09



Debridement Products

UCS® Debridement Cloth A sterile, pre-moistened, single use cloth for wound debridement and cleansing of surrounding area. Contains a mild cleansing solution that moisturises and softens without damaging healthy cells. Can also be used to remove hyperkeratosis.

Dressing Size (Pack Size) SDT Price -July 2018(Each)

UCS ®Debridement Cloth 20cm x20cm (10) (10)

£3.25

Debrisoft® Pad Debrisoft® consists of soft, polyester fibres which are secured and knitted together. These fibres are cut at a special angle, length and thickness to ensure good effect and flexibility. The pad comes in a 10cm x 10xm size and is used to remove slough and other debris from the wound bed to aid debridement. It can be used on sloughy leg ulcers and surrounding skin to remove debris.

Dressing Size (Pack Size) SDT Price –July 2018(Each)

Debrisoft ® Pad 10cm x 10cm (5) £6.55

Tulle Dressings

Urogtul® A non adherent, non – occlusive flexible contact layer derived from Technology Lipido-Colloid (TLC Technology). It is composed of a flexible polyester mesh impregnated with hydrocolloid and petroleum jelly particles. Can be used on acute wounds, skin abrasions and may be left for up to 7 days.


Urgotul® 5cm x 5cm (10) 10cm x 10cm (10) 15cm x 15cm (10) 10cm x 40cm (10) 15cm x 20cm (10) 20cm x 30cm (5)

£1.57 £3.13 £6.66

£10.53 £8.86

£14.25

Technology Lipidocolloid (TLC) - Urgo Dressings

Urgo® Clean Pad & Rope

Description A TLC Healing Matrix dressing which allows a pain free desloughing action, trapping and binding slough with its polyabsorbent fibres. It is also available as a rope which has similar absorption properties to Aquacel

Indications For use in moderate to heavily exuding wounds. Change Urgo® Clean 1-2 days during the desloughing phase, then as often as required (up to 7 days)depending on levels of exudate.

Contraindications Do not use Urgo®Clean in combination with hydrogen peroxide organomercuric antiseptics or heocamidine.

Dressing Size (Pack Size) SDT Price - July 2018(Each)

Urgo® Clean Pad 6cm x 6cm(10) £0.97 10cm x 10cm (10) £2.16 20cm x 15cm (10) £4.06

Urgo® Clean Rope/Probe 5cm x 40cm (10) £3.21 2.5cm x 40cm (10) £2.43

34



Urgo® Start/Urgo® Start Contact

Description

Urgo® Start is a soft adherent TLC foam dressing which stimulates fibroblast proliferation. The dressing neutralises excess proteases and re –establishes wound equilibrium. The semi-permeable backing prevents maceration. Urgo ®Start Contact is a contact layer which should be used with a pad or absorbent dressing for heavily exuding wounds.

Indications For use on low to moderately exuding chronic wounds, leg ulcers, pressure and diabetic foot ulcers, Can be used under compression and may be left in place for 7 days. Urgo ®Start Contact can also be used in cavity wounds.

Contraindications Urgo® Start/Urgo® Start Contact should not be used on infected or critically colonised wounds. Not to be used in cancerous or fistula wounds which may reveal a deep abscess. It is also not recommended to use as first line treatment in acute wounds or in the treatment of Epidermolysis Bullosa (EB).

35

Dressing Size (Pack Size) SDT Price – July 2018 (Each)

Urgo® Start 6cm x 6cm (10) £4.49 10cm x 10cm (10) £6.21 20cm x 15cm (10) £11.17

Urgo® Start Contact 5cm x 7cm (10) £3.03 10cm x 10cm (10) £4.28 15cm x 20cm(10) £10.20 16cm x 21cm (10) £9.95



Specialist Plastic Surgery Dressings

PolyMem Description PolyMem is polyurethane foam dressing with a vapour permeable backing. Dressing structure contains a tissue – friendly wound cleansing agent and glycerol. PolyMem is available in a non adhesive and adhesive version.

Indications Low to moderately exuding wounds including skin tears and other traumatic wounds

Contraindications Not suitable for full thickness burns. Do not use in conjunction with solutions containing hypochlorite


Polymem® Non-Adhesive 8cm x 8cm (15) 10cm x 10cm (15) 13cm x 13cm (15)

17cmx19cm (15)

10cmx61cm (4)roll 20cmx60cm (4)roll

£1.60 £2.49 £4.15 £6.13

£13.20 £31.13

Polymem®Adhesive 5cm x 5cm (15) 5cm x 7.6cm (15)

8.8cm x 12.7cm (15) oval 16.5cm x 20.9cm (10) oval 18.4cm x 20cm (10)Sacral

£0.52 £1.16 £2.06 £6.79 £4.56

Scar Management Products

Mepiform® Dressing Description

Self adherent, silicone gel scar dressing


Mepiform® Dressing 5cm x 7cm (5) 9cm x 18cm (5) 4cm x 31cm (5)

£3.61 £13.75 £11.10

Kelo-cote® Spray Dermatix®Gel

Description Silicone spray/gel for the reduction or prevention of hypertrophic & keloid scars


Kelo-cote® Spray 100mls £51.00

Dermatix ® Gel 15g 60g

£16.66 £60.53

Specialist Use Only ( Dermatology, Vascular, Podiatry)

Granulox ® Spray

Description Granulox® Spray increases levels of oxygen at the wound bed, speeding up the rate of healing


Granulox® Spray 12mls £125.00

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Larvae Therapy Larvae reduce or eliminate odour and combat infection by ingesting and killing bacteria. Sterile larvae of the common green-bottle Lucilia Sericata are used to treat most types of sloughy, infected or necrotic wounds. They may also reduce wound pain and stimulate the formation of granulation tissue. Larvae therapy is available on a GP10 prescription.

Dressing Size (Pack Size) SDT Price - Jan 2017 (Each)

BioBag® Dressing 2.5cm x 4cm (1) 5cm x 6cm (1) 10cm x 10cm (1)

£195.00 £245.00 £295.00

Negative Pressure Wound Therapy (NPWT)

Negative Pressure Wound Therapy (NPWT) is a treatment used across the wound through a dressing positioned in the wound cavity or over a flap or graft. Excess fluid is collected in a disposable canister. NPWT helps to reduce oedema, increase blood supply and decrease bacterial colonisation. It has proven to be effective with acute surgical wounds, pressure ulcers, chronic wounds, including diabetic feet, and skin grafts.

Patients may be discharged from the Acute Services Division into Community with NPWT in situ. S t a f f should consult local policy with regards to obtaining units. In the community setting, permission must be granted from the Lead Nurse for hire of unit and dressings. Dressings and canisters are available on drug tariff. All pumps once discontinued must be returned to the original source.

Avelle® (Disposable NPWT system) A disposable and portable system combining negative pressure wound therapy with hydrofiber® Technology. Can be used on acute and chronic wounds, pressure, venous and diabetic foot ulcers as well as flaps, grafts, surgically closed and dehisced wounds Advice should be sought from the local tissue viability nurse or specialist nurse before using. Pumps last for 30 days and are ordered separately from the dressings.

Contraindications Contraindicated in the presence of: malignancy in the wound bed or wound margins (except in palliative care to enhance quality of life), burns, necrotic wounds or wounds where eschar is present, non enteric or unexplored fistulas.(Please refer to literature for full list of contraindications).


Avelle® Pump

Dressing

N/A £99.76 16cm x 16cm (5) £15.12 16cm x 21cm (5) £22.17 12cm x 21cm (5) £15.12 12cm x 31cm (5) £24.18 12cm x 41cm (5)

Whilst above disposable NPWT system will be suitable in the majority of cases, please contact relevant Specialist nurse to discuss further options if required.

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Wound Drainage Bag

Wound drainage bags have a central hydrocolloid island that can be cut and shaped to fit the wound. They are particularly useful in large abdominal wounds with high levels of exudate, where conventional dressings would need to be changed more than twice daily.


Biotrol®Draina S Fistula Mini (30) £2.60 Medium (30) £2.59 Large (20) £4.77

Eakin® Wound Pouches Small (10) From £4.77 (fold and tuck or bung closures) Medium (10) From £6.89

Large (10) From £9.00 Extra Large (5) From £15.89

Other sizes/styles are available, contact companies directly for sizes and prices.

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Glossary of Wound Terms

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Angiogenesis Generation of new blood vessels initially seen at the base of a wound.

Autolysis Breakdown of devitalised tissue by leucocytes.

Biofilm A thin but robust layer of micro – organisms that cannot be seen by the naked eye, adhering to a solid surface and containing a community of bacteria and other organisms.

Cellulitis A spreading non-suppurative infection of the soft tissue.

Colonisation Multiplication of micro-organisms without a corresponding host reaction.

Contraction Function of the healing process in granulating wounds whereby the edges of the wound are drawn towards each other.

Debridement Removal of devitalised tissue and foreign matter from a wound.

Epithelialisation Final stage of the proliferative phase.

Eschar Scab consisting of dried serum and devitalised dermal cells.

Granulation Formulation of new tissue filling the defect which takes place during the proliferative phase of healing. The name is derived from the fact that the buds of new tissue take on the appearance of small granules.

Healing by first intention Also called Primary Intention. Wounds are closed with sutures, staples or skin glue, leaving a minimal defect.

Healing by secondary intention

Wound left open and allowed to heal by granulation.

Healing by third intention Also called Tertiary intention, or delayed closure. Wound left open often to assist drainage and closed surgically at a later date.

Infection Micro-organisms present and multiplying, producing an associated host reaction. Reaction may take various forms.

Maceration Softening or sogginess of the tissue owing to retention of excessive moisture.

Necrosis Local death of tissue. Tissue is often black/brown in colour and leathery/waxy in texture.

Overgranulation Granulation tissue is raised above the peri-wound area.

Slough Devitalised tissue which has yellow/white/grey hue.



Reading List

Barwell et al (2015) Diabetes Foot Infection Antibiotic Protocol

Briggs et al (2004) Principles of best practice: Minimising pain at wound dressing – related procedures. A consensus document http://www.woundsinternational.com/media/issues/79/files/content_39.pdf

Cooper R (2009) Biofilms: hard to detect, easy to under estimate, but most definitely here to stay. Wounds UK. 9 (1) p.12.

Cope G (2014) The effects of smoking on wound healing. Wounds UK Vol 10 (2)

Dow G (2003) Bacterial swabs and the chronic wound: When, how and what do they mean. Ostomy Wound Management. 49; 5A supplement: p. 8-13.

Drugs and Therapeutic bulletin (2010) Silver dressings - do they work? Dtb.bmj.com. p. 38-42.

European Wound Management Association (2004) Position Document Wound bed preparation in practice. London: MEP Ltd.

European Wound Management Association (2005) Position Document Identifying criteria for wound infection. London: MEP Ltd.

European Wound Management Association (2006) Position Document Management of wound Infection. London: MEP Ltd.

European Wound Management Association (2007) Position Document Topical Negative Pressure In wound Management. London: MEP. Ltd

European Wound Management Association (2008) Position Document Hard-to-heal wounds: A holistic approach. London: MEP Ltd.

Gottrup F, Apelqvist J et al (2013) EWMA Document: Antimicrobials and Non-healing wounds- Evidence. Controversies and suggestions. Journal of Wound Care. 22 (5 suppl): S1-S92.

Guy H (2012) The Difference Between Moisture Lesions and Pressure Ulcers. Wound Essentials. Vol. 1 p. 36-44. Available at: www.wounds-uk.com

Healthcare Improvement Scotland (2015)., Antimicrobial Wound Dressings for Chronic Wounds – HTA Report 13, Edinburgh: HIS. Available at www.healthcareimprovementscotland.org

King B (2003) A review of research investigating pain and wound care. Journal of Wound Care. 12(6) p. 219-223.

Medlin S (2012) Nutrition For Wound Healing. British Journal of Nursing (Tissue Viability Supplement) Vol, 21, No 12. S11-15.

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http://www.woundsinternational.com/media/issues/79/files/content_39.pdf


http://www.healthcareimprovementscotland.org/



NHS Quality Improvement Scotland (2009) Best Practice Statement. Prevention and Management of Pressure

Ulcers. Available at www.healthcareimprovementscotland.org

Phillips PL, Wolcott RD, et al. (2010) Biofilms Made Easy. Wounds International 1(3). Available at www.woundsinternational.com

Strohal R, Apelqvist J, Dissemond J et al (2013) EWMA Document: Debridement. Journal of Wound Care. 22 (suppl.1) S1-S52.

Toit DF (2009) An in vitro evaluation of the cell toxicity of honey and silver dressings. Journal of Wound Care. 18 (9) p.383-399.

Yates S (2012) Differentiating Between Pressure Ulcers and Moisture Lesions. Wound Essentials. Vol 2. p.16-22. Available at www.wounds-uk.com.

White R, Cutting K (2008) Critical colonisation of chronic wounds: microbial mechanisms. Wounds UK. 4(1) P70-78.

Wounds International (2012) Appropriate use of Silver Dressings in Wounds. An expert working group consensus. London. Available to download from www.woundsinternational.com

Wounds UK (2016) Cavity Wounds, Quick Guide www.woundsuk.com

Wounds UK (2010) PHMB and its potential contribution to wound management. Wounds UK, Aberdeen. Available at www.wounds-uk.com.

Winter GD (1962) Formation of the scab and rate of epithelialisation of superficial wounds in the skin of young domestic pig. Nature 193: 293-294.

Resources/ Links

Local Tissue Viability Resource: NHS Fife Tissue Viability Webpage (Intranet)

Tissue Viability Resource: www.tissueviabilityscotland.org

Tissue Viability Resource: www.wounds-uk.com

Skin Tear Guidelines: www.tissueviabilityscotland.org

Best practice for leg ulcer management: www.legulcerforum.org

Diabetic Foot Infection Guidelines: ..\..\Desktop\Diabetic Foot Guidance Final - April 2014.pdf

Learn Pro Modules: Preventing and Managing Pressure Ulcers, CPR For Feet (NHS Education for Scotland)

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http://www.woundsinternational.com/


http://www.woundsinternational.com/

http://www.woundsuk.com/





http://www.legulcerforum.org/



Related policies, standard operating procedures and guidance

NHS Fife Procedure for Prevention and Management of Pressure Ulcers (2016)

NHS Fife Policy for Obtaining Informed Consent (2013)

SIGN Guidelines 120. Management of Chronic Venous Leg Ulcers (August 2010)

Healthcare Improvement Scotland, Prevention and Management of Pressure Ulcer Standards, 2016 ..\..\Desktop\HIS Pressure Ulcer Standards 2016.pdf Healthcare Improvement Scotland, Resources to guide the management of suspected infection in chronic wounds, 2018. www.healthcareimprovementscotland.org

NHS Fife Podiatry Foot Protection and Offloading Guidance 2015

NHS Fife Community Exception Form http://www.fifeadtc.scot.nhs.uk/formulary/woundcare-formulary/woundcare-catheter-product-request-and- exception-form.aspx The lists above are not exhaustive. It is the practitioner’s responsibility to be aware of up to date policies and procedures.

42


http://www.fifeadtc.scot.nhs.uk/formulary/woundcare-formulary/woundcare-catheter-product-request-and-



WRITE, IMPRINT OR ATTACH LABEL

Surname ……………….... CHI No ….…………..

Forenames ………………… Sex…………………..

DoB ………………..

Location……………………………………………………

Appendix 1 – Wound Assessment Chart

Assessment Chart for Wound Management

For multiple wounds complete formal wound assessment for each wound. Add Inserts as needed.

43

Factors which could delay healing: (Please tick relevant box)

Immobility □ Poor Nutrition □ Diabetes □ Incontinence □ Respiratory / Circulatory

Disease □ Anaemia □ Medication □ Chemotherapy □ Wound Infection □ Previous History of MRSA Infection □

Inotropes □ Anti-Coagulants □ Oedema □ Steroids □

Other ………….. Allergies & Sensitivities ……………………….

Body Diagram

Front Back

Mark location with ‘X’ and number each wound

Type of Wound Total number & duration

of each type of wound

Leg Ulcer …………………………………..

Surgical Wound ……………………………….

Diabetic Ulcer ………………………….…

Pressure Ulcer ………………………………..

Other, specify ………………………………

Feet Diagram

Right Left

Mark location with ‘X’ and number each wound

Date referred to:

TVN …………….Physiotherapist…………….

Podiatrist………………Dietician……………...

Other (please specify)………………………….

Assessors signature: ……………………….. Date: ………………………..…………………...



Formal Wound Assessment Complete on initial assessment and thereafter complete at every dressing change

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Date of Assessment Number of wound Analgesia required

(Refer to local pain assessment tool)

Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No

Regular/ongoing analgesia Pre-dressing only Wound Dimensions (enter size) Length (cm/mm) Width (cm/mm) Depth (cm/mm) Or trace wound circumference Is wound tracking/undermining Photography Tissue type on wound bed ( enter percentages)

Necrotic (Black) Sloughy (Yellow/Green) Granulating (Red) Epithelialising (Pink) Hypergranulating (Red) Haematoma Bone/tendon Wound exudate levels/ type (tick all relevant boxes)

Low Moderate High * Serous (Straw) Haemoserous (Red/Straw) Purulent (Green/Brown/Yellow)* Peri-wound skin (tick relevant boxes)

Macerated (White) Oedematous * Erythema (Red)* Excoriated (Red) Fragile Dry/scaly Healthy/intact Signs of Infection * 1 or more of these signs may indicate possible infection

Heat * New slough/necrosis(deteriorating wound bed)* Increasing pain* Increasing exudate* Increasing odour* Friable granulation tissue* Treatment objectives (tick relevant box)

Debridement Absorption Hydration Protection Palliative / conservative Reduce bacterial load Assessors Print Initials Dressing Renewed (planned or unplanned dressing change)

Re-assessment date



Wound Treatment Plan and Evaluation of Care

To be completed when treatment or dressing type / regime altered NB Please write clearly

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Date Wound Number

Cleansing Method, Dressing Choice & Rationale

Frequency Evaluation & Rationale for changing dressing type

Signature

Packing Yes / No (circle)

Amount …………………

Packing Yes / No (circle) Amount …………………









Wound Conversion Chart

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PRODUCT GROUP FIRST CHOICE SECOND CHOICE EXAMPLES OF NON FORMULARY PRODUCTS

Barrier Film Sureprep™ Wand Secura™ (Non Sting) Brava™ Medi™ Derma S Sudocrem™

Sureprep™ Spray Clinfilm™ Ostoguard™ Trio Silesse™ Sorbaderm™ Sachets Cavilon™ sachets LBF™ Non Sting

Barrier Film Pelican™ Protest Cutimed™ Protect

Sorbaderm™ Tube Cavilon™ Tube Peri-prep™ SkinSafe™

Cleansing Solution Irripod™ Steripod™ Sterowash™ Sal-e-pods™ ISO-POD™

Normasol™ Clinipod™ Crest Medical™ Generics UK™

Alissa™ Non Adherent Dressing

N-A Ultra™ Primary™ Tricotex™

Hydrocolloid Dressing Comfeel™ Plus Transparent Comfeel™Plus Ulcer

Duoderm™ Extra Thin

ActivHeal™ Askina™ Biofilm

Duoderm ™Signal Flexigran™ ( & Thin)

Granuflex™ Hydrocoll™

Nu-Derm™ (&Thin)

Tegaderm™ Hydrocolloid Suprasorb™ H Ultec™ Pro

Foam Dressings Tegaderm™ Foam/Tegaderm™ Foam Adhesive

Biatain™/Biatain™ Adhesive

ActivHeal™Foam Allevyn™ Allevyn™Adhesive

Permafoam™ Permafoam™ Comfort

Allevyn™Plus Adhesive

Hydrofibre™ Aquacel™ Extra Aquacel™ Ribbon

Activheal™ Aquafibre

CMC ™ Exufibre™

Hydrofibre Foam Dressings

Aquacel™Foam Adhesive/Non Adhesive

Hydrogel Dressings Purilon™ Askina™Gel Aquaflo™ Aquaform™ Coolie™ Flexigran™ Geliperm™ Granugel™ Hydrosorb™ Intrasite™ Mesitran™ NovogelV Nu-Gel™

ActivHeal™

Alginate Dressings Kaltosat™ Tegaderm™Alginate Activheal™Alginate Algosite™M Sorboglon™ Melgisorb™ Sorbasan™Flat Cutimed™Alginate

Deodorising Dressings Clinisorb™ Carboflex™ Askina™ Carbosorb Carbopad™VC Sorbsan™Plus Carbon



47

Silicone Dressings Allevyn™ Gentle Border Adhesive Allevyn™ Gentle Allevyn™ Gentle Border Lite

Mepilex™Border Mepitel™ Silflex™ Silon-TSR™ Mepilex™ Askina™SilNet Mepilex™Transfer Cutimed™Siltec

Lite Silicone Dressings Mepilex™Lite Allevyn™ Gentle

Lite Kliniderm™Lite Advazorb™ Silfix Lite

Advazorb™ Border Lite Biatain™ Silicone Lite

Super Absorbent Dressings

Kliniderm™ Eclypse™ Flivasorb™ Eclypse™ Adhesive Mesorb™ Flivasorb™ Adhesive

Eclypse™ Boot Zetuvit™E™-E Kerramax™

Silver Containing Dressings

Aquacel™Extra Ag+ Melgisorb™Ag Askina™Calgitrol Ag

Acticoat™Flex 3 Acticoat™Flex 7

Acticoat™Moisture Actisorb™Silver

Algisite™Ag Allevyn™Ag

Biatian™Ag Atrauman™Ag Mepilex™Ag Physiotulle™Ag

Polymen™Silver Silvercel™& N/A Sorbsan™Silver Urgocell™Silver

Urgosorb™Silver Urgotul™Silver Tegaderm™Alginate Ag

Antimicrobial Dressings

Cutimed™ Sorbact Gel Cutimed™ Sorbact Swabs Cutimed™ Sorbact Hydroactive

Honey Preparations Medihoney™Tulle Activon™ Tulle Medihoney™Alginate Actilite™

Algivon™ Mesitran™

Iodine Containing Preparations

Inadine™ Iodoflex™

Iodosorb™ Iodozyme™ Oxyzyme™

Antimicrobial Alginate Gel

Flaminal™ Forte Flaminal™Hydro

Pain Management Dressings

ActiformCool™ Hydrosrorb™ Kerralire™ Biatain™ IBU

Debridement UCS Wipe™ Debrisoft™pad Tulle Dressings Urgotul™ Physiotulle™ Paraguaze™ Wound Contact Layer Mepitel One™ Siliflex™ Adaptic™Touch Mepitel™ Cuticell™

Cutimed™Siltec Askina™SilNet Activheal™

nhs fife woundcare guidelines · wound care consumes a significant amount of resources in terms of...

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