wound product formulary - uhb · soft white dressings, which are available as flat or rope/ ribbon...

of 39

Wound Product Formulary Issued: 21/05/2016 Controlled Document Number: 994 Version 1

Wound Product Formulary

CATEGORY: Procedure

CLASSIFICATION: Clinical

PURPOSE To provide information for all clinical staff on wound management products.

Controlled Document Number:

994

Version Number: 1

Controlled Document Sponsor:

Executive Chief Nurse

Controlled Document Lead:

Lead Tissue Viability Nurse

Approved By: Medicines Management Advisory Group

On: 21st June 2016

Review Date: 21st May 2019

Distribution: • Essential

Reading for:

• Information for:

All clinical staff caring for patients with wounds. All clinical staff

CO

NTR

OLL

ED D

OC

UM

ENT

of 39


Contents

1. General Information

Paragraph Page 1 General Information 3

1.1 Introduction 3 1.2 Principles Of Wound Dressings 3 1.3 Dressing Product Categories 4 1.4 Wound Product Selection 5 1.5 Product Availability 6 1.6 Product Trials 6 1.7 Admission And Discharge 6 2 Formulary Wound Care Products 6

2.1 Quick Reference Guide To Formulary Wound Care Products 6 2.2 Formulary Wound Care Products Details 7 3 Specialist Use Only Wound Care Products 20

3.1 Quick Reference Guide To Specialist Use Only Wound Care Products

20

3.2 Specialist Use Only Wound Care Products Details 21 4 Skin Care Products 26

4.1 Quick Reference Guide To Skin Care Products 26 4.2 Skin Care Products Details 27 5 Other Wound Care Products 31

5.1 Quick Reference Guide To Other Wound Care Products 31 5.2 Other Wound Care Products Details 31 6 References And Bibliography 32 7 Associated Policy and Procedural Documentation

Appendices Appendix A Wound Product Formulary And Dressing Selection Guide 34 Appendix B Wound Dressing Product Categories And Supply Routes 35 Appendix C Wound Care Advice Letter 36

of 39


1.1 Introduction

1.1.1 There are a vast array of wound care products available, however

following evaluation and trials and taking into account quality and cost effectiveness the Tissue Viability Service in conjunction with Procurement and Pharmacy have devised this formulary which outlines the wound care products that are recommended for use by all practitioners within the Trust.

1.1.2 The formulary is designed to be used in conjunction with the Trust’s

Wound Management Guidelines (current version) which aims to support all registered nurses, medical staff and allied healthcare professionals to implement consistent, high quality, cost effective, first line wound management to patients within the Trust.

1.1.3 Certain practitioners e.g. physiotherapists working in specialised areas

such as hand injury may carry out wound care for their client group as directed by relevant protocols. Complex wounds such as fungating tumours, larger dehisced surgical wounds and burns may require specialist care which is beyond the remit of these guidelines and the relevant specialists should be consulted for advice. Other tissue viability resources are available for information regarding the management of specific wound types e.g. clinical guidelines for management of leg ulcers, pressure ulcers and infected wounds and expanded practice protocols for therapies such as larvae and negative pressure wound therapy all of which can be found on the Trust Intranet.

1.1.4 The formulary is divided into sections: including sections for formulary

products and a specialist use only section which lists products that are available for use in the Trust by specialists who have received training on how to use them or for use within specific clinical areas. If you require products that are not listed in either of these sections, please contact the Tissue Viability Service for further advice.

1.2 Principles of Wound Dressings

For a wound dressing to be safe and effective for use in clinical practice it needs to meet the following criteria:

• Create a moist wound environment at the wound/ dressing interface

• Allow gaseous exchange

• Provide thermal insulation

• Impermeable to micro – organisms

• Non adherent to the wound bed

of 39


• Safe to use (non-toxic, non sensitizing, non allergenic)

• Acceptable to the patient

• Manage exudate

• Cost effective

• Be a carrier for medicaments (antimicrobial/antiseptics)

• Allow monitoring of the wound

• Provide mechanical protection

• Non flammable

• Sterilisable

• Conformable and mouldable (especially over awkward, boney areas)

• Available to the hospital and community in a range of sizes

• Require infrequent dressing changes (Thomas, 2009).

1.3 Dressing Product Categories

1.3.1 Wound Contact Layers

Low or non adherent dressing that can be used on lightly exuding granulating wounds that allow exudate to pass through into the secondary dressing. These dressings do not allow the in growth of granulation tissue. They also can be used as carriers for other products such as a hydrogel. The contact layer requires a secondary dressing whilst preventing adhering to the wound.

1.3.2 Hydrocolloids Adhesive and mouldable dressing that consists of carboxymethalcellulose with a backing made of foam or film. Hydrocolloids are indicated for low to medium exudate wounds and are impermeable to oxygen, water and vapour. These dressings turn to a gel as they absorb and assist in supporting rehydration and autolytic debridement of necrotic and sloughy wounds and provide a moist healing environment.

1.3.3 Films

of 39


A transparent dressing, permeable to oxygen and water vapour but not water. They allow visual inspection and provide a warm clean environment. Films may also be useful in reducing friction and providing protection. To avoid contamination large sheets of Opsite can be used as a sterile drape in theatre. Films with pad have an absorbent pad in the centre which is designed to reduce blistering and aid comfort (see island dressings).

1.3.4 Alginate and Fibrous Dressings

Soft white dressings, which are available as flat or rope/ ribbon dressing turn into a gel. Indicated for moderate to high exudating wounds, they absorb exudate, promote autolysis, keep the wound bed moist and promote healing. They maintain their integrity, are easy to remove when irrigated and create lateral wicking to prevent damage to surrounding skin. A secondary dressing is required to contain moisture and aid autolysis.

1.3.5 Foams

Made of polyurethane foam and can be either adhesive or non adhesive. They are an absorbent product for low to moderately exuding wounds of any tissue type. They promote a moist wound healing environment and have a moisture vapour transfer rate (MVTR) which assists in reducing skin and wound maceration.

1.3.6 Hydrogels

Water based dressings which are available in tubes or sheet form and donate fluid when placed in contact with a dry, necrotic/ sloughy wound. They can be used throughout the healing process on low exuding, granulating and epithelising wounds. They require a secondary dressing, which can support autolytic debridement.

1.3.7 Island Dressings

Low adherent primary dressing with an adhesive border. Island dressings with film borders are recommended immediately post operatively to allow post operative inspection of the peri wound area, provide a barrier to external contamination, allow ease of removal, allow showering and maintain a moist healing environment (Roberts et al, 2011, NICE, 2008).

1.3.8 Silicone based Dressings

Dressings which are coated with a soft silicone which minimises tissue adherence and so reduces wound bed trauma and pain on removal. Silicone dressings are available as wound contact layers and absorbent foams. These types of dressing should only be used when either the wound bed or surrounding skin is fragile or the wound is painful particularly at dressing change. The wound contact layers can be used on skin tears.

of 39


1.3.9 Antimicrobial Dressings

These dressings can help to reduce the level of bacteria at the wound bed but will not eliminate a spreading infection. Depending on the product they will either release the antimicrobial into the wound or kill the bacteria once it has been absorbed from the wound. The choice of product will depend on exudate and infection levels. Antimicrobial dressings contain antiseptics. Mupericin and Metronidazole are the only antibiotics recommended for topical use in the UK (Cowan, T. 2016-17). The most popular antimicrobial dressings are those containing silver, iodine, Polyhexamethlene Biguanide (PHMB) and honey. Further information on the use of antimicrobials is available in the Trust’s Wound Infection Guidelines (current version).

1.3.10 Absorbent Dressings

There are various dressing pads with have different levels of absorbency depending on the consistency of the layers in their composition. Many of these dressings comprise of a soft viscose, polyester bonded pad and may have an external polyethylene contact layer. Some of the products known as “superabsorbers” contain absorbent polymers.

1.3.11 Odour Control

The carbon layer within these dressings absorbs the odour and withholds it.

1.3.12 Protease Modulators

These dressings can prolong the inflammatory stage of wound healing and delay granulation which can help promote healing.

1.4 Wound Product Selection

1.4.1 Wound dressing products should only be selected once a holistic

assessment of the patient and their wound has been carried out. Wound assessment must include the cause of the wound, site and shape of the wound, size and depth of the wound, tissue types, appearance of the wound, surrounding skin, factors that may delay healing and identification of infected wounds. Full details on wound assessment and treatment are in the Trust’s wound management guidelines (current version). Once the wound has been assessed treatment aims (goals) can be established e.g. to promote granulation, reduce odour, reduce pain, reduce bacterial load. The plan of care MUST be documented on the wound assessment chart and must include an appropriate:

• Cleansing regime e.g. saline, tap water • Skin care regime e.g. barrier film, moisturizer • Primary dressing (wound contact layer) e.g. Granugel, Cosmopore

of 39


• Secondary dressing (if required) e.g. pad or foam • Securing mechanism e.g. tape/bandage if primary or secondary dressings are non

adhesive/skin is vulnerable or adhesive dressing.

1.4.2 The frequency of dressing change will depend on the exudate levels, patient comfort, presence of infection and advised wear time. If strikethrough occurs the dressing MUST be changed as soon as possible. The Wound Product Formulary and Dressing Selection Guide can aid with choosing the most suitable dressing for the patient (see Appendix A).

1.5 Product Availability

Wound products are available via two routes into the Trust, pharmacy and supply chain (see Appendix B). If you require products that are not currently on the formulary please contact Tissue Viability to discuss.

1.6 Product Trials

All product trials must be registered with procurement, and master indemnity numbers from suppliers provided. (see Trust’s Procedure for Trails and Evaluation of Medical Devices, current version)

1.7 Admission and Discharge

All patients discharged with a wound must be provided with a letter (Appendix C) and sufficient dressing changes for a week. The Trust formulary is a locally agreed formulary and therefore it may be necessary to arrange a product switch on admission or discharge or arrange for a particular product to be obtained on admission depending on the patient’s individual requirements.

2. Formulary Wound Care Products

2.1 Quick Reference Guide to Formulary Wound Care Products Product Name *requires a prescription

Description Sizes and forms (in cm unless otherwise stated)

ActiForm Cool Sheet hydrogel 10x10/ 10x15 ActivHeal foam tracheostomy

Non adhesive foam dressing fenestrated for use around tracheostomy tubes

10x10 tracheostomy

Activon Tulle and Activon Tube/Algivon

A range of dressings containing 100% Manuka honey

Tulle 5x5,10x10 Activon Tube 25g Algivon 5x5, 10x10

Allevyn non adhesive Non– adhesive foam sheet 5x5/10x10/10x20/20x20 Heel 10.5x13.5

Allevyn Gentle Border Island foam with an adhesive border

7.5x7.5/10x10/10x20/12.5x12.5/15x15/17.5x17.5

Allevyn Gentle Border Lite

Foam with soft silicone adhesive border in shaped form

Oval 8.6x7.7/15.2x13.1

of 39


Allevyn Gentle border Multisite

Tri-lobed version of Allevyn Gentle Border for use on difficult to dress areas

17.1x17.9

Anabact* Antimicrobial gel for malodourous fungating wounds

15 and 30g tubes

Aquacel Extra Hydrofibre for moderate/heavily exuding wounds e.g. leg ulcers, fungating wounds or tracheostomy wounds

Ribbon 2x45 Square 5x5,10x10,15x15 Rectangular 4x10,4x20,4x30

Aquacel Ag+ Extra* Hydrofibre impregnated with silver Ribbon 2x45 Square 5x5,10x10,15x15 Rectangular 4x10,4x20,4x30

Clinisorb Activated charcoal sandwiched between layers of cloth

10x10/10x20/15x25

CosmoporE Adhesive island dressing 5x7.2,8x10,8x15,10x20,10x25,10x35

CView Vapour permeable transparent film dressing

6x7, 10x12, 12x12, 15x20, 20x30

CView Post Op Vapour permeable transparent film dressing with absorbent pad

6x7, 8.5x9.5, 8.5x15, 10x12, 10x20,10x25,10x35

DuoDERM Signal Thin hydrocolloid Square: 7.5 x 7.5, 10 x 10, 15 x 15cm. Rectangular: 5 x 10, 5 x 20, 9 x 15, 9x25, 9 x 35

Flamazine* Antimicrobial cream for burns and infecte wounds

50g tubes, 250g, 500g tubs

Granugel Hydrogel for low exuding wounds 15 g single use tubes Inadine Iodine impregnated gauze 5x5, 9.5x9.5 KerraMax Care A superabsorbent dressing 10x10,10x22, 20x22, 20x30 Mepitel One Non-adherent wound contact layer with

silicone on one side only 6x7,9x10,13x15,24x27.5

L-Mesitran Hydro and Border

An anti-bacterial honey dressing which debrides and has anti-inflammatory properties – available with or without an adhesive border

L-Mesitran border 10x10 L-Mesitran hydro 10x10,20x15

Sorbsan range Alginate sheet and cavity dressings for moderate to heavy exuding wounds

Flat 5x5,10x10,10x20 Packing 2g – 30cm long. Ribbon – 40cm long

Telfa Clear Transparent, non adherent wound contact layer

7.5x7.5,10x12.5,30x30,30x60

UrgoTul Low adherent, hydrocolloid dressing 5x5,10x10, 10x40,15x15,15x20,20x30

Urgotul Ag/ Silver* Low adherent, antibacterial hydrocolloid dressing

10x12,15x20

Wound pad (Premier/Xupad)

Sterile, absorbent, dressing pad 10x12 10x20 20x20 20x40

2.2 Wound Care Products Details

ACTIFORM COOL What is it?

A sheet hydrogel held in a blue mesh with a top liner. The liner should be left in place on dry wounds and removed on moderately exuding wounds to increase the moisture

of 39


vapour transmission rate. How does it work?

Hydrates necrotic or sloughy tissue to facilitate debridement. It can improve the condition of surrounding skin by re-hydrating it. Has a cooling effect which can provide pain relief.

What can it be used on?

Leg ulcers, burns, scalds, radiation therapy damage (post treatment), diabetic wounds unless evidence of irreversible arterial disease. It is also useful to use when dressing awkward areas such as heels. Can be used prior to larvae therapy as it does not contain the preservative Propylene Glycol, which is harmful to maggots.

What should it not be used on?

Cavity wounds

How to use it

• Can be cut to size if required or overlapped onto surrounding skin if this is dry or irritated.

• Place onto wound and remove top layer if wound is wet or leave insitu if wound is dry.

• Secure in place using tape or a bandage. • The dressing becomes transparent initially then as the

fluid is absorbed it becomes cloudy and will fall apart when saturated.

• The dressing should be checked daily initially as fluid absorption can be rapid.

• Can be left in place up to a week dependant on exudate levels.

• Can be removed in one piece if the gel has not formed or removed by irrigation if in gel form.

ACTIVHEAL FOAM NON ADHESIVE/TRACHEOSTOMY What is it?

Consists of three layers: a low friction backing, an absorbent and a perforated wound contact layer. Fenestrated to fit around tracheostomy tube.

How does it work? Absorbs low to moderate amounts of exudate. What can it be used on?

Around tracheostomy tubes


Anything else

How to use it

• Can apply around tracheostomy tube. • Change daily or more frequently if saturated. • If stoma site is becoming macerated consider changing

to Aquacel Foam. ACTIVON TUBE/ACTIVON TULLE/ /ALGIVON What is it?

Medical grade honey is filtered, gamma irradiated and produced under controlled hygiene standards. Activon tube is 100% medical grade honey which can be used directly on the wound or on top of other Activon honey dressings to top them up.

of 39


Activon Tulle is a knitted viscose mesh containing 100% manuka honey. Algivon is an alginate dressing impregnated with 100% manuka honey.

How does it work?

Honey provides a moist healing environment due to its high sugar, low water content which promotes osmosis by drawing fluid into the dressing away from surrounding tissues. Honey has antimicrobial properties against bacteria and fungi. It promotes autolytic debridement through facilitating a moist environment and provides a deodorising action. It is also effective at reducing biofilms (Wounds UK, 2014).


It is indicated for use on all wound types including infected, acute and chronic wounds and oncology related wounds.


Patients who are sensitive to any additives or agents in the honey, bee stings or bee products. Patients’ blood sugars must be monitored if they are diabetic. May cause stinging when first applied.

How to use it

• Activon tube can be used directly on the wound or on top of other Activon honey dressings to top them up if they are drying out.

• Activon Tulle is suitable for shallow low exuding wounds.

• Algivon can be used on cavity wounds or those that have moderate to heavy exudate levels.

• Apply appropriate size to wound and use a secondary dressing depending on exudate levels and select an appropriate method of securing dependant on location of wound.

ALLEVYN NON ADHESIVE What is it?

A hydrophilic polyurethane dressing with three layers; a non-adherent wound contact layer, a highly absorbent central layer and a bacteria-proof, waterproof outer layer.

How does it work?

Manages moderate amounts of exudate. Can absorb up to 10 times its own weight in exudate.


Moderately exuding granulating wounds where an adhesive dressing is not suitable. Non infected external fixator pinsites


Infected wounds. Wounds with high levels of exudate. Wounds with a dry necrotic eschar.

How to use it

• Select an appropriate size of Allevyn non adhesive which leaves a 2-3cm margin around wound.

• Can be cut to shape for use on awkward areas e.g. heels.

• Place white side of Allevyn non adhesive over the wound.

• Secure in place with bandage, tape to edges or tubular bandage.

of 39


• Do not use occlusive film as secondary dressing. • May be left in place for up to 7 days depending on the

degree of exhudate. • Leakage will occur sideways when dressing change is

necessary. ALLEVYN GENTLE BORDER What is it?

A sterile polyurethane foam dressing with a soft silicone adhesive border.

How does it work?

Manages moderate amounts of exudate. Can absorb up to 6 times its own weight in exudate.


Moderate to heavily exuding wounds where an adhesive border is required to keep the dressing in place.


Infected wounds. Wounds with a dry necrotic eschar.

How to use it

• Select an appropriate pad size of Allevyn Gentle Border which leaves a 2-3cm margin of adhesive around wound.

• Remove backing and apply to wound. • May be left in place for up to 7 days depending on the

degree of exhudate. • Leakage will occur sideways when dressing change is

necessary. ALLEVYN GENTLE BORDER LITE What is it?

Same as Allevyn Gentle Border but available in an oval shape for ease of application/wear time.

How does it work? See Allevyn Gentle Border What can it be used on?

See Allevyn Gentle Border



How to use it See Allevyn Gentle Border ALLEVYN GENTLE BORDER MULTISITE What is it?

Same as Allevyn Gentle Border but available in a tri-lobed for use on difficult to dress areas.

How does it work? See Allevyn Gentle Border What can it be used on?




How to use it See Allevyn Gentle Border

of 39


ANABACT What is it?

Colourless, transparent gel containing 0.75% metronidazole. Requires an approved prescription.

How does it work?

Can be used on its own or with systemic antibiotic therapy to combat infection and odour in malodourous wounds. Effective against anaerobic and aerobic bacteria.


Malodorous fungating tumours. Malodorous wounds e.g. pressure ulcers and leg ulcers - when other methods have failed e.g. charcoal dressing. However the widespread and indiscriminate use of Anabact in these wounds is not recommended.


Individuals who have a known hypersensitivity to metronidazole. Women in stages of pregnancy or lactation.

How to use it • Apply gel thickly to wound surface. • Cover with a non-adherent secondary dressing for wet

wounds or film for dry wounds. • Anabact gel can be used alone in small cavity wounds. • Secure with tape or bandage. • Apply once or twice daily depending on exudate levels

and condition of wound. AQUACEL EXTRA What is it?

A non-woven dressing composed of hydrofiber fibres. Absorbs exudate and create a gel.

How does it work?

As it absorbs exudate vertically, protecting the peri wound skin. As it absorbs the exudate it forms a soft gel, providing a moist healing environment. The gel will retain its integrity allowing ease of removal. Easy to remove – does not breakdown when saturated, safe in wounds close to the trachea. Capable of managing large quantities of exudate. May cause wounds to desiccate if inadequate amounts of exudate.


Moderate to heavily exuding wounds including: • Leg ulcers • Pressure ulcers • Neck wounds that connect to the trachea • Fungating tumours • Deep, narrow cavity wounds – removal of dressing in

one piece required Traumatic wounds.


Dry or low exuding wounds. Narrow sinuses.

How to use it • Flat – apply over the wound with 1cm overlapping the surrounding skin.

• Ribbon – insert loosely into the wound. • Can be cut to size.

of 39


• Cover with absorbant pad and tape, film or hydrocolloid depending on exudate levels.

• Frequency of dressing change is dependent on secondary dressing and exudate.

• Usually 1-2 days, however can be left for up to 7 days if occlusive dressing applied.

AQUACEL® AG+ Extra What is it?

Ionic Silver containing anti- biofilm, hydrofiber dressing. Absorbs exudate and create a gel. Requires a prescription.

How does it work?

Disrupts biofilm. The ionic silver kill bacteria. Prevents biofilm reformation. Can be cut to any size without shedding fibres. Forms a gel sheet in presence of exudate. May cause wounds to desiccate if inadequate amounts of exudate.


Moderate to heavily exuding acute or chronic wounds, requiring a dressing with an antimicrobial effect. Effective against pseudomonas aeruginousa, staphylococcus aureus, MRSA, and VRE.


Patients with known sensitivities to silver. Dry or low exuding wounds. Narrow sinuses.

How to use it • Flat - apply directly to the wound overlapping the skin by at least 1cm.

• Ribbon - insert loosely into the wound. • Can be cut to size. • Cover with absorbent pad and secure film, tape or

bandage. • May be left in place for up to 7 days depending on

exudate levels. • Should be used for 2 weeks then reviewed.

CLINISORB What is it?

Activated charcoal sandwiched between layers of nylon/viscose rayon cloth.

How does it work?

Activated charcoal is produced by heating carbon which leads to small pores


Management of malodourous such as fungating wounds, pressure ulcers, leg ulcers and diabetic foot ulcers.


Exudate will reduce the effectiveness of the dressing.

How to use it • Can be used as a primary or secondary dressing. • Can be cut to size.

of 39


COSMOPORE What is it?

Low adherent, absorbent perforated dressing with a hypoallergenic adhesive border.

How does it work?

Provides a low adherent, dressing pad with an adhesive border for minor wounds.


Post operative wounds healing by primary intention and minor, low exuding wounds.


Heavily exuding wounds. Patients with sensitization to components.

How to use it • Select appropriate size. • Peel backing. • Stick to wound ensuring low adherent pad covers wound

surface. • Change prior to occurrence of strike through.

C VIEW What is it?

A vapour permeable transparent film dressing which allows the wound bed to be inspected without having to remove the dressing.

How does it work?

Maintains moist healing environment and prevents scab formation. Impermeable to fluids and bacteria.


Low exuding superficial wounds.


Moderate to highly exuding wounds. Wounds with necrotic tissue or thick adherent slough. Cavity wounds. Patients with thin, friable intact skin. Infected wounds.

How to use it • Select most appropriate size. • Peel off backing and apply to wound. • Can be used as a primary or secondary dressing. • Stretch and release to remove. • Can leave in place for up to 7 days unless wound

exuding. • Patients can shower with dressing insitu.

C VIEW POST-OP What is it?

Low adherent absorbent pad with polyurethane vapour permeable film, providing a waterproof adhesive island dressing.

How does it work?

Minimal exudate is absorbed into pad and dressing is held in place by an adhesive border. As this is a film early signs of inflammation are visible through the dressing without removal.


Surgical wounds closed by primary intention. Superficial low exuding wounds.


Wounds with necrotic tissue or thick adherent slough. Cavity wounds.

of 39


Patients with thin, friable intact skin. Infected wounds. Heavily exuding wounds.

How to use it • Choose the correct size of dressing to ensure the absorbent pad will cover the wound.

• Remove the first backing strip, apply to wound, then remove the second backing strip.

• Can be left for up to seven days, however leakage will occur rapidly in heavily exuding wounds.

DUODERM SIGNAL What is it?

DuoDERM signal is an adhesive, hydrocolloid wound dressing with a tapered edge and a change indicator. The indicator helps to determine when to change the dressing and the tapered edge helps to prevent rucking up.

How does it work?

The adhesive hydrocolloid matrix contains sodium carboxymethylcellulose, gelatin, pectin and adhesive polymers which create a moist environment that can help facilitate autolytic debridement. The outer film on DuoDERM® Signal™ is permeable to moisture vapour and provides an occlusive waterproof barrier.


Lightly exuding superficial wounds.


Deep, heavily exuding wounds.

How to use it • Cleanse and dry wound. • Select a suitable size of dressing, ensuring it extends

3cm beyond the wound margin. • Remove backing paper, line centre of dressing with

centre of wound and apply. • As exudate is absorbed, the hydrocolloid layer liquefies

into a gel. This looks like pus and has a distinctive odour. This is normal, but patients should be told in advance.

• Change as clinically indicated but maximum of 7 days. The green line indicator identifies when the dressing needs changing.

• To remove press down gently on the skin and lift one corner of the dressing, stretching each edge until free.

FLAMAZINE What is it?

A hydrophilic cream containing silver sulphadiazine 1% w/w. Requires an approved prescription.

How does it work?

Effective anti-bacterial cream. May cause skin maceration. Relatively expensive.


Burns (usually under supervision of Burns Team). Infected wounds especially if Pseudomonas Aeruginosa

of 39


present. What should it not be used on?

Impairment of renal or hepatic function. Sensitivity may occur but lower than in other sulphonamides. Heavily exudating ulcers.

How to use it • Apply cream to wound with finger using sterile glove • Take care not to spread onto surrounding skin as this will

cause maceration • Cover with non adherent dressing and/or absorbent pad • Secure with tape or bandage. • Reapply cream at least daily. • Keep refrigerated when not in use. • Change dressing at least daily or more frequently if strike

through occurs. GRANUGEL What is it?

A sterile Hydrogel composed of hydrocolloids (pectin and sodium carboxymethyl-cellulose) containing 80% water.

How does it work?

The dressing has the ability to absorb excess exudate from exuding wounds but donate moisture to dry necrotic tissue or slough. Granugel maintains a moist environment which can facilitate the formation of granular tissue.


Necrotic tissue. Sloughy wounds - deep or shallow. Granulating wounds - deep or shallow. Epithelialising wounds. Sinuses.


Known sensitivity to the gel or its components (propylene glycol). Appropriate antibiotic therapy should be initiated where infection is suspected or develops during the use of Granugel.

How to use it • Unscrew the tube cap and remove the white safety ring. Replace the cap to puncture the tube membrane.

• Apply Granugel directly into the wound. The sterile applicator nozzle may be used to apply the gel into deeper wounds.

• Apply to a depth of 1cm on necrotic tissue and 0.5cm on other wounds.

• Cover with low adherent dressing e.g. Dressing pad or Foam.

• Change daily on necrotic tissue, or every seven days on granulating wounds.

NB: Do not use gauze over top as this will absorb the gel making it ineffective.

INADINE What is it?

A knitted viscose fabric dressing impregnated with an ointment containing 10% Povidone Iodine. This is equivalent to 1% available iodine.

of 39


How does it work?

In the presence of exudate the povidine- iodine is released from the ointment and has a broad spectrum antimicrobial effect. The dressing is low adherent and water soluable.


At risk diabetic feet Prophylaxis and treatment of infected wounds. Shallow infected wounds. Contaminated traumatic injuries. Superficial burns (under supervision of Burns Team).


Known allergy to povidone iodine or iodine. Before and after use of radio – iodine If the patient is being treated for kidney problem’s In cases of Duhrings herpetiformdermatitis(rare skin condition) Heavily exuding wounds. Pregnant or lactating mothers. Cavity wounds. Must be under supervision: In patients with thyroid disease

How to use it • Remove backing strips. • Apply Inadine dressing to wound. • No more than 4 dressings may be used to cover the

surface area of a large wound. • Cover with an absorbent pad and secure with tape or

bandage. • Dressing needs changing when Inadine becomes white,

daily initially, then every 2-3 days depending on degree of exudate.

KERRAMAX CARE What is it? A superabsorbent dressing. How does it work?

Exudate and matrix metalloproteinases (MMPs) are pulled into absorbent polymers and stay within the dressing preventing leakage. This helps to prevent maceration and maximises comfort.


Moderate to heavily exuding wounds.


Dry or minimally exuding wounds.

How to use it • Select appropriate size and apply to wound. • Can be used as a primary or secondary dressing. • Do not cut/tear

MEPITEL One What is it?

A porous, semi-transparent net which is silicone coated on one side. It is non-absorbent but will allow the passage of wound exudate through to a secondary dressing. It will adhere to intact skin but not to the wound surface.

How does it work?

The silicone coating is slightly tacky which allows the dressing to be retained by the periwound area. However it will not adhere to

of 39


the wound surface allowing dressing changes with minimum discomfort and the prevention of trauma to fragile tissue.


Wounds where adherence of the dressing to the underlying tissue may cause trauma or pain on removal e.g. skin tears, abrasions, extensive blistering, lacerations, grafts, burns, skin damage following radiotherapy. Can also be used under or over topical steroids and antimicrobials.


Should not be used if allergic to silicone.

How to use it • The dressing is supplied between 2 layers of plastic film which require removal.

• Select an appropriate size of Mepitel One that allows at least 2cm margin of intact skin around the wound – can be cut to size before film removed.

• Apply with sterile gloves, moistened with saline – reduces tackiness of Mepitel One.

• Remove one of the outer films from the Mepitel One and place the Mepitel One onto the wound

• Remove the second outer film. • Cover with appropriate secondary dressing and secure

with tape, or retention bandage. • Can be left in place up to seven-ten days but the

secondary dressing can be changed as often as necessary.

• If more than one piece is used the dressings can be partially overlapped ensuring that the pores are not blocked.

• Imprints can occur in areas where pressure is exerted therefore if used following facial resurfacing the Mepitel One should be lifted and repositioned alternate days.

L-MESITRAN HYDRO AND BORDER What is it?

A hydro active gel dressing containing medical grade honey available without or with an adhesive film border. L-Mesitran has anti-bacterial properties and can debride and reduce malodour.

How does it work?

Contains digested sugars, vitamins, minerals and enzymes. The high osmotic action draws fluid into the wound to aid autolytic debridement, softening and lifting of dead tissue. Does not support bacteria due to high osmotic pressures and presence of hydrogen peroxide. Acts as a stimulant for growth of new capillaries, fibroblasts and epithelial cells.


Burns. Chronic wounds. Necrotic/sloughy wounds. Surgical wounds. Diabetic wounds with caution and regular monitoring of blood sugars. Donor sites.

of 39


Fungating wounds. What should it not be used on?

Honey can cause maceration to surrounding tissue therefore frequent observation and protect of surrounding tissue is essential. Caution must be exercised when applying honey to the diabetic patient, blood sugars must be frequently monitored. Hayfever sufferers should not use honey – risks associated with pollen gathered by bees in the content of the honey.

How to use it • L-Mesitran hydro – has film backing but is non adhesive and requires a secondary dressing.

• L – Mesitran border has an adhesive film border. SORBSAN RANGE What is it?

A biodegradable dressing consisting of calcium salt of alginic acid derived from seaweed.

What sizes are available?

Flat (sheet) dressing - 5 x 5cm, 10 x 10cm, 10 x 20cm Packing 2g - 30cm long with probe Ribbon - 40cm long with probe

How does it work?

The calcium alginate forms a hydrophilic gel at the wound surface in the presence of exudate which facilitates wound healing. Sorbsan also has haemostatic properties.


Sorbsan flat can be used on exuding wounds e.g. leg ulcers, pressure ulcers, donor sites. Packing and ribbon is generally indicated for use in cavity wounds or sinuses – as the packing is wider this should be used on larger cavities and the ribbon used for smaller cavity wounds.


Dry, necrotic wounds. Narrow sinuses. Neck wounds close to the trachea.

How to use it • Flat - apply over surface of wound. • Packing or Ribbon - insert loosely into wound. • Cover with pad and Mefix to allow moisture to evaporate or

film to keep moisture in. • Irrigate with saline to remove. • Change every 1-3 days depending on exudate levels/

condition of wound. TELFA CLEAR What is it?

A low cost low adherent, non absorbent dressing consisting of a polyester mylar film, available as a sterile dressing or a non sterile bulk roll.

How does it work?

Clear perforated polyester film, low adherent plus allows the clinician to view the wound without removing the dressing therefore not disturbing the wound bed.


Burns, skin grafts, donor sites, abrasions, surgical incisions and chronic wounds Can be used as a liner for wounds underneath foam in Topical

of 39


Negative Pressure Therapy to prevent adherence. Can be used with ointments. Can also be used as a membrane for larvae therapy to secure maggots within the wound.


Highly exuding wounds.

How to use it • Apply appropriate sized Telfa Clear directly to wound bed. • Can be cut to size. • A secondary dressing is required to absorb exudate,

secure and act as a barrier to infection. NB: Product must be fully opened or may cause maceration

URGOTUL What is it?

A non occlusive, low adherent, hydrocolloid dressing. Comprises of a polyester mesh impregnated with hydrocolloid particles dispersed in a petroleum jelly matrix (lipido-colloid technology). The mesh has an open diameter of 0.5mm. Non greasy to touch.

How does it work?

On contact with wound exudate hydration of the hydrocolloid particles occur producing a lipido-colloid interface. This creates a moist environment to promote healing and prevents adhesion to the wound so that it can be easily and painlessly removed. Has continuous threads, so there no risk of microfibres being shed into the wound creating a foreign body reaction. Has non-deformable links so that the mesh is permanently open. This helps prevent maceration and the small size helps prevent migration of granulation tissue through the mesh. Stimulates fibroblast proliferation.


Acute and chronic non infected wounds eg burns, donor sites, dermabrasions, traumatic wounds, post operative wounds, leg ulcers, pressure ulcers, diabetic foot ulcers, stump wounds and epidermolysis bullosa.


Infected wounds.

How to use it • Apply Urgotul straight onto a cleaned wound surface and shape to contours of wound.

• Cover with a secondary absorbent dressing and tape or bandage in place.

• Urgotul can sometimes stick to surgical gloves making application difficult. Consequently the wetting of the gloves with saline prior to the handling of Urgotul is recommended to make it easier.

• Can be left in place for up to 7 days depending on the wound.

URGOTUL Ag What is it? A non occlusive, low adherent, antibacterial, hydrocolloid dressing

of 39


Comprises of a polyester mesh coated with hydrocolloid, Silver sulphadiazine (0.45mg/cm2), petroleum jelly and cohesion polymer. The mesh has an open diameter of 0.5mm Non greasy to touch. Has a broad spectrum antibacterial activity

How does it work?

On contact with wound exudate hydration of the hydrocolloid particles occur producing a lipido-colloid interface. This creates a moist environment to promote healing and prevents adhesion to the wound so that it can be easily and painlessly removed. Has continuous threads, so there no risk of microfibres being shed into the wound creating a foreign body reaction. Has non-deformable links so that the mesh is permanently open. This helps prevent maceration and the small size helps prevent migration of granulation tissue through the mesh. Stimulates fibroblast proliferation. The bactericidal effect occurs from Sulphadiazine aiding the movement of the silver ion through the bacteria membrane. The silver ion then reacts with the bacteria’s DNA, replacing the hydrogen atom and blocking duplication and replication of the bacteria.


This dressing is suitable for any wound that is infected or contaminated or where there is a high risk of this occurring and a protective non/low adherent dressing is required e.g. superficial and partial thickness burn wounds, donor sites, graft sites.


The use of Urgotul Ag is contraindicated if patient has a known sensitivity to silver.

How to use it • Apply Urgotul Ag straight onto a cleaned wound surface. • Apply an absorbent secondary dressing over the top. • Can be left in place up to seven days depending on

exudate levels and wound type. WOUND PAD – PREMIER/XUPAD What is it?

A sterile absorbent dressing pad.

How does it work?

Absorbs exudate into wadding.


Can be used as a primary or secondary dressing. Wet wounds to absorb exudates. Dry wounds as padding.


Wounds where it is likely to stick and cause trauma on removal.

How to use it • Select appropriate size. • Apply as a primary or secondary dressing. • Secure with loose bandage, tape or Mefix.

3. Specialist Use Only Wound Care Products

of 39


3.1 Quick Reference Guide to Specialist Use Only Wound Care Products

Product Name Description Sizes and Forms Allevyn Ag Non adhesive foam dressing with

silver sulphadiazine- used for pin sites 5x5,10x10,15x15,20x20

Aquacel Foam non adhesive

Hydrofibre foam with waterproof outer layer and absorbent pad- used for tracheostomies

10x10cm

Drawtex A hydroconductive that is very absorbant dressing that wicks away the exudate

5x5,7.5x7.5,10x10,15x20,20x20,7.5x1m,10x1m,20cmx1m,10cmx1.3m

Flaminal Forte and Hydro

Alginate gel containing two antimicrobial enzymes. Forte is for wetter wounds.

15g and 50 gram tubes

Granuflex An outer waterproof polyurethane foam, bonded to a matrix of hydrocolloid particles

Square 10x10cm, 15x15cm, 20x20cm

Haelan Tape Adhesive, waterproof, occlusive tape impregnated with a topical steroid

7.5x50 cm, 7.5x200cm

Kytocel Gelling fibre dressing 5x5,10x10,15x15,4x10,4x20,4x30,2.5x45cm (ribbon)

Medihoney Barrier Cream

Barrier cream containing medihoney antibacterial honey

2g sachet or 50g tube

Mepilex Absorbent soft silicone dressing for patients with fragile skin

10x11/11x20/15x16/20x21cm

Opsite Flexigrid Semi-occlusive film dressing for superficial wounds or as secondary dressing

10x12

PolyMem Range Thin foam containing a cleanser and moisturiser- for radiotherapy reactions

8x8cm,10x10cm,13x13cm,17x19cm,10x61 cm roll. Also finger/toe dressings

Suprasorb X Bio-cellulose dressing designed to regulate moisture levels in the wound

5x5, 9x9, 14x20, 2x21(rope)

Suprasorb X + PHMB

Bio-cellulose dressing with broad spectrum antimicrobial

5x5, 9x9, 14x20, 2x21(rope)

Urgostart contact Polyester mesh with hydrocolloid and a healing accelerator

5x7, 10x10, 15x20

3.2 Specialist Use Only Wound Care Products Details

ALLEVYN Ag What is it?

A non adherent foam dressing impregnated with silver sulphadiazine that can be cut to suit the patient.

How does it work?

Used round infected pin sites of metal work to help prevent bacterial contamination


Infected pin sites under advice of specialist nurse.


It is not recommended for any other wound types in the Trust unless advised by a specialist practitioner.

How to use it • Cut to allow application around the metalwork

of 39


AQUACEL FOAM What is it? A non adhesive hydrofibre foam pad. How does it work?

Absorbs fluid into the multilayer pad and wicks away preventing maceration of the skin.


Tracheostomy sites when cut to shape and where Activheal tracheostomy dressing is not providing sufficient absorbency.


Any other wound types in the Trust unless advised by specialist practitioner.

How to use it • Cut a slit in the dressing and place around the tracheostomy tube.

• Change as clinically indicated. DRAWTEX What is it?

A hydroconductive dressing that is very absorbent and wicks away the wound exudate.

How does it work?

Manages and controls excessive wound exudate Facilitates removal of wound debris Draws bacteria from the wound bed into the dressing Draws out harmful MMPs from the wound bed into the dressing


Moderate to heavily exuding wounds


Wounds at risk of bleeding

How to use it • Cut Drawtex to conform to the wound shape if required • Apply Drawtex directly to the wound surface. For heavy

exudate, apply additional layers as necessary • Cover with a dressing or bandage of choice • Change Drawtex every 1–3 days as clinically indicated. • Once volume of exudate is under control, dressing may be

changed less frequently (not to exceed 7 days). FLAMINAL HYDRO/FORTE What is it?

Alginate gel containing 2 antimicrobial enzymes, glucose oxidase and lactoperoxidase.

How does it work? Debrides the wound and manages moisture balance. What can it be used on?

Wide range of wounds a most stages of healing. Useful for cavity wounds e.g pilonidal sinuses. Forte is for wetter wounds as contains a higher proportion of alginate than the Flaminal Hydro.


Full thickness burns. Patients with a sensitivity to alginate dressings or polyethylene glycol

How to use it • Select either Flaminal Hydro or Flaminal Forte

of 39


depending on exudate levels • Clean and rinse the wound as you would normally and dry

carefully. • Apply a thick layer (5mm) of either Flaminal Hydro or

Flaminal Forte to the wound in a sterile manner. Flaminal does not need to spill over the wound edge.

• Cover with a suitable secondary dressing either an absorbent dressing for wetter wounds or on drier wounds, use a dressing that reduces evaporation and prevents the wound from drying out.

• The dressing can stay in place for as long as the gel structure is intact: 1-4 days, depending upon the amount of exudate.For wounds treated with Flaminal Hydro, i.e., lower exudate wounds, this generally means every 3-4 days. Flaminal Forte wounds, being higher in exudate, are usually changed every 1-2 days. Change from Flaminal Forte to Flaminal Hydro as exudate reduces.

• When using Flaminal Hydro, if the gel becomes too liquid, the wound is too wet for Flaminal Hydro. Use Flaminal Forte.

• When using Flaminal Forte, if dry flakes of alginate appear in the wound, the wound is too dry for Flaminal Forte. Use Flaminal Hydro.

• During Flaminal treatment, dry whitish alginate flakes may appear on the wound border. They should not be removed as the flakes will prevent border maceration.

GRANUFLEX What is it?

An outer waterproof polyurethane foam, bonded to a matrix of hydrocolloid particles (gelatin, pectin and methylcellulose) and a hydrophobic polymer.

How does it work?

Waterproof so patient can bathe or shower. Hydrocolloid layer may squeeze out of wafer if applied to weight bearing areas.


Necrotic wounds, sloughy wounds, granulating wounds, epithelialising wounds. Bordered Granuflex shaped for more difficult areas such as the sacrum or heels.


Wounds with exposed tendon or bone - only use under medical supervision. Ulcers resulting from tuberculosis, syphilis and deeper fungal infections. Third degree/full thickness burns greater than 2% body surface area.

How to use it • Select a suitable type and size of dressing, ensuring it extends 2-3cm beyond wound margin. When cutting large wafers to size, curve corners.

• Warm dressing between gloved hands, remove backing

of 39


HAELAN TAPE What is it?

A thin, adhesive, waterproof, occlusive tape impregnated with a topical steroid, fludroxycortide.

How does it work?

The steroid tape is used as an adjunctive therapy for chronic, localised, recalcitrant dermatosis that may respond to topical corticosteroids . Each square centimetre contains 4 micrograms of the steroid. It is waterproof and makeup can be applied on top.


Overgranulation tissue


Chicken pox Hypersensitivity to any of the components

How to use it • Clean and dry skin • Cut a piece large enough to cover the affected area with a

0.5 cm border onto unaffected skin. Round off corners to prevent catching.

• Remove the paper backing and apply the adhesive to the skin

• Do not use a secondary dressing • Should not be used for long term use.

KYTOCEL What is it?

A highly absorbent conformable, gelling dressing composed of natural biodegradable chitosan fibres. Can be removed in one piece. It has a natural antimicrobial action that makes it effective against wound pathogens including Candida albicans, Pseudomonas Aeruginosa and MRSA.

How does it work?

The fibres bond with the wound exudate and transform into a gel that locks the fluid away. The positive charge allows it to interact with negatively charged molecules such as gram- positive bacteria, blood cells, proteins, metals and lipids.


Moderately to heavily exuding chronic and acute wounds. Can be used to control minor bleeding insuperficial wounds.


Not indicated for surgical implantation, third degree burns or to control heavy bleeding. Should not be used on patients who are sensitive to chitin.

How to use it • Select appropriate size, apply to wound as a primary

paper and apply to wound in a rolling motion. • Smooth into place, particularly edges. Adhesion improves

as the dressing warms. • Change every 3-7 days depending on exudate levels.

N.B. As exudate is absorbed, the hydrocolloid layer liquefies into a gel. This looks like pus and has a distinctive odour. This is normal, but patients should be told in advance.

of 39


dressing. • Cover with suitable secondary dressing and secure using

tape, film or bandage. MEDIHONEY BARRIER CREAM What is it?

Barrier cream containing 30% sterile manuka honey with antibacterial and anti-inflammatory properties.

How does it work?

Helps to reduce inflammation, prevent maceration, excoriation and irritation effects of incontinence and diarrhoea.


Wound edges to protect skin from exudate. For treatment of incontinence associated dermatitis and atopic eczema. Prevention and treatment of maceration and excoriation. Can be used on broken skin


Patients allergic to honey

How to use it • Clean and dry the area • Apply 3 times a day or as required.

MEPILEX What is it?

An absorbent dressing with a soft silicone wound contact layer, a polyurethane foam pad and an outer film that is vapour permeable and waterproof.

How does it work?

Minimises the pain to the patient and trauma to the wound bed at dressing changes as the soft silicone layer prevents adherence to the wound bed. Will gently adhere to the surrounding skin but can be removed with no epidermal stripping.


A wide range of low to moderately exuding wounds such as leg and foot ulcers/pressure ulcers/ painful wounds/wounds with compromised/fragile surrounding skin. Indicated for use on patients receiving radiotherapy.


Heavily exuding wounds.

How to use it • Select correct size. • Cut to shape to fit difficult to dress areas.

OPSITE FLEXIGRID What is it?

Vapour permeable transparent film dressing with a 1cm grid marked on it to aid wound management.

How does it work? Maintains moist healing environment What can it be used on?

Superficial, low exuding wounds


See C View

How to use it • See C View. • Can also use large rolls of Opsite Flexifix in theatre as a

of 39


drape. POLYMEM What is it?

PolyMem is a hydrophilic polyurethane thin foam that contains a wound cleanser (F68 surfactant) and a moisturiser (glycerine). Available with or without an adhesive border and in various shapes. Polymen Max is a more absorbent version.

How does it work?

The wound cleanser is constantly released from the dressing minimising the need for cleansing at dressing changes. The combination of the surfactant and glycerine works on the nociceptors to reduce pain and inflammation.


Low to moderately exuding wounds including skin tears, superficial and partial thickness wounds, burns, donor and graft sites, and radiotherapy- induced skin reactions.


Full thickness burns and in conjunction with solutions containing hypochlorite.

How to use it • Choose relevant size/shape. • Apply to wound. • Fix in place using appropriate securing mechanism. • Can cut slits along the edge of the dressing to help with

conformability. • The outer layer of the dressing is printed with a 1cm grid

which can help with fitting the dressing to the patient. SUPRASORB X What is it?

Bio-cellulose dressing designed to regulate moisture levels in the wound

How does it work?

Creates hydro balance by absorbing surplus exudate from the wound into the dressing and releasing moisture from the dressing into the wound.


Light to moderately exuding wounds Superficial and deep


Infected wounds. If the dressing dries out rehydrate with saline until it is soft enough to remove. This can take up to 30 minutes.

How to use it • Clean and dry the wound • Position the dressing over the wound • If using the rope, fold this several times and place it gently

into the wound leaving 2-3cms visible to ensure it can be removed easily.

• Hold in place with an appropriate secondary dressing. SUPRASORB X + PHMB What is it?

Bio-cellulose dressing with broad spectrum antimicrobial (PHMB)designed to regulate moisture levels in the wound

How does it work?

Creates hydro balance by absorbing surplus exudate from the wound into the dressing and releasing moisture from the dressing

of 39


into the wound. Microorganisms are killed by the PHMB. What can it be used on?

Light to moderately exuding wounds Superficial and deep infected wounds


If the dressing dries out rehydrate with saline until it is soft enough to remove. This cantake up to 30 minutes.

How to use it • Clean and dry the wound • Position the dressing over the wound • If using the rope, fold this several times and place it gently

into the wound leaving 2-3cms visible to ensure it can be removed easily.

• Hold in place with an appropriate secondary dressing. URGOSTART CONTACT What is it?

UrgoStart® Contact is a contact layer with TLC-NOSF (Technology lipido- colloid). It consists of a polyester mesh impregnated with hydrocolloid, petroleum jelly and particles of the healing accelerator NOSF.UrgoStart® Contact is a contact layer with TLC-NOSF (Technology lipido- colloid). It consists of a polyester mesh impregnated with hydrocolloid, petroleum jelly and particles of the healing accelerator NOSF.

How does it work?

Promotes faster healing and improves patients’ quality of life Neutralises excess proteases (MMPs) Re-establishes wound equilibrium With all the benefits of TLC: pain-free dressing changes, moist wound-healing, good tolerance, stimulation of fibroblast proliferation


Non to low exuding leg ulcers, pressure ulcers, diabetic foot ulcers and recurring wounds Can be combined with an absorbent layer Can be used in cavity wounds Minimum duration of treatment 4-5 weeks


Infected or critically colonised wounds. Known sensitivity to any components of the dressing

How to use it • Select an appropriate size • Secure with a retention bandage or a secondary dressing • Can be left in place for up to 7 days

4. Skin Care Products

4.1 Quick Reference Guide to Skin Care Products

Product Name Description Sizes Appeel A no sting silicone fluid that can help

facilitate the easier removal of adhesive dressings

Sachet 5ml/wipes 30/foam applicator

Cavilon* No Sting Barrier Film/Durable Barrier Cream

No sting barrier film/ Durable barrier cream

1ml/3ml applicators/28ml spray 2g sachets/28/92g tubes

of 39


Dermol 500 An antimicrobial emollient for the management of dry and pruritic skin conditions

500ml

Fifty:50 ointment Emollient containing white soft paraffin and liquid parafin

250g 500g

Proshield Plus Skin Protectant

A skin protectant to protect intact and skin damaged from incontinence

115g

Tena wash cream A creamy 3-in-1 formula that should be used in place of soap and water to cleanse skin contaminated with urine and faeces

150ml

Zerobase Emollient Cream

Emollient cream contains liquid paraffin which can moisturise dry skin

50g tube 500g pump

* see specialist formulary for Medihoney Barrier Cream

4.2 Skin Care Products Details APPEEL What is it?

Appeel Sterile Medical Adhesive Remover facilitates the quick and easy removal of dressings, tapes and other medical adhesives.

How does it work?

When the silicone comes into contact with the adhesive of the dressing it temporarily changes the surface energy of the skin, disrupting the adhesive properties between skin and device. This facilitates gentle removal of the dressing.


Use of Appeel Medical Adhesive Remover helps to protect skin, whilst reducing the risk of damaging skin or experiencing pain from repeated dressing changes. Can be used on intact and broken skin.


Any patients with a known sensitivity to any of the ingredients.

How to use it • Spray: Skin should be clean and dry prior to application Spray 10 – 15 cm from the skin Spray onto a permeable dressing/tape to release If impermeable, spray under one edge and repeat for complete removal For single patient use. Can be used at any angle

• Wipes: Skin should be clean and dry prior to application To open the sachet, tear along notch across the top Wear sterile gloves to maintain sterility when using this product Remove wipe from sachet. Lift a corner of the dressing/tape and gently wipe under the dressing/tape to release the adhesive from the skin Appeel Sterile Medical Adhesive Remover dries quickly, leaving no residue. Once dried, it will not affect any further adhesion Use additional sachets if required for larger areas

• Foam applicator: Skin should be clean and dry prior to

of 39


application To open the sachet, tear along either notch across the top Wear sterile gloves to maintain sterility when using this product Remove the foam applicator from the sachet and gently wipe the applicator over a permeable tape/dressing or under the edges of an impermeable tape/dressing to release it from the skin Appeel Sterile Medical Adhesive Remover dries quickly, leaving no residue. Once dried, it will not affect any further adhesion of tapes/dressings Use additional sachets if required for larger tapes/dressings

Also available as a sterile liquid sachet. CAVILON NO STINGBARRIER FILM / DURABLE BARRIER CREAM What is it?

Cavilon No Sting Barrier Film is an alcohol-free liquid barrier film that when dry forms a breathable, transparent coating on the skin. It lasts for up to 72 hours, and will not sting when applied to broken skin.

Cavilon Durable Barrier Cream provides protection from bodily fluids whilst moisturising the skin. It is both fragrance and parabens free.

How does it work? Contains silicone which has a water repellent property. Applying too many layers of product may make the area feel stiff.

What can it be used on? Film: Designed to protect intact, damaged or 'at-risk' skin from

urine, faeces, other body fluids, adhesive trauma and friction.

Cream: Recommended to prevent skin breakdown on intact skin and is safe for use on injured skin.

What should it not be used on? Use of the product with other barrier ointments, creams or lotions

may significantly reduce its effectiveness

Not to be used on infected areas of the skin - for example fungal infections

How to use it Barrier cream

• Use on clean, dry skin. • Apply a small amount of Cavilon Durable Barrier

Cream to the affected area, gently smoothing it into the skin.

of 39


• Re-apply following every 3rd episode of incontinence. Apply sparingly. If the ‘after-feel’ is ‘oily’, you have applied too much.

Barrier film

• Skin should be clean and dry prior to application • Apply a uniform coating of film over the entire treatment

area when using the foam applicator or stoma wipe. When using the spray bottle, hold the spray nozzle 10 to 15cm from the skin and apply in a smooth, even coating over the entire treatment area, whilst moving the spray in a sweeping motion.

• If an area is missed, re-apply to that area only after the first application has dried (approximately 30 seconds).

• If applied to an area with skin folds or other skin-to-skin contact, make sure that the skin contact areas are separated and allow the coating to dry before returning to normal positions.

• Re-application is recommended at least every 48-72 hours (under normal use) or more frequently if needed

DERMOL 500 What is it?

An antimicrobial emollient for the management of dry and pruritic skin conditions, especially eczema and dermatitis. The lotion is suitable for direct application, and for use as a soap substitute.

How does it work?

The active ingredients are presented in an aqueous lotion and so are readily absorbed into the stratum corneum when the product is gently massaged over the areas of dry skin. The antiseptic ingredients are in intimate contact with the skin, and as they are in solution, their availability is optimal.


Dry and pruritic skin conditions


Do not use in cases of known sensitivity (especially generalised allergic reaction) to any of the ingredients.

How to use it • For application to the skin: apply the lotion to the affected areas as required. Massage into the skin, until absorbed.

• For use as a soap substitute: use as a cleanser in the bath or shower, or for other toiletry purposes, instead of ordinary soap or shower gel.

Fifty:50 What is it?

Liquid Paraffin, White Soft Paraffin An emollient ointment for the symptomatic relief of dry skin conditions

How does it work? Moisturises the skin

of 39



Dry skin conditions


Most people will not have problems, but some may get some of these: Rarely, allergic reactions (e.g. skin rash, red or itchy skin) Irritation of hair follicles if used for a long period of time This ointment is greasy, and so if you apply it to your hands, be careful if you drive or use machines. NB: patients using these products should be advised not to smoke: use naked flames (or to be near people who are smoking or using naked flames) or go near anything that may cause a fire whilst emollients are in contact with their medical dressings or clothing. Clothing and bedding should be changed daily to prevent emollients soaking into fabric (Drug Safety Update, 2016).

How to use it • Apply a thin layer of ointment to the affected area. • Apply in the direction of hair growth to help prevent

irritation of hair follicles. • Apply when you need to, at least twice a day or ideally

three or four times a day. • If you are an adult treating a large area of your body you

may use up to one tub a week. • For use on the skin only.

PROSHIELD PLUS SKIN PROTECTANT What is it?

A greaseless, fragrance free dimethicone based skin protectant to protect intact and damaged skin from incontinence.

How does it work?

Moisturises the skin leaving it supple and hydrated.


Intact and damaged skin up to grade 2 damage. To be used when Cavilon has been ineffective


Under dressings as the adhesive will not stick. Wounds greater than partial thickness.

How to use it • Smooth gently over the area of damaged skin • Do not rub as this may cause friction. • A thin layer is sufficient for protection of intact skin.

TENA WASH CREAM What is it?

A creamy 3-in-1 formula that should be used in place of soap and water to cleanse skin contaminated with urine and faeces. Dermatologically tested. Helps to maintain the skin’s natural pH. Alcohol-free and soap-free. Helps to leave the skin feeling fresh, clean and free from unpleasant odours.

How does it work?

Eliminates cross contamination through sinks and washcloths.

What can it be Primarily used for frequent perineal skin care of incontinent

http://www.gov.uk/

of 39


used on? individuals when changing absorbent products, but can also be used for full body cleansing when soap and water may otherwise dry the skin.


Known sensitives to any of the ingredients

How to use it • Unlike soap and water there is no need to rinse off. ZEROBASE EMOLLIENT CREAM What is it? An emollient containing liquid paraffin How does it work? Moisturises dry skin What can it be used on?

Dry skin


Broken skin

How to use it • Apply to dry skin 5. Others

5.1 Quick Reference Guide to Other Products Product Name Description Sizes Comfifast Tubular retention bandage – blue,

yellow or beige line Blue - 7.5x1m,7.5x3m,7.5x5m Yellow – 10.75x1m,10.75x3m,10.75x5m, Beige – 17.5 x1m

Viscopaste/Ichthopaste Bandages impregnated with zinc paste/ichthammol

7.5cmx6m

5.2 Other Products Details

COMFIFAST What is it?

An elasticated viscose tubular retention bandage available in a variety of sizes. Blue line 7.5 x 1,3, & 5m roll (most commonly used for venflons). Yellow line 10.75 x 1,3 & 5m roll (most commonly used for legs). Beige line 17.5 x 1m roll (for trunks).

How does it work?

Easier to apply than conventional bandages therefore may save nursing time. Holds primary and secondary dressings securely in place. May cause trauma if a size that is too small is used and is ineffective if too big a size used.


Leg, arms, trucks for the retention of dressings when unadvisable/unable to use adhesives to secure dressings.


Patients with discomfort/ allergy to product.

How to use it • Must be applied from joint to joint (e.g. toe to knee) to avoid oedema above and below bandage line.

• Change when contaminated with exudate/or soiled.

of 39


VISCOPASTE/ICHTHOPASTE What is it?

Cotton fabric, plain weave bandage impregnated with a zinc oxide paste. Requires additional banding over the top.

How does it work?

The zinc paste will help dry out and soothe irritated skin around ulcers.


Used in the treatment of a variety of skin conditions associated with leg ulcers e.g. inflammation, eczema. Can be used under 4 layer compression bandaging to act as a buffer between fragile skin and the compression bandage.


Patients with known sensitivity to paste.

How to use it • As a bandage - from base of toes to below knee in a spiral covering heel. Apply using a pleat at each turn or cut leaving overlap on each turn.

• Cover with Soffban (one of the layers of the K Four system see section 3.4.3) applied toe to knee in a spiral and secure with toe to knee retention bandage.

• Can be left on for up to a week but in warm hospital environment change every 2 -3 days to prevent drying out.

6. References and Bibliography

Cowan, T. (ed) (2016-17) Wound Care Handbook. 2016-16 (9th edn). Mark Allen Healthcare, 2016. Mahoney, K (2015) How to choose the correct dressing. Wound Care Today. 2015,Vol 2, No1. Medicines and Healthcare products Regulatory Agency (2016) Parafin-based skin emollients on dressings or clothing: fire risk Drug Safety Update Volume 9 issue 9, April 2016:9. www.gov.ukdrug-safety-update National Institute for Clinical Excellence (2008a) Prevention and Treatment of Surgical Site Infection. Clinical Guideline 74. National Institute for Health and Clinical Excellence, London www.nice.org.uk National Institute for Clinical Excellence (2014) The prevention and management of pressure ulcers Clinical Guideline 179. National Institute for Health and Clinical Excellence, London www.nice.org.uk Roberts,N. Sorrell,J. Bielby,A.Searle, R. (2011) A survey of post operative wound dressing practice before and after implementing national guidelines. Wounds UK, 2011, Vol 7. No4. 12-21.

http://www.nice.org.uk/

http://www.nice.org.uk/

of 39


Thomas, S (2009) Formulary of Wound Management Products. A Guide for Healthcare Staff, Tenth Edition. Euromed Communications Ltd, Hampshire.

7. Associated Policy and Procedural Documentation Guidelines for urinary continence care for adults patients aged 16 years or above Guidelines for the Prevention, Detection, Treatment and Management of Infected Wounds Guidelines for the Management of Patients with Leg/Foot Ulceration Infection Prevention and Control Policy Expanded Practice Protocol for the Use of sterile larvae Expanded Practice Protocol for the Application of Negative Pressure Wound Therapy Procedure for the Decontamination of Reusable Medical Devices prior to patient use, inspection, servicing, repair or return to departments or organisations Wound Management Guidelines

of 39


Appendix A

of 39


Wound Dressing Product Categories and Supply Routes PICS = obtain from pharmacy via Prescription only/ S = obtain from supplies/stores / TV = obtain from Tissue Viability

FORMULARY WOUND CARE PRODUCTS ALGINATES and FIBRES FOAMS ANTIMICROBIALS OTHERS

Sorbsan Flat (S) Sorbsan Ribbon (S) Sorbsan Packing (S)

Aquacel Extra Ribbon (S) Aquacel Extra Sheet (S)

Allevyn Gentle Border(S) Allevyn Non Adhesive (S)

Allevyn Cavity (S) Allevyn Multisite(S)

Allevyn Heel (S) Allevyn Gentle Border Lite

Oval (S) Activheal trachy (S)

Inadine (PICS) Aquacel Extra Ag+ Ribbon/Sheet

(PICS) L-Mesitran hydro and border (S)

Activon Tulle & Ointment (S) Algivon (S)

Flamazine (PICS) Anabact (PICS)

Urgotul Ag (PICS)

SKIN PROTECTION/ADHESIVE REMOVER

Proshield Plus(S) Cavilon No sting barrier film and

Cavilon Durable Barrier Cream (S) Tena wash (S)

Appeel Adhesive Remover(S)

SILICONE ODOUR CONTROL HYDROGELS PASTE BANDAGES Mepitel One(S) /Silflex (S) Anabact (PICS)

Clinisorb (S) Granugel (S)

Actiform Cool (S) Viscopaste /Ischthopaste (PICS)

HYDROCOLLOID FILMS ABSORBENT DRESSINGS TUBULAR BANDAGES DuoDERM Signal(S)

CView (S)

Xupad or Premier Dressing Pad

(sterile) (S) KerraMax Care(S)

Comfifast(S) Various sizes: 5/7.5cm width for

arms/10cm for legs/beige line 17.5x1m for trunks (S)

WOUND CONTACT LAYER

ISLAND DRESSINGS MOISTURISER/SOAP SUBSTITUTE

Telfa Clear (S) Urgotul (S)

CosmoporE (S) CView Post OP (S)

Dermol 500 (PICS)/ Fifty:50 Zerobase Emollient Cream(PICS)

SPECIALIST USE ONLY WOUND CARE PRODUCTS Drawtex/Granuflex/Kytocel (TV)/Mepilex (S)/Suprasorb X & Suprasorb X +PHMB (TV)/ Polymem (Radiotherapy OP)/

/Silver Nitrate (PICS)/Haelan Tape (PICS/Allevyn Ag (Trauma)/Aquacel Foam (ITU)/Medihoney Barrier Cream (TV)/Urgostart TV)/Flaminal Forte/Hydro(TV)

Any other non formulary /specialist use only products can ONLY be obtained after consultation with Tissue Viability and approval by the relevant supply route

Dressing for IV and Central Lines and some products used in Podiatry and Dermatology are not included For further advice please contact the Tissue Viability Team via PICs or refer to the Wound Management Guidelines/Wound Product Formulary

Appendix B

of 39

Document Number 359 Version 6 Wound Product Formulary

Appendix C

of 39

Document Number 359 Version 6 Wound Product Formulary

wound product formulary - uhb · soft white dressings, which are available as flat or rope/ ribbon...

Documents