Is Silver Dressing More Effective Than Alginate Dressing on Infected Diabetic Ulcer - Term Paper Example

Name) (Instructors’ name) (Course) (Date) WHICH WAY, SILVER DRESSING OR ALGINATE DRESSING? Introduction Diabetic foot conditions, for instance gangrene, infections and ulcerations are the rampant causes of hospital admission among patients who are diabetic. Hospitalizations, amputations, infection treatments and routine ulcer management costs run into billions of dollars annually and create huge burden within the medical care system. The standard cost of treating an infected ulcer is approximately $17,000, while that of treating a single ulcer is about $8,000 and for major amputation would cost about $45,000. In United States for instance, over 80,000 amputations are carried out every year, and about 50% of amputees will develop infections and ulcerations within their contra-lateral limb within a period of 18 months. It is even disturbing that 58% of them would after between 3 and 5 years have contra-lateral amputation following their initial amputation, in spite of tremendous advances in surgical and medical treatments of diabetic patients (Palfreyman, Nelson, Lochiel &Michaels 16). According to Meaume et al. diabetic ulcer is one of the complications linked to diabetes mellitus a condition that arises from a patient having abnormal high blood sugar either a result of the pancreas not producing insulin or the body cells not responding to the insulin that is being produced, whose conditions are quite complex and if not well addressed in time, the risk of limb amputation is eminent (Meaume et al. 26). Selection of the type of wound dressing to be deployed when dressing an infected diabetic ulcer forms an integral part of a comprehensive diabetic ulcer care and it involves among other things: effective diagnosis, restoring of circulation and also the provision of secondary measures with an aim of blocking further infections and promote wound healing process. According to a number of research programmes that have been conducted to ascertain the efficacy and limitation of either silver dressing or alginate dressing, it is quite debatable on which type of wound dressing between the two wound dressing types is superior over the other. Before the writer can draw a conclusion on which is the most appropriate wound dressing mode to be adopted, the study first examines the benefits and limitations of each and at the end, a conclusion with a number of recommendations shall be made. . This paper critically reviews the studies on the efficacy of alginate dressing and silver dressing in healing of acute and chronic ulcer (wounds) through secondary intention. The type and range of ulcer dressings available have augmented since the systematic review publications (Franks and Moffatt 35). Several ulcer dressings are presently available, having different modes of categorizing them, for instance through physical composition or through describing them as reactive, active or passive. Nonetheless, the evidence for their application remains equivocal. Whether a given type of dressing affects ulcer healing requires to be established. Moreover, a number of these dressings are comparatively expensive. The systematic review offered a frail degree of evidence regarding the clinical efficacy of either silver dressing or alginate dressing if the two are compared. If fact, no evidence was given to indicate that one is more effective than the other, in view of the criteria for general performance. Therefore, more research on diabetic ulcer care offering level A is critical needed. This paper was based on literature published between 2008 and 20102 and aims to evaluate the effectiveness of silver dressing and alginate dressing applied for the treatment of diabetic ulcers. Search Strategy The sources of data: The author did a search on three databases including (the Cochrane Clinic trails database, MEDLINE and EMBASE) from 2008 to 2013 that was done by a manual research, for both English and French articles. Study Selection: The selection of studies end points comprised; the complete healing time, the complete healing rate, the level of wound area change, and other common performance criteria (i.e. ease of use, pain, level of wound trauma while removing dressing, as well as ability to contain and absorb exudates). Only one reviewer selected the studies. In overall, 50 studies met the criteria for selection (39 were RCTs or Randomized Control Trails, three were meta-analyses [in which case 1 came from the chosen systematic reviews], 1 from the cost-effective study and 7 were drawn from systematic reviews. Literature Review Silver nano-materials or sulfadiazine can be used in the treatment of wounds. Silver dressing was basically developed to treat acute and chronic diabetic wounds that could have defied other known ulcer dressing mechanisms (Thomas and Lawrence 17). Though, the exact mode of action of silver still isn’t clearly known, but it is thought to distort microbial cell walls, block replication and deter metabolism and the general growing of the cell leading to healing of the wound. Silver in dressing agents may be in form of inorganic compounds or as nanoparticles. When silver reacts with moisture, say wound discharge; it releases silver ions which in turn exchange with sodium ions in the discharge. The prevalent silver ions impart a wide antimicrobial impact on the bacteria thus rendering them redundant by neutralising any toxins within the wound. Silver-containing dressing materials have a number of benefits or advantages when used in dressing of acute or chronic diabetic ulcers. Some of these benefits are: First, according to vitro experiment results, silver being bioactive kills bacterial infections however in human beings, it exhibits low perilousity and minimal risks can be anticipated perhaps from clinical subjection through inhaling or ingesting thus, to some extent, silver-containing materials are a safe way of dressing wounds with an intention of deterring further infections and also promoting the wound healing process (Anon Silver Dressings 25). Secondly, in 2010 Cochrane report, some observations were made that silver-containing material dressings boosts the healing of especially chronic wounds albeit in a short term (Sayag, Meaume and Bohbot 17). In the same report, it was noted that effective use silver dressing greatly reduces wound size thus suggesting that indeed silver-containing materials do aid in healing wounds or infected diabetic ulcers. In the 2008 report, it was observed that, patients with chronic diabetic ulcers got better when silver dressing type was administered on them though the period taken to recover was much longer. Finally, silver dressing is among the few viable options that can be applied when dealing with acute or chronic wounds that could have defied any other forms of wound dressing. The discovery of silver dressing as a way of treating complicated diabetic wounds was a breakthrough in a way. This is because, when diabetic ulcers becomes so chronic , it is a bit complicated to treat them As explained earlier, silver ions do kill microbial cells that promotes the wound to further infections hence improving the wound healing process. However, despite the above effects of silver-containing materials on bacterial infections, silver dressings have some limitations to their usage. To start with, silver dressings are more expensive than any other accepted standard wound dressings and this may discourage many patients who may not have the financial muscles to use it. In modern times where many people will wish to save some money and only incur an extra expense when necessity compels so, few people will be willing or able to part with exorbitant amount of money on silver-containing materials of dressing ulcers. This is therefore a major concern to many patients. Additionally, research reviews has shown that diabetic ulcers that have been dressed with silver-containing materials took a much longer time to heal as compared to those that other wound dressing types were applied. These delays on the healing process may pose a real danger to the patient as it may cause further infections. Besides this, there are a limited number of researches on the long term effects of silver materials especially the nanomaterials but according to a research that was conducted in Beijing China, increased exposure to toxic substances like nanaomaterials without adequate care, lung damages can be eminent (Piaggesi et al. 176). Therefore, caution should be practised when using them. From trial evidence of additional benefits from the use of silver especially on acute and chronic diabetic ulcers are very few and of low quality and also from data collected from these trials, there were no diverse disparities in various healing parameters when comparisons are made between silver related dressing and other modes of dressing in the treatment of infected ulcers. Therefore, the usage of silver dressing mechanism on diabetic wounds if they are not acute or chronic is purely a waste of resources and a risky medical adventure on the part of the patient. Finally, all these trials whose findings have been published, they reveals that there isn’t enough evidence to establish whether silver-containing dressing do boost, hasten or deters further wound infections but while on the contrary, patients treated using silver-containing materials took a much longer time to heal than any other standard accepted material (Franks and Moffatt 69). After examining the efficacy and limitations of the usage of silver wound dressing mechanism, alginates shall also be looked at in a similar manner so that a clear and impartial verdict is made on the better wound dressing type between the two that should be given more priority and prominence. Alginates are non-woven pads that contain natural polysaccharide fibre and are biodegradable that are harvested from brown sea weeds. For close to 50 years, they have been successfully deployed with an aim of cleansing a variety of wound secretions (O’Donoghue and O’Sullivan 6). This preference is due to their high absorption ability that emanates from a hydrophilic gel that is formed. This is what deters wound discharges besides minimizing bacterial contamination and further wound infections. In fact, alginate always balances between absorbing harmful wound discharges and retaining the highly needed moisture on the wound surface. From a number of trial tests and findings published, alginates have been found to have a number of benefits to the patients: First, when they are used to dress slough wounds that produce discharges, the gel which is formed as a result the alginates absorbing exudates from the wound. It is known that alginates can absorb wound secretion and in the process form a moist outer covering that deters the wound from drying out and possibly lead further complications. The fluid handling capacity of alginates permits them to be in place longer than any other wound dressing agent, thus aiding wound healing without any disturbance. Generally, the alginate always balances between absorbing the excess and dangerous wound exudates that can result to further infections and retaining the necessary moisture on the wound surface so that the wound does not dry up, strain its healing process or lead to further complicated infections (Storm-Versloot et al. 14). Also, alginates performs so well in terms of filling spaces and also given their soft and easy to apply nature besides, they aren’t adherent to the wound bed thus can be removed without causing any pain to the patient and also due to their biodegradable nature is an added advantage to the user besides being used to dress a series of wound types (Colin, Kurring and Yvon 13). Unlike other dressing agent like silver-containing dressing, alginates can be used to fill wounds and other cavities that may lead to further wound infections. This will promote faster wound healing and also the general appearance of the scar after the healing. From numerous research that have been conducted on a variety of wounds like: leg ulcers and pressure wounds to ascertain the efficacy of alginates, it has been confirmed that, efficient use of alginates have strongly boosted the wound healing process. This is basically because of the alginates’ ability to promote cytokines which are very integral in the process of healing the wound. When dealing with a wounds that are from moderately to highly exuding discharges, alginates comes in handy because of their high absorption power. These discharges if not well gotten rid off, they can cause further complications to the wound healing process. There, according to research, alginates have been shown as the perfect solution to wounds that exudes a lot of secretions (Stacey et al. 14). Additionally, researchers like Vermeulen et al. demonstrated that when alginates are used to dress a wound, the wound healing timeline is significantly shorter than when other types of dressing the wound are used (Vermeulen et al. 43). Therefore, it can be prudent for nurses and other medical practitioners to apply this type of wound dressing so that the healing timeline can be shortened or otherwise the wound may develop further complications. Further, unlike silver –containing dressings that are far expensive and thus out of reach for many patients, alginates are relatively cheaper and therefore can be afforded by many. Bergin and Wraight proposed that alginate dressing is cost effective due to the frequency at which dressing is changed (51). This frequency is greatly reduced when using alginates as a means of dressing infected diabetic wounds. Therefore, it is extremely prudent for any medical practitioner to apply alginates to a patient so that less amount of money can be used without compromising the quality of the services provided and its efficacy (Singer and Clark 21). Finally, any alginate fibre that may be trapped in the wound will not be harmful to the body because of the biodegradable nature of alginates and also the process of removing alginates from the wound surface is easier. They can simply be removed by rinsing them away through the use of saline irrigation. This can be done without interfering with the wound healing process. Because of this, alginate changing is purely pain free (Moher et al. 13). Despite the many benefits of alginates do have over other dressing types, silver- containing dressings in particular, alginates have their own limitations. Some of these limitations are: First, alginates can stimulate cellular reactions as a result of foreign bodies. Sackett (88) observed that there could be a high likelihood of provoking cellular reactions where there is insufficient amount of wound discharge so as to moisten the alginate fibres. To supplement these findings, similar observations have been reported in animal experiments (Falanga 55). However, clinical findings involving human beings have not been made. Secondly, Alginates can only be applied on wounds that have sufficient moisture so that a gel can be formed. Lazarus (98) observed that a florid alien body-giant cell. This was triggered by an alginate that was deployed in dental cavity but was left there. This is what emphasizes that alginates must be restricted to only wet wounds to avoid foreign body reactions and if need be, the wound that is being dressed should be well irrigated to deter further wound complications hence boosting a faster healing process (Scottish Intercollegiate Guidelines 11). In addition to the above, alginate dressing type cannot be used when treating acute or chronic diabetic ulcers. Therefore, its usage is only limited to treating simple diabetic ulcers or wounds. Conclusion In conclusion, based on the already exclusively explained benefits and limitations of the two types of wound dressing, silver dressing is not better than alginate dressing when dealing with the not so complicated diabetic ulcers. Its use can be justified when a patient has an acute or chronic diabetic infected ulcer which may have defied other wound dressing mechanisms say alginates. A blatant use of silver-containing material to dress simple wounds will amount to unnecessary exorbitant expenditure besides double risking the healing process of the patient. In general, alginates are far better to use in dressing of such wounds and it is only when they fail that silver dressing or any other option can be deployed and other wound treatment Because of the numerous complexities that are involved in dressing and treating infected diabetic ulcers, earlier and proper diagnosis is recommended and an effective mode of dressing adopted without risking, derailing or further complicating the healing process of the wound. All this is aimed at deterring further wound complications that can even lead to the limb from being amputated. Recommendations Some of the recommendations that can be made after looking at pros and cons associated with the two wound dressing methods are as follows: First, the writers honest opinion, silver type of dressing should be used as the last resort given its many limitations like: limited studies on the long term exposure to nanaoparticles that are contained in these silver dressing materials, its expensiveness, patients taking much longer time to heal as compared to other dressing materials et cetera coupled with the real danger that nanoparticles that may pose to not only the patients but also to the general public. Secondly, Alginates should therefore be used given their many benefits like absorbing excess wound discharges, quite cheaper to use and also patients taking a shorter time to heal and few limitations like: only applicable to wounds that have discharges. These limitations can be minimised through proper practises like ensuring that they are strictly applied on wounds that exudes some discharges to avoid the wound from drying up an issue that may lead to further complications. Additionally, before any wound dressing mechanism is applied on a patient, that patient ought to be given proper information as far as the wound dressing mechanism to be used is concerned. This is to make the patient be aware of the medical and economic implications of the wound dressing type and be psychologically prepared for any eventuality. Finally, more research ought to be conducted to alleviate fears on the use of both silver and alginate diabetic ulcer dressing mechanisms. Silver should be subjected to a number of studies to ascertain the effects of nanoparicles in this dressing material and more side effects of alginates, if any ought to be revealed. For instance, in a study carried out in Beijing China, it was claimed that continued human exposure to nanaomaterials can lead to lung damage especially if the people exposed to the materials are not taking proper safety like using gas masks among others. This is a serious issue and therefore, facts concerning nanomaterials ought to be investigated and the findings properly documented. Also, in alginates, a further comprehensive research ought to be conducted. This is because, as it is now, only foreign materials in form of giant cells are the known side effects of alginates when used to dress diabetic wounds. Appendix 1 Source Study Design Type of Dressing Patients(Wounds)No Type of wound Outcome Meaume et al. RCT Ag vs PGD N=36 Diabetic foot lesions Patients’ %age with granulation tissue above 75% of area of wound SAR within six weeks Lower pain during dressing removal Anon RCT Silver Aligate and SSD N=65 Partial thickness Time for healing was shorter in compared to the SSD group (recording p Read More