Comparing Antimicrobial Wound Dressings

The Antimicrobial Agent May Make the Difference

When comparing antimicrobial dressings, the antimicrobial agent used is one of the most important considerations. Here is a look at some of the most common antimicrobials in use today.

How does CHG compare?

Chlorhexidine Gluconate (CHG)

Core Strength: Efficacy
Potential Limitation: Too much CHG may cause skin irritation¹

CHG is a broad-spectrum antimicrobial that can effectively provide a 99.99% (4-log) reduction of gram-positive and gram-negative bacteria and yeast (fungi) for up to seven days.^1,2 It is widely used in hospitals for preoperative cleansing. Chlorhexidine has a broader spectrum of activity than other antimicrobials and has a quicker kill rate than povidone-iodine antimicrobials—killing nearly 100% of gram-negative and gram-positive bacteria in vitro within 30 seconds of application.¹ Its ability to destroy most types of microorganisms may also mean chlorhexidine may limit the risk of developing opportunistic infections.¹

CHG works by binding to and damaging bacterial cell walls—disrupting the bacteria’s structure and osmotic balance to cause leakage of its contents and ultimately cell death.³ When applied to or impregnated in medical devices or dressings, chlorhexidine can not only kill harmful pathogens but can also protect against microbial colonization and biofilm development.¹ In fact, CHG-impregnated intravenous dressings have proven effective in reducing the risk of catheter-related bloodstream infections.⁴ Additionally, a CHG dressing was shown to provide significant antimicrobial activity against a MRSA-contaminated surgical wound in a porcine, incision-wound model.⁴

Povidone-Iodine (Betadine®)

Core Strength: 70-year history
Potential Limitation: Can be compromised by blood and exudate¹

Iodine has long been recognized as a broad-spectrum bactericide that is effective against yeasts, molds, fungi, viruses and protozoans.¹ First sold in 1955, povidone-iodine (PVP-I) rapidly became the preferred iodine-based antiseptic, used to treat minor wounds, skin infections, ulcers, and for pre- and post-operative skin cleansing. Bacteria do not appear to develop resistance to PVP-I.¹

Unlike CHG, PVP-I’s activity may be compromised by the presence of blood and body fluids and its potential side effects include skin-site irritation, hives and staining of surrounding tissue.¹ PVP-I has also been found to be not as effective as other antimicrobials in eradicating Staphylococcus epidermis within in vitro biofilms.⁵

Silver antimicrobial dressings

Core Strength: Long history in the market
Potential Limitations: Skin discoloration, local sensitivity and potential toxicity^1,5

The use of silver for wound healing dates back centuries.^1,6 In high concentrations, silver acts as a broad-spectrum antimicrobial. However, sustaining such concentrations on material or biologic surfaces has been a challenge.¹ The clinical performance of silver may also be compromised by proteins or lipids binding to silver ions, thus inactivating their antimicrobial effect.¹

The current available evidence indicated that silver-containing dressing, as compared with silver-free dressing, was not associated with lower incidence of SSIs.⁷ In fact, silver has only been shown effective in short-duration in vitro studies. A qualitative analysis of 59 studies found silver to be beneficial only for the first few days or weeks, after which time non-silver dressings are preferred.⁶

Silver dressings also come with risks of local sensitivity or skin discoloration.^1,5 There have also been more recent concerns about potential silver toxicity linked to the uptake and deposition of silver in certain organs. Finally, there are fears about the emergence of silver resistance.⁵

Polyhexamethylene Biguanide (PHMB)

Core Strength: Broad spectrum activity
Potential Limitation: Still relatively unknown

PHMB is a compound composed of synthetic polymers structurally similar to antimicrobial peptides (AMPs) produced by keratinocytes and neutrophils to help protect against infection.⁵ This similarity endows PHMB with a broad spectrum of activity against bacteria, viruses and fungi, that leaves the integrity of animal cells unharmed.⁵

PHMB has been incorporated into a range of wound products, including antimicrobial foam dressings. It appears to protect against wound infection by decreasing bacterial load in the dressing and preventing bacterial penetration through the dressing.⁵ PHMB dressings have gained significant clinical acceptance and use in many European countries.⁵

DOWNLOAD THE LATEST ARTICLE COMPARING STANDARD DRESSINGS TO CHLORHEXIDINE IMPREGNATED DRESSINGS

Clearly superior

BeneHold™ CHG Dressing Stands Above Competitors

While the efficacy of the CHG platform sets the BeneHold™ CHG Dressing apart, additional features make it clearly superior to others in the marketplace:

Absorptive properties to manage fluid or exudate

Sustained antimicrobial activity against various skin flora for up to 7 days^8,9

Transparency for easy site monitoring

Access Our Latest Webinar on the Innovations in antimicrobial technology, with BeneHold CHG

Custom Solutions and Future opportunities

BeneHold CHG antimicrobial adhesive technology can be customized to meet the needs of a wide range of applications and performance requirements.

If you are searching for an adhesive solution that offers the additional benefit of an antimicrobial agent, or would like more information on how you can take advantage of this unique BeneHold™ CHG adhesive technology, contact Avery Dennison Medical by completing the form below and a member of our team will contact you shortly.

CHG is incorporated directly into the adhesive

Option to tailor onset and duration of antimicrobial activity

Ability to tailor the adhesive thickness, adhesion level and fluid management

Connect with us and uncover how BeneHold CHG can advance your product portfolio

We exclusively license the technology for specific applications and territories
Opportunity to bring innovation where infection prevention is of strategic focus
Currently expanding into Surgical and Advanced Wound Care markets
Open to reviewing opportunities in other areas adjacent with the right partnership opportunity

References:

1. https://www.chlorhexidinefacts.com/mechanism-of-action.html Accessed 9.10.20.

2. https://www.woundsource.com/product/reliatect-post-op-dressing-chg Accessed 9.10.20.

3. Denton, Graham. “Chlorhexidine.” In Block, S., editor. Disinfection, Sterilization and Preservation, 5th edition. Philadelphia: Lippincott, Williams & Wilkins, 2001, 321-336. [Ref from current ADM website]

4. Mana, TSC, Donskey C, Carty, N, Perry, L, Leaper, D, Edmiston, CE. Preliminary analysis of the antimicrobial activity of a postoperative wound dressing containing chlorhexidine gluconate against methicillin-resistant Staphylococcus aureus in an in vivo porcine incisional wound model. Am J Infect Control. 2019; 47: 1048-1052.

5. Butcher, M. PHMB: an effective antimicrobial in wound bioburden management. British Journal of Nursing. 2012 (Tissue Viability Supplement); 21(12): S16-S21.

6. Khansa, I, Shoenbrunner AR, Kraft CT, Janis, JE. Silver in sound care—friend or foe?: a comprehensive review. Plast Reconstr Surg Glob Open. 2019;7:e2390; doi: 10.1097/GOX.0000000000002390; Published online August 9, 2019.

7. Li HZ, Zhang L, Chen JX, Zheng Y, Zhu XN. Silver-containing dressing for surgical site infection in clean and clean-contaminated operations: a systematic review and meta-analysis of randomized controlled trials. J Surg Res. 2017 Jul;215:98-107. doi: 10.1016/j.jss.2017.03.040. Epub 2017 Apr 2. PMID: 28688669.

8. Carty, N., Wibaux, A., Ward, C., Paulson, D., and Johnson, P. “Antimicrobial activity of a novel adhesive containing chlorhexidine gluconate (CHG) against the resident microflora in human volunteers.” J Antimicrob Chemother, 2014, 69(8):2224-2229.

9. Hidron, A., et al. “Antimicrobial-Resistant Pathogens Associated With Healthcare-Associated Infections: Annual Summary of Data Reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007”. Infection Control and Hospital Epidemiology. 29(11): 996-1011 (2008)