Sårvæske INFEKTION Biofilm Der har altid været skurke i sårheling Nu findes der en løsning ® Ingen bandage kan mere.† Ingen bandage kan mere. 3 2 1 † Tre skurke i sårbehandlingen: Sårvæske, infektion og biofilm To effektive teknologier. NY Ag+ Teknologi En unik teknologi som nedbryder biofilm og dræber infektionsfremkaldende bakterier.*1-3 Hydrofiber® Teknologi Dokumenteret teknologi som absorberer og binder sårvæske og skaber et optimalt sårhelingsmiljø.*4-8 Én løsning til sårheling. ® Fås i AQUACEL® Ag+ Extra™ og AQUACEL® Ag+ kavitetsbandager. *Som påvist in vitro †Påvist evne til at håndtere sårvæske, infektion og biofilm. TE KNOLOG I Biofilm forsinker sårheling. Biofilm er almindelig. Biofilm dannes, når kolonier af bakterier danner et slimlag for at beskytte sig selv.9 Den er involveret i omkring 80% af alle infektioner i sundhedsvæsenet.10 Plakken på dine tænder, urinvejsinfektioner og øjeninfektioner står alle i forbindelse med biofilm.11-13 Selv om du ikke altid kan se det, indeholder størstedelen af kroniske sår biofilm14 – og den er en vigtig årsag til forsinket sårheling15 og et forstadium til infektion.16 Biofilm er vanskelig at fjerne helt17 – selv med debridering – og den gendannes hurtigt.18 Biofilm tåler: •Antimikrobielle stoffer som PHMB**19, honning20, jod21,22 og sølv23 •Antibiotika24 •Kroppens egne forsøg på at rense sårbunden25 og lukke såret19 Formodet biofilm Mikroskopisk billede af biofilm ** polyhexamethylenbiguanid Alle billeder bruges med deres respektive ejeres tilladelse. Biofilm Biofilm er stædig. To stærke teknologier, der arbejder de vigtigste barrierer for sårheling. Ag+-teknologi er en unik antibiofilmformulering med et TE KNOLOG I indhold af sølv, som:26 •OPLØSER og nedbryder biofilm, så bakterierne eksponeres*1-3 •DRÆBER et bredt spektrum af bakterier, herunder antibiotikaresistente "superbugs", ved hjælp af sit indhold af sølv*2,3,27 •FORHINDRER gendannelse af biofilm*2,3 AQUACEL® Ag+ Extra (n=5) AQUACEL® Ag Extra (n=5) Acticoat 7 (n=5) Genpodning Levedygtige bakterier (cfu) I en in vitrobiofilmmodel viste AQUACEL® Ag+ Extra™ bandagen større evne til at ødelægge biofilm og forhindre gendannelse.28-30 30,000,000,000 3,000,000,000 300,000,000 30,000,000 3,000,000 300,000 30,000 3,000 300 Ingen påvist 024487296120 144 Tid (timer) Opløser biofilm / dræber bakterier Forhindrer gendannelse af biofilm MRSA Levedygtige bakterier (cfu) Dokumenteret i laboratorieforsøg Pseudomonas aeruginosa: 30,000,000,000 3,000,000,000 300,000,000 30,000,000 3,000,000 300,000 30,000 3,000 300 Ingen påvist 0 24 48 72 96 120 Tid (timer) Opløser biofilm / dræber bakterier 144 168 192 216 Dag 9 Forhindrer gendannelse af biofilm I denne in vitro-model blev færdigudviklet biofilm dyrket på et gazesubstrat og bekræftet ved hjælp af mikroskopi. Gazebiofilmsubstrater blev herefter overført til agarplader for at skabe en simuleret sårbiofilmmodel; biofilmoverfladen blev dækket med bandager, hydreret og dækket med en passende sekundær bandage. Efter inkubation blev bandagens dræbende virkning på biofilmindlejrede bakterier vurderet på forskellige tidspunkter hen over et maksimum af 120 timer. Gendannelsen af biofilm blev også vurderet ved at indpode friske bakterier på gazesubstratet under bandagen efterfulgt af en vurdering af tilstedeværelse eller fravær af biofilm over et maksimum af 96 timer. *Som påvist in vitro synergistisk på at håndtere Hydrofiber®-teknologi hjælper med at skabe det ideelle miljø til sårheling – og til at få Ag+-teknologien til at virke. •BINDER sårvæske, bakterier og biofilm med henblik på at minimere krydsinfektioner og forhindre maceration*4-7,31,32 •FORMER SIG PÅ MIKROPLAN efter sårbunden, opretholder en optimal fugtbalance og fjerner dead space, hvor bakterier og biofilm kan vokse*33-35 •REAGERER på sårets tilstand ved at danne en sammenhængende gel og minimerer samtidig smerterne i forbindelse med bandageskift*36-38 Ekstra absorptionskapacitet betyder længere bæretid*39-41 Ekstra trækstyrke gør det lettere at fjerne bandagen*39 AQUACEL® Ag+ kavitetsbandage AQUACEL® Ag+ Extra™ bandage ® *Sammenlignet med standard AQUACEL® Ag bandage - supporte ® Dokumenteret ved videnskabeligt kontrollerede sår. vs. en PHMB-gaze. 41 95 % større reduktion ved dag 6 (p<0,05) signifikant En større forekomst af epitelialisering og granulation vs. en PHMB-gaze.41 48 % 24 % 100,000,000 10,000,000 1,000,000 100,000 10,000 2 46 Behandlingsdage ■ PHMB-gaze ■ AQUACEL® Ag+ bandage 140 Granulationsareal (mm2) (n=18) signifikant større En reduktion af biofilm Gennemsnitstal af levedygtige bakterier (cfu/sår)(n=6) I en tilpasset in vivo-biofilmmodel19 viste Ag+-teknologi i kombination med Hydrofiber®-teknologi:* 120 100 80 60 40 20 0 PHMB-gaze AQUACEL® Ag+ bandage PHMB-gaze AQUACEL® Ag+ bandage mere granulationsvæv ved dag 6 (p<0,05) 120 Epitelareal (mm2) (n=18) mere epitelvæv ved dag 6 (p<0,05) 140 100 80 60 40 20 0 *AQUACEL® Ag+ bandage blev anvendt i dette studie erer sårheling. Påvist sårheling i klinikken 42 I et prospektivt, ikke-komparativt multicenterstudie med 42 patienter med kroniske, venøse bensår, der var eller risikerede at blive inficeret, og hvor mistanke om biofilm eksisterede, viste Ag+-teknologi i kombination med Hydrofiber®-teknologi:* 54 % 70 % reduktion af sårstørrelse % reduktion af sårarealet for alle sår -20 -10 0 10 20 30 40 50 60 70 80 0 1 2 3 4 5 6 7 8 UGER reduktion af sårarealet for inficerede sår AQUACEL® Ag+ bandage ■ Alle sår ■ Inficerede sår Dag 1 Dag 28 Dag 49 - helet Dag 1 Dag 22 Dag 56 - helet 10 inficerede sår og 32 sår med risiko for at blive inficeret *AQUACEL® Ag+ bandage blev anvendt i dette studie AQUACEL® bandage Alle billeder bruges med deres respektive ejeres tilladelse. AQUACEL® Ag+ bandager Ingen bandage kan mere. Wounds that Tilføj AQUACEL® Ag+ bandager til jeres behandlingsprotokol for kroniske og akutte sår, der er inficerede eller i risiko for at blive inficeret. Protocol of Care for Effec risk of infec tive Use tion are infec ted, or at Fig. 1 Diabetic wound foot ulcer showing infectionbed and presenc a sloughy on the . Evidence of e of localised wound devitalis bed. ed tissue Images 1 2 reproduced ASSESS with kind permission of R Mathison, Stockport Fig. 2 NHS Trust, Stage 4 colonise pressure ulcer with a a suspectd, sloughy wound heavily ed layer of biofilmbed, and (right). UK (Fig. Evaluat e both 1), D Copson, Nottingham University Hopitals Cleanse and the pati ent and GE 3 approp accord riate debride ing to • Mechan the wound and ment method patient cotton ical, e.g. using goals: 3,4 pad. gauze • Larval or therapy . • Ultraso nic, surgica † hydrosurgical, l. sharp, • Apply an wound AQUACEL ™ Ag+ dressin preven to disrupt biofilm t g exudat biofilm reform , kill bacter to the e and infectio ation* 1,2 ia, • Cover whilst and n. manag with an ing AQUAC EL ™ Foam dressin g. Extra ™ Infected exuding leg ulcer which surroun causing maceratis heavily ding skin. with areas Dull red ion to the or Ribbon the wou nd. Fig. 4 Minor traumat chronic ic ulceratio injury resulting n and infection in . debride . Dress. MANA Fig. 3 NHS Trust, of slough. UK (Fig. wound 2), D Nelson, • Carry bed Derby Hospitals out a holistic NHS Foundation • Assess patient Trust (Fig 3&4). the wound assess ment, : • Wound e.g. co-mo rbiditie • Wound type. s, medica bed appea tion etc. • Size rance (tissue (length , width, • Exudat type and depth) e %: slough • Associ (colour, consist . , necros ated pain ency, level). is, granula • Peri-w ound skin and/or odour. tion, biofilm • Signs conditi ). on (swellin and sympto ms of infectio g, discolo uration n (pain, , macer odour, heat, rednesation). s, swellin g, purulen ce). Cleanse • Cleans and Debr e • Irrigate necess and debride with water ide Tips ary to approp e.g. slough remove the wound or cleanse riate Irriclens ™ wound cleanse with an , necros barriers to where healing is, biofilm cleanse r e.g. • Select , r. . the + (with strength ening fibre) Adhesiv e or non-adh esive dressing dressing Dressing Tips ‡ • AQUAC ™ overlap EL Ag+ Extra ™ dressin surroun at least 1 cm g should onto ding • For cavity the wound. the skin wounds dressin Dehisced surgical with suspected wound prior to biofilm debridem ent. Wound post using a debridement curette. g is recommAQUACEL ™ • When Ag+ Ribbon ended. dressin g deep 80% to wounds contac allow for dressin only t with wound g expans fill to • When ion on using AQUAC fluid. dressin EL ™ g, outside leave 2.5 cm Ag+ Ribbon of • The absorbthe cavity to length of ribbon aid remova ent pad dressin l. of AQUAC g least 1 should overlap EL ™ cm. the woundFoam by at Reasses at eac s and doc h dres ument sing cha the wou nge. nd • If the wound or AQUAC remains EL ™ Ag+ infected or • For a at risk Ribbon shallow of infectio dressin and second wound g covere n continu d with e to use ary dressininfected or at • If an AQUAC g combin risk of infectio AQUACEL ™ antimic EL ™ Ag+ Foam robial dressin ation, use dressin n dressin Extra ™ * As demonstrated g AQUAC and no longer g. dressin in combination g is no longer in vitro †Require EL ™ Ag requirin specialist g alone. Foam dressin g the use with AQUAC require skills and ‡Refer to equipment. product of a primar pack insert(s) Reference: Referral EL ™ Foamd, use AQUAC g. to the appropriate for complete formation 1. WHRI3850 y directions EL ™ by Ag+ MA232: specialist dressin Debridement EXTRA. may be 2013. Physical Disruption for use. g, or for Extra ™ or AQUAC required. TM indicates Made Easy. WoundsData on file, ConvaTecof Biofilm by AQUACEL a shallow a trademark UK. 2011;7(4). Inc. 3. of ConvaTec Ag+ Wound Effective Available wound EL ™ Ribbon debridement from www.wounds Dressing. Inc. AQUACEL , AQUAC 2013. in is a registered -uk.com. a changing NHS: Data on file, EL ™ Foam ConvaTec trademark a UK consensus. Inc. of MONIT OR ® ConvaTec Perfekte partnere: Størrelse Antal/æskeVarenummer AQUACEL® Ag+ Extra 5 cm x 5 cm 10 413566 10 cm x 10 cm 10 413567 15 cm x 15 cm 5 413568 20 cm x 30 cm 5 413569 4 cm x 10 cm 10 413581 4 cm x 20 cm 10 413598 4 cm x 30 cm 10 413599 AQUACEL® Ag+ kavitetsbandage 2 cm x 45 cm 1 cm x 45 cm 5 5 og ® 413571 413570 Inc. in the US. ©2013 London: ConvaTec Inc. 2. WHRI3857 Wounds UK,2013. MA236: Antimicrobial Available Activity from www.wounds and Prevention AP-014142-M -uk.com. of Biofilm M 4. Vowden ReK, Vowden P. ® Størrelse Antal/æskeVarenummer AQUACEL® Foam klæbende bandage 8 cm x 8 cm 10 420804 10 cm x 10 cm 10 420680 12,5 cm x 12,5 cm 10 420619 17,5 cm x 17,5 cm 10 420621 21 cm x 21 cm 5 420623 25 cm x 30 cm 5 420624 19,8 cm x 14 cm hæl 5 420625 20 cm x 16,9 cm sakral 5 420626 24 cm x 21,5 cm sakral 5420828 AQUACEL® Foam ikke-klæbende bandage 5 cm x 5 cm 10 cm x 10 cm 15 cm x 15 cm 20 cm x 20 cm 15 cm x 20 cm 10 10 5 5 5 420631 420633 420635 420636 420637 1. Physical Disruption of Biofilm by AQUACEL® Ag+ Wound Dressing. Scientific Background Report. WHRI3850 MA232, 2013, Data on file, ConvaTec Inc. 2. Antimicrobial activity and prevention of biofilm reformation by AQUACEL® Ag+ EXTRA dressing. Scientific Background Report. WHRI3857 MA236, 2013, Data on file, ConvaTec Inc. 3. Antimicrobial activity against CA-MRSA and prevention of biofilm reformation by AQUACEL® Ag+ EXTRA dressing. Scientific Background Report. WHRI3875 MA239, 2013, Data on file, ConvaTec Inc. 4. Newman GR, Walker M, Hobot JA, Bowler PG, 2006. Visualisation of bacterial sequestration and bacterial activity within hydrating Hydrober® wound dressings. Biomaterials; 27: 1129-1139. 5. Walker M, Hobot JA, Newman GR, Bowler PG, 2003. Scanning electron microscopic examination of bacterial immobilization in a carboxymethyl cellulose (AQUACEL®) and alginate dressing. Biomaterials; 24: 883-890. 6. Bowler PG, Jones SA, Davies BJ, Coyle E, 1999. Infection control properties of some wound dressings. J. Wound Care; 8: 499-502. 7. Walker M, Bowler PG, Cochrane CA, 2007. In vitro studies to show sequestration of matrix metalloproteinases by silver-containing wound care products. Ostomy/Wound Management. 2007; 53: 18-25. 8. Assessment of the in vitro Physical Properties of AQUACEL EXTRA, AQUACEL Ag EXTRA and AQUACEL Ag+ EXTRA dressings. Scientific background report. WHRIA3817 TA297, 2013, Data on file, ConvaTec Inc. 9. Bjarnsholt T, 2013. The role of bacterial biofilms in chronic infections. APMIS. 121. 1-51. 10 Research on microbial biofilms. National Institute of Dental and Craniofacial Research. http://grants.nih.gov/grants/guide/pa-files/PA-03-047.html; Sept. 9, 1997. 11. Marsh PD, Bradshaw DJ, 1995. Dental plaque as a biofilm. J. Industr. Microbial; 15: 169‑175. 12. Trautner BW, Darouiche RO, 2004. Role of biofilm in catheter-associated urinary tract infection. Am J Infect Control; 32: 177-183. 13. Elder MJ, Stapleton F, Evans E, Dart JK, 1995. Biofilm-related Infections in Ophthalmology. Eye (Lond.) 9: 102-109. 14. James GA, Swogger E, Wolcott R, Pulcini EL, Secor P, Sestrich J, et al, 2008. Biofilms in Chronic Wounds. Wound Rep Regen; 16: 37-44. 15. Metcalf D, Bowler P, 2013. Biofilm delays wound healing: A review of the evidence. Burns & Trauma. 1: 5-12. 16. Percival SL, Bowler PG, 2004. Biofilms and their potential role in wound healing. WOUNDS, 16: 234-240. 17. Wolcott RD, Rumbaugh KP, James G, Schultz G, Phillips P, Yang O, et al, 2010. Biofilm maturity studies indicate sharp debridement opens a time-dependent therapeutic window. J Wound Care; 19: 320-328. 18. Wolcott RD, Kennedy JP, Dowd SE, 2009. Regular debridement is the main tool for maintaining a healthy wound bed in most chronic. J Wound Care; 18: 54-56. 19. Gurjala AN, Geringer MR, Seth AK, Hong SJ, Smeltzer MS, Galiano RA, et al, 2011. Development of a novel, highly quantitative in vivo model for the study of biofilm-impaired cutaneous wound healing. Wound Rep Reg. 19: 400-410. 20. Brackman G, De Meyer L, Nelis HJ, Coenye T, 2013. Biofilm inhibitory and eradicating activity of wound care products against Staphylococcus aureus and Staphylococcus epidermidis biofilms in an in vitro chronic wound model. J Appl Miocrobial; 114: 1833-42. 21. Darouiche RO, Mansouri MD, Gawande PV, Madhyastha S. Antimicrobial and antibiofilm efficacy of triclosan and Dispersin B combination. J Antimicrob Chemother. 2009 Jul;64(1):88-93. 22. Thorn RM, Greenman J. A novel in vitro flat-bed perfusion biofilm model for determining the potential antimicrobial efficacy of topical wound treatments. J Appl Microbiol. 2009 Dec 1;107(6):2070-9. 23. Bjarnsholt B, Kirketerp-Moller K, Kristiansen S, Phipps R, Nielsen AK, Jensen Po, et al, 2007. Silver against Pseudomonas aeruginosa biofilms. APMIS 115: 921-8. 24. Stewart PS, Costerton JW, 2001. Antibiotic resistance of bacteria in biofilms. Lancet; 358: 135-138. 25. Thurlow LR, Hanke ML, Fritz T, Angie A, Aldrich A, Williams SH, Engebretsen IL, et al, 2011. Staphylococcus aureus biofilms prevent macrophage phago-cytosis and attenuate inflammation in vivo. J Immunol; 186: 6585-96. 26. Composition comprising antimicrobial metal ions and a quaternary cationic surfactant. Scientific Background Report. WO 2012136968 A1, 2012, Data on file, ConvaTec Inc. 27. Bowler PG, Welsby S, Towers V, Booth V, Hogarth A, Rowlands V, Joseph A, et al, 2012. Multidrug-resistant organisms, wounds and topical antimicrobial protection. Int Wound J. 9: 387-396. 28. Antimicrobial activity against CA-MRSA and prevention of biofilm reformation by AQUACEL® Ag+ EXTRA Dressing and Acticoat 7 Dressing. Scientific Background Report. WHRI3876 MA240, 2013, Data on file, ConvaTec Inc. 29. Antimicrobial Activity and Prevention of Biofilm Reformation by AQUACEL® Ag+ EXTRA Dressing and Acticoat 7 Dressing. WHRI3858 MA237, 2013, Data on file, ConvaTec Inc. 30. Antimicrobial Activity and Prevention of Biofilm Reformation by AQUACEL® Ag EXTRA Dressing and Silvercel® Non Adherent Dressing. WHRI3877 MA241, 2013, Data on file, ConvaTec Inc. 31. Walker M and Parsons D, 2010. Hydrofiber Technology: its role in exudate management. Wounds UK; 6: 31-38. 32. Parsons D, Bowler PG, Myles V, Jones SA, 2005. Silver antimicrobial dressings in wound management: A comparison of antibacterial, physical and chemical characteristics. WOUNDS; 17: 222-232. 33. Jones SA, Bowler PG, Walker M, 2005. Antimicrobial activity of silver-containing dressings is influenced by dressing conformability with a wound surface. WOUNDS; 17: 263-270. 34. Bowler P, Jones S, Towers V, Booth R, Parsons D, Walker M, 2010. Dressing conformability and silver-containing wound dressings. Wounds UK; 6: 14-20. 35. Walker M, Jones S, Parsons D, Booth R, Cochrane C, Bowler P, 2011. Evaluation of low-adherent antimicrobial dressings. Wounds UK; 7: 32‑45. 36. Barnea Y, Armir A, Leshem D, Zaretski A, Weiss J, Shafir R, et al, 2004. Clinical comparative study of Aquacel and paraffin gauze dressing for split-skin donor site treatment. Ann Plast Surg; 53: 132‑136. 37. Kogan L, Moldavsky M, Szvalb S, Govrin-Yehudain J, 2004. Comparative study of Aquacel and Silverol treatment in burns. Ann Burns Fire Disasters; 17: 201-207. 38. Brunner U, Eberlein T, 2000. Experiences with hydrofibres in the moist treatment of chronic wounds, in particular of diabetic foot. VASA; 29: 253-257. 39. Assessment of the in vitro physical properties of AQUACEL Ag, AQUACEL Ag EXTRA and AQUACEL Ag+ Dressings, Scientific Background Report. WHRI3817 TA297, 2013, Data on file, ConvaTec Inc. 40. Harding K, Ivans N, Cains J, An opened randomized comparative study to evaluate the clinical and economic performance of two absorbent dressings in venus leg ulcers. Poster presented at EWMA; May 15-17 2013; Copenhagen, Denmark. 41. Parsons D, Mustoe T, Seth A. A new anti-biofilm Hydrofiber ® dressing: an in vivo investigation. Poster presented at Wounds UK; Nov 11-13 2013; Harrogate, UK. 42. Harding K, Ivans N, Cains J, Peters K, Parsons D. A new anti-biofilm dressing – a clinical study. Poster presented at EWMA; May 15-17 2013; Copenhagen, Denmark. ConvaTec Denmark Aps Skinderskovvej 32-36, DK -2730 Herlev, Denmark Tlf.: 48 16 74 74, e-mail: [email protected] www.convatec.dk AQUACEL, Extra, ConvaTec, ConvaTec-logoet, Hydrofiber og Hydrofiber-logoet er varemærker tilhørende ConvaTec Inc. og er registrerede varemærker i USA. Alle andre varemærker tilhører deres respektive ejere. ©2013 ConvaTec Inc. AP-014140-MM ®
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