Der har altid været skurke i sårheling Nu findes der en

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: convatec.danmark@convatec.com
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
®