Tips and Tricks: Part 1

Join us twice a month for our insightful podcasts with leading expert guests, who will look at the latest 'hot topics' in wound care to update and inspire you.

Join us for this informative podcast which discusses  some helpful Tips and Tricks with S+N expert and Trainer Darlene Middlecoat.

Part 1 focuses on antimicrobials such as IODOSORB and ACTICOAT

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SPEAKER: 00:00:01
Welcome to Smith and Nephews, Closer to Zero podcast. Bi-monthly podcast with leading experts and wound care hosted by Smith and Nephew. Helping health care professionals in reducing the human and economic cost of wounds.

RUTH TIMMINS: 00:00:16
Hello, I'm Ruth Timmins, and it's my pleasure to welcome you to our first podcast to kick off 2021. Today we will be hearing about some really useful tips and tricks using Smith and Nephew products in practice. I'd like to welcome our special guest today, Darlene Middlecoat, who is the senior training manager for the wound care division. 

She has extensive knowledge and experience of Smith and Nephew products. Darlene has a registered nursing background and has been with Smith and Nephew for over 12 years. So welcome, Darlene, and thanks for joining us today to share your knowledge.

DARLENE MIDDLECOAT: 00:00:50
Hi, Ruth. Thanks for having me.

RUTH TIMMINS: 00:00:54
So many of our listeners will be familiar with products such as at ACTICOAT, IODOSORB, ALLEVYN and PICO, and it would be really great to hear from you on some of the, you know, really useful tips that you've come across over the years that may help our listeners.

DARLENE MIDDLECOAT: 00:01:11
Yeah, that's great. Where would you like to start?

RUTH TIMMINS: 00:01:14
I was thinking perhaps with ACTICOAT, obviously, it's a very familiar product to many. So what would be some of the top tips that you would say using ACTICOAT?

DARLENE MIDDLECOAT: 00:01:26
OK, so when we say ACTICOAT, I guess the first thing to clarify is there's two different variants of ACTICOAT. One would be the ACTICAOT that's been around for over 20 years now and probably most of our listeners would be familiar with that. It looks like its silver on one side. And then if you turn it over, it looks, a kind of blue colour on the other side. This is our ACTICOAT Classic, and that is the one that was first released to the market in Australia. 

And then we have ACTICOAT Flex and that looks like just a single layer mesh, it has a one way stretch in it and it's a kind of just a grey, dark grey sort of colour. So you do use the two a little bit differently. So the reason you would be using ACTICOAT in your wound is to have a great antimicrobial and you're using an antimicrobial to kill the bacteria that are causing potential problems in the wound. The first thing we need to remember about ACTICOAT is that it needs to stay moist. OK? And the reason for that is that it is the moisture that helps release the silver ions out of the dressing and deposit them into the wound where they're going to effectively manage the bacterial load. 

So there's a couple of different ways we can moisten ACTICOAT. And the differences between the two products are important here. ACTICOAT classic or the blue and silver coloured one is what we call hydrophilic, which means it likes water. So you will notice that if you squirt some water or some sterile water onto the ACTICOAT Classic, it will very quickly just suck it up and you don't need to use a whole lot of water to moisten that variant. If you're using ACTOCOAT Flex, what you'll notice is that the water will bead on the top, because ACTICOAT Flex is what we call hydrophobic. 

So all that means is that you want to moisten your ACTICOAT Flex earlier in the dressing process. So one of the ways around doing that is to just open a corner of the sterile pack, squeeze your sterile water into the packet that it comes in, and let it sit whilst you do your dressing regime in that when you're cleaning the wound and before you go to actually put the ACTICOAT on to the wound in the new dressing. And by that time it will have absorbed enough moisture to start that silver ion exchange. 

Another way of doing that is to scrunch it up in one of the little galley pots on your dressing trolley tray and scrunch it up into one of those and squirt the water in there and let it sit for a couple of minutes as well, because that will change the surface tension of the product and allow it to just absorb some of that water. 

So moisture is one of the keys with ACTICOAT, you need to pre moisten it to start that silver ion release, as we said, and you need to keep it moist for the full duration of the wear time of the dressing. And if you've got a wound that's quite dry, then there is this chance that the ACTICAOT will dry out and stick when you go to remove it. If it is allowed to dry out during that three or seven days of the wear time. So a tip around that is to use your product like INTRASITE, or INTRASITE Conformable or your SOLOSITE as a layer on top of the ACTICOAT prior to putting your secondary dressing on. So that's a couple of the hints and tips around moisture and ACTICOAT.

RUTH TIMMINS: 00:05:39
With cutting ACTICOAT, the Classic. Any tips about how we should go about that?

DARLENE MIDDLECOAT: 00:05:47
Yeah, absolutely. So remembering the classic is the one that has the silver and the blue and there's that like a rayon core piece in between. So it's actually a three layer dressing. And there's little spot welds when you look at the product that hold those three layers together. So if you're cutting the ACTICAOT Classic and it's perfectly OK to do so, make sure you have one of those little spot welds that hold those layers together so it doesn't separate in the wound. If you're cutting ACTICOAT Flex, there's no problem at all because it's a single layer dressing. 

It's got that one way stretch. It's not going to fall apart. You can cut it in a spiral shape. Like you might have done with minty wrapper papers in the past to make it long and skinny. And then you can use it to pack into a, lightly pack into a sinus or cavity at the base of the wound. So the ACTICOAT Flex is a really flexible variation of the product and very easy to use.

RUTH TIMMINS: 00:06:57
And have you got any other tips on perhaps how it could be a little bit more comfortable for patients when we apply ACTICOAT?

DARLENE MIDDLECOAT: 00:07:06
Yeah, so one of the things that often comes up when we talk about antimicrobials is the fact that there can be some stinging when the products are first placed on the wound. ACTICOAT’s no different, and the stinging does reduce over time. However, there are some hints and tips, particularly I would suggest, if you are using on a patient who is very sensitive, or a patient who is young like a small child, then I would suggest that you put a very thin layer of INTRASITE or SOLOSITE directly to the wound bed before you put your ACTICOAT on the top, and that will help reduce that stinging sensation. Also, again, as I said before, if you pre-moisten the product a while, like at the beginning of your dressing regime and let it sit for a while. Some clinicians will tell me that that seems to reduce some of that potential stinging as well.

RUTH TIMMINS: 00:08:14
You mentioned that we need to moisten ACTICOAT with water before we use it. Can we use saline or is it only water?

DARLENE MIDDLECOAT: 00:08:25
Yeah, so we only use water, and that's because saline, obviously from a chemical component has chloride ions. If you use saline to moisten the ACTICOAT, the silver ions and the chloride ions will join together and make the ACTICOAT less effective than it would be otherwise. So we always suggest just water, sterile water, or it is absolutely OK to moisten the product with INTRASITE or SOLOSITE. We have the testing internally to show that either of our hydrogels do not decrease the activity of the silver with the ACTICOAT.

RUTH TIMMINS: 00:09:05
OK, thank you for clarifying that. So moving on perhaps to one of our other products IODOSORB, I know a lot of our listeners will have used IODOSORB to manage biofilm and infection. But there are some other great advantages aren't there to IODOSORB, Darlene?

DARLENE MIDDLECOAT: 00:09:25
Yeah, IODOSORB is one of my favourite products, actually. And as you said, it has great evidence in being an effective biofilm buster, if you like, for want of a better term. But it's also brilliant and very efficacious, antimicrobial in general. So IODOSORB is made up of iodine as its active ingredient, but it's a cadexomer iodine. So the iodine is actually impregnated in a starch matrix and that gives it some additional benefits to any other sort of iodine dressing on the market as well. 

And those things are that not only is it that effective antimicrobial and your biofilm buster, but it's really good at debriding and desloughing your wound. So if you've got a wound, that's say a venous leg ulcer that has that dirty, mucky, sloughy look to it and you are not or you don't have access to a clinician who is trained to do conservative sharp-wound debridement, you can use IODOSORB to debride and deslough that wound for you with autolytic debridement. 

So that's the third thing it's really, really good at. The fourth thing is, that it's because it's in that starch molecule or the starch matrix, it's really good at absorbing exudate as well. So we have three different variants of the IODOSORB and they will absorb up to six or seven times their own weight in exudate, which is great.

RUTH TIMMINS: 00:11:08
So what are the other variants? Can you just run us through those? Perhaps people aren't aware of them. They're probably more familiar with the ointment.

DARLENE MIDDLECOAT: 00:11:16
Yeah, sure. So we have the IODOSORB ointment. We have the IODOSORB dressing or sheet, and we also have the IODOSORB powder. So in New Zealand, the ointment and the dressing sheet is available. In Australia, all three variations are available. The ointment may be the one that you're most familiar with and that's the one that comes in the tube. The powder literally looks like brown granules and comes in a little sachet. So to use that, you would just tear the corner off the sachet and tap it into the wound bed so that you're lining the wound bed, but not that so that you're not filling the wound bet because it absorbs so much and swells, you don't want to fully fill the wound bed with the powder because it will over expand. 

And whilst we're on that topic, it's really important because of that absorption that you ensure the IODOSORB is not sitting on the peri-wound area or the surrounding skin around the wound because we don't want it to sit there and potentially macerate because it absorbs fluid. So the powder is the most absorbent out of the three variants, the second is the, the dressing sheet, so that kind of looks like... it comes in a, I think it's a maybe a six centimetre by four centimetre sort of size and it has a gauze carrier on either side of it. 

Once you remove those white gauze carriers, you can put the product between your sterile gloves and roll it up in a little ball like you would have used to have done with Playdoh or Plasticine as a kid. And then you can mould it out to the shape of the wound. So the sheet is great for wounds where gravity is involved. So like your lower leg venous leg ulcers, or your wound on the bottom of the heel where it's really difficult to twist the patient around so that that wound is upside right. When you're dressing it, the dressing, the IODOSORB dressing or sheet or paste, depending on what people like to call it, is great for those sort of wounds, whereas the ointment is kind of your all-rounder.

RUTH TIMMINS: 00:13:50
And any tips with application for perhaps the ointment, sometimes that can be a bit tricky, can't it?

DARLENE MIDDLECOAT: 00:13:58
Yeah, yeah, it can, absolutely. So sometimes what customers will find is that when they're squeezing the ointment directly out of the tube into the wound, it can kind of hang on the end of the tube, particularly if your wound is quite moist. It's difficult to get the ointment off the end of the tube and maintain your sterile field. So one of the best ways, actually, is to decant the ointment into a 10 ml syringe. 

So the way to do that is to get a sterile 10 ml syringe, pull the plunger out, squeeze your tube of IODOSORB ointment into the syringe, put your plunger back in the end, and then squeeze it out of your syringe and you'll find that you get really good control over the IODOSORB ointment that way and you'll be able to control exactly where it's going in the wound.

RUTH TIMMINS: 00:14:59
OK, and how long can you keep a tube of IODOSORB, I know we get asked this question.

DARLENE MIDDLECOAT: 00:15:06
Oh, look, that's a great question, and what you will find is that any dressing that says it is sterile is single use. In other words, if it's been sterilised prior to use and with IODOSORB particularly, there's no preservatives in it. So it is, all of the variants are designed to be sterile, single use only. The reason it says single patient use on the tube is to doubly ensure that you're not inclined to put the cap back on and then take it into the next patient's room.

RUTH TIMMINS: 00:15:45
So really, it should be discarded after the use.

DARLENE MIDDLECOAT: 00:15:48
Should be, ideally it should be discarded after use. Yes.

RUTH TIMMINS: 00:15:52
OK, well, thank you, Darlene. That's been really wonderful to hear those tips and tricks there. And I'm sure that's been really useful. So thank you for joining us today. And thank you to our listeners.

DARLENE MIDDLECOAT: 00:16:04
Thanks so much for having me.

RUTH TIMMINS: 00:16:06
Thanks, Darlene. And be sure to tune in for our next podcast. And we hope to see you soon. Thank you.

SPEAKER: 00:16:15
Meet the challenge of biofilm. Antibiotics are ineffective against biofilm and misuse can lead to resistance. Disrupt biofilms with IODOSORB, up to three days of iodine release. 1-12 For more information, contact your local Smith and Nephew representative or email us at profed.anz@smith-nephew.com

SPEAKER: 00:16:40
The information presented in this podcast is for educational purposes only. It is not intended to serve as medical advice. Products listed, outline of care are examples only. Product selection and management should always be based on comprehensive clinical assessment. Detailed product information including indications for use, contraindications, precautions and warnings please consult the products applicable instructions for use prior to use. Closer to Zero. The only target worth aiming for.


Refs 

1.Akiyama H, Oono T, Saito M, Iwatsuki K. Assessment of cadexomer iodine against Staphylococcus aureus biofilm in vivo and in vitro using confocal laser scanning microscopy. J. Dermatol. 31, 529–34 (2004). 

2. Fitzgerald DJ, et al. Cadexomer iodine provides superior efficacy against bacterial wound biofilms in vitro and in vivo. Wound RepairRegen. 25, 13–24 (2017). 

3. Roche ED, et al. Cadexomer iodine effectively reduces bacterial biofilm in porcine wounds ex vivo and in vivo. Int. Wound J. 1–10 (2019). doi:10.1111/iwj.13080.

4. Malone M, et al. Effect of cadexomer iodine on the microbial load and diversity of chronic non-healing diabetic foot ulcers complicated by biofilm in vivo. J. Antimicrob. Chemother. 72, 2093–2101 (2017). 

5. Vaughan J, Lumb H, Driffield, K. IODOFLEX dressings - disruption of a variety of micro-organisms grown in pre-established single and mixed species biofilms. Smith&Nephew Data on File #0804007. (2008). 

6. Vaughan J, Lumb H, Driffield K. Testing of IODOFLEX dressings against a variety of micro-organisms grown in single and mixed species biofilms Smith&Nephew Data on File #0804006. (2008).

7. Forest E. Antimicrobial activity of IODOSORB range against a broad spectrum of wound pathogens. Smith&Nephew Data on File #1801001. (2018). 

8. Harrow J. A comparison of the antimicrobial activity of a cadexomer iodine dressing and a povidone iodine dressing. 6763/IODOSORB/TECHMON/GLOBAL/0404. (2009).


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Speakers

Darlene Middlecoat

Senior Commercial Training Manager – Wound

Darlene first commenced nursing about 30 yrs ago. Since that time, she has worked in many roles in the healthcare industry and has been with Smith and Nephew for the last 12 years. She is  currently the Senior Training Manager for ANZ for the wound division. She is passionate that all clinicians understand how to get the best performance and value from the wound products they use for their patients and that they are also maximising the use of their healthcare budget.

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