International consensus: Appropriate use of silver dressings in wounds
International consensus guidelines that describe which patients are most likely to benefit from silver dressings and detail how these types of dressings should be used.
An international group of experts in wound care met in December 2011 to compile consensus guidelines on the appropriate use of silver dressings. The meeting was convened by Wounds International in response to the negative findings of the VULCAN study  and two influential Cochrane reviews [2,3], which have led to restrictions in the use of silver dressings.
The consensus guidelines  describe which patients are most likely to benefit from silver dressings and detail how these types of dressings should be used.
Silver is well established as an agent capable of killing bacteria and has been applied to wounds to manage infection in burns and chronic wounds for many years. However, in some areas of the world, silver dressings have been withdrawn from use in response to the VULCAN study, which found that silver dressings did not improve healing. However, many have commented that the results of this study are not generalisable for a number of reasons. The study used silver dressings in an inappropriate way: silver dressings were not restricted to use in wounds with signs of infection or at high risk of infection and the dressings were used for inappropriately long periods. Furthermore, the major outcome of the study - healing - is not a suitable outcome for a treatment intended to reduce wound bioburden.
Professor David Leaper, Chair of the expert working group, said "There is growing concern amongst clinicians that arbitrary withdrawal of silver dressings could lead to increased morbidity and prolonged treatment times. I am delighted that we have been able to bring together a group of experts in wound care from around the world to produce straightforward, clear guidance on how to use silver dressings judiciously to benefit patients."
The consensus document recommends that silver dressings should be used in the context of accepted standard wound care for infected wounds or wounds that are at high risk of infection or reinfection. It is recommended that silver dressings are used for an initial two week 'challenge' period after which the wound, patient and management approach should be re-evaluated before deciding whether a silver dressing remains appropriate or more aggressive intervention such as the use of systemic antibiotics is indicated. The signs and symptoms of infection and the difficulties of recognising when wound bioburden is causing problems in some wounds are discussed. The thorough document also reviews the evidence for the use of silver dressings and discusses some common misperceptions relating to silver dressings.
The consensus document has been supported by unrestricted educational grants from B Braun, ConvaTec and Systagenix and is innovative in bringing industry together in this way.
The document is currently available in English, French, German, Spanish and Italian.
- Michaels JA, Campbell B, King B, et al. Randomized controlled trial and cost-effectiveness analysis of silver-donating antimicrobial dressings for venous leg ulcers. Br J Surg 2009; 96(10): 1147-56.
- Vermeulen H, van Hattern JM, Storm-Versloot MN, Ubbink DT. Topical silver for treating infected wounds. Cochrane Database Syst Rev 2007; 24(1): CD005486
- Storm-Versloot MN, Vos CG, Ubbink DR, Vermeulen H. Topical silver for preventing wound infection. Cochrane Database Syst Rev 2010; 17(3): CD006478.
- International consensus. Appropriate use of silver dressings in wounds. An expert working group consensus. London: Wounds International, 2012.