Cutimed® Sorbact® Made Easy
Complex wounds, Infection | Probst A, Norris R, Cutting KF.
Bacterial colonisation and infection may contribute to delayed healing and present a major challenge for wound care clinicians. Intervention with antimicrobial dressings using active ingredients is recommended to control bacterial load and prevent spreading infection. Cutimed® Sorbact® (BSN medical) is a range of non-medicated dressings that has a unique bacterial binding action using the principle of hydrophobicity to remove bacteria and fungi from a wound. These products can be used to reduce bacterial loads and provide an alternative to silver, iodine, PHMB and other antimicrobial agents.
What is Cutimed® Sorbact®?
This is a range of primary wound contact dressings that includes Cutimed® Sorbact®, Cutimed® Sorbact® Gel and Cutimed® Sorbact® Hydroactive. These products have been developed for the treatment of infected wounds and fungal infections. They can be used on all types of wounds, from lightly to highly exuding and from contaminated and colonised to infected wounds (Table 1).
Unlike traditional antimicrobial dressings, they do not contain any chemically or pharmacologically active substances and rely on a physical mode of action using a hydrophobic coating made from dialkylcarbamoylchloride (commonly known as DACC) to reduce the bacterial load in a wound.
What is DACC?
DACC is a synthetically produced derivative of a naturally occurring hydrophobic fatty acid, which is also found in spiders' webs. The droplets of water that form on a spider's web are a visible indication of its hydrophobic properties.
DACC encourages a natural hydrophobic interaction (Box 1)whereby hydrophobic organisms are attracted and irreversibly bound in an aqueous environment and held together by the surrounding water molecules.
This principle has been applied to the wound care environment to provide an alternative approach to reducing bacterial burden.
What is the role of DACC in wound care?
Cutimed® Sorbact® is coated with DACC, resulting in a dressing with highly hydrophobic properties. Most microorganisms found in a wound also have hydrophobic properties[3,4]. In the presence of moisture, when microorganisms come into close contact with DACC, they become irreversibly bound to the dressing as a result of hydrophobic interaction. Once bound to the dressing these microorganisms are rendered inert and prevented from reproducing or releasing harmful toxins. The hydrophobic microorganisms are then removed with each dressing change, helping to reduce the bacterial load in the wound bed and leaving the non-hydrophobic microorganisms to stimulate healing[3-7].
Why is it important to reduce the bioburden in wounds?
Infection not only impairs healing, resulting in morbidity and hospitalisation, but in the absence of careful management, can lead to a rapidly spreading infection with the loss of an affected limb or even death. Debridement (removal of devitalised tissue) is an integral part of good wound practice and is vital when reducing bacterial burden within the wound[9-11]. Debridement is often the first component of care and can be supported through autolysis and the use of dressings to lower the bioburden in the wound.
The effects of bacteria in a wound are often described as a continuum that extends from contamination through to colonisation and infection with invasion of the tissues. Identification of wound infection is a clinical skill and it is important that early signs of infection are detected promptly to help reduce patient morbidity.
Acute wound infection is easily diagnosed using the classic signs, including erythema, swelling, local warmth/heat and pain. These may be accompanied by purulent discharge and pyrexia. Identifying infection in chronic wounds is more challenging and clinicians may need to rely on a range of criteria that have been shown to be relevant to different wound types. These are sometimes of a subtle nature and will only be detected by consistent and repeated observation.
Routine or indiscriminate sampling (swabbing) is rarely justified due to the drain on human and financial resources[2,13]. However, selective swabbing can provide useful information on the presence of potential pathogens and local micro-ecology.
The role of antimicrobial wound dressings in reducing bioburden
Recent guidelines on the management of wound infection suggest that most topical antimicrobial dressings reduce wound bioburden by killing bacteria. Wound dressings containing antiseptic agents such as silver, honey, and iodine as well as wound dressings impregnated with polyhexamethylene biguanide (PHMB) are among the most common antimicrobial wound dressings. These dressings have a broad range of antimicrobial activity and can be used to treat localised wound infection and/or to provide a barrier to microorganisms in wounds at high risk of infection or re-infection. Where indicated, antimicrobial dressings can be used in preference to topical or systemic antibiotics[15-17].
When antimicrobial dressings are used to treat cases of systemic or spreading infection, this should be in conjunction with prescribed treatments such as systemic antibiotics[2,18].
However, antimicrobial dressings should be restricted to limited periods of time and reviewed on a regular basis (ie every two weeks)[2,19]. These recommendations were developed because of a growing concern regarding the widespread misuse and long-term use of antimicrobial substances and the perceived high costs associated with their use in health services.
Unlike traditional antimicrobial dressings, Cutimed® Sorbact® does not contain antiseptic agents and instead works through the binding of bacteria and fungi to the dressing, with no disruption to the cell wall and no systemic absorption. The microogranisms are removed with the dressing and there is no cell debris left in the wound.