Dressings(Table 6-18) | | | | | | | Table 6-18 Antiseptics | | Name | | Spectrum | | Advantages | | Disadvantages | | | Chlorhexidine
(Hibiclens) | | Broad antimicrobial spectrum (bacterial, viral, fungal) | | Rapid onset, sustained activity, additive effect w/ repeated use, ↓ skin absorption | | Ocular irritation and ototoxicity | | | Hexachlorophene
(pHisoHex) | | Gram + cocci | | Sustained activity | | Teratogenic; skin absorption can cause neurotoxic effects | | | Povidone-Iodine
(Betadine) | | Broad antimicrobial spectrum
including fungi | | Fast acting | | Skin irritant, contact dermatitis, effective only if dry; skin/fabric staining, inactivated by blood or sputum, ↓ duration of action | | | | | | | | | | | | | | | | | | | | May cross-react with radiopaque iodine or iodides in medications | | | | | | | | | | | | | | |
| | | | Benzalkonium
(Zephiran) | | Gram + bacteria
Gram - bacteria | | Not irritating to tissue; stable, strong antimicrobial action | | Slow onset, no sustained activity, inactivated by anionic Gram − bacteria compounds such as soap | | | | | | | | | | | | | | | | | | | | Quaternary ammonium (cationic) detergent | | | | | | | | | | | | | | |
| | | | Isopropyl Alcohol | | Gram + bacteria | | Inexpensive | | Flammable in setting of cautery; skin irritant | | | Silver Sulfadiazine
(Silvadene) | | Broad spectrum | | Broad coverage | | Contraindicated if sulfonamide hypersensitivity; argyria (local), leukopenia; caution if renal or liver disease or G6PD deficiency | | | | | | | | | | | | | | | | | | | In addition to sulfonamide component, silver interacts with bacterial cell wall and membrane | | | | | | | | | | | | | | |
| | | | Hydrogen
Peroxide | | Bacteria, fungi
(at ↑ H2O2 concentration) | | Rapid onset | | Corrosive to normal skin, bleaching action | | | | | | | | | |
| | | | | |
|
Dressings (Table 6-19) - Wound dressing substitute for native epithelium; ideally dressing should maintain moist environment at wound interface, remove excess exudate, provide mechanical protection and hemostasis, serve as barrier to microorganisms, provide gaseous exchange but prevent leakage, be nonadherent with easy removal
- Wounds: if scab thick, slower process of reepithelialization; fluid from occluded wounds contains many endogenous wound healing factors; low oxygen requirement for optimal fibroblast proliferation (hypoxia increases angiogenesis)
- Least to most absorbent (in order): films, hydrocolloids, hydrogels, foams, alginates
| | | | | | | Table 6-19 Dressings | | | Dressing | | Structure | | Uses | | Advantages | | Disadvantages | | | Films (Tegaderm, Opsite) | | Polyurethane semipermeable transparent thin sheet | | IV sites, superficial burns, wounds with minimal exudate | | Transparent, permeable to H2O vapor, ↑ reepithelialization, barrier to bacteria, ↓ pain | | May adhere to wound
No absorption of wound drainage | | | Hydrocolloids (Duoderm, NuDerm) | | Semipermeable opaque sheet of starch, gelatin, elastomer, pectin, adhesive (turns into gel when exudate absorbed) | | Chronic ulcers, burns, surgery wounds | | Adherent (occlusive), absorbs drainage, debrides wound, ↑ granulation tissue in open wounds, creates bacterial and physical barrier, stays on wound several days | | Opaque, expensive, trauma with dressing changes, may stimulate excess granulation tissue | | | Hydrogels (NuGel,
2nd Skin, Vigilon) | | Hydrophilic semipermeable semitransparent polymer gel | | Ulcers, thermal burns, painful wounds, laser resurfacing, graft donor sites, mild-moderately exudative sites | | Semi-transparent, highly absorbent, hydrating, ↓ pain, no adherence to wound | | Frequent dressing changes, requires secondary dressing | | | Foams (Hydrasorb, Vigifoam, Synthoderm, Flexzan) | | Polyurethane semipermeable opaque sponge-like foam | | Wounds with moderate exudate, burns, Mohs defects | | Permeable to H2O vapor, conforms to wound shape, absorbent | | Opaque, drying effect, requires secondary dressing (not adherent) | | | Alginates (Sorbsan,
Algisorb, Seasorb) | | Composed of calcium alginate (seaweed component) | | Highly exudative wounds, full-thickness burns, STSG, Mohs defects | | Highly absorbent, hemostatic, no adherence to wound, infrequent dressing change | | Requires secondary dressing, may have unpleasant odor | | | | | | | | | | | |
| | | | | |
|
|
