Wound Product Formulary. Medicines Management Advisory Group On: 21 st June 2016 Review Date: 21 st May 2019 Distribution: Essential Reading for:

Transcription

1 CONTROLLED DOCUMENT Wound Product Formulary CATEGORY: CLASSIFICATION: PURPOSE Controlled Document Number: Version Number: 1 Controlled Document Sponsor: Controlled Document Lead: Procedure Clinical To provide information for all clinical staff on wound management products. 994 Executive Chief Nurse Lead Tissue Viability Nurse Approved By: Medicines Management Advisory Group On: 21 st June 2016 Review Date: 21 st May 2019 Distribution: Essential Reading for: Information for: All clinical staff caring for patients with wounds. All clinical staff Page 1 of 39

2 Contents Paragraph Page 1 General Information Introduction Principles Of Wound Dressings Dressing Product Categories Wound Product Selection Product Availability Product Trials Admission And Discharge 6 2 Formulary Wound Care Products Quick Reference Guide To Formulary Wound Care Products Formulary Wound Care Products Details 7 3 Specialist Use Only Wound Care Products Quick Reference Guide To Specialist Use Only Wound Care 20 Products 3.2 Specialist Use Only Wound Care Products Details 21 4 Skin Care Products Quick Reference Guide To Skin Care Products Skin Care Products Details 27 5 Other Wound Care Products Quick Reference Guide To Other Wound Care Products Other Wound Care Products Details 31 6 References And Bibliography 32 7 Associated Policy and Procedural Documentation Appendices Appendix A Wound Product Formulary And Dressing Selection Guide 34 Appendix B Wound Dressing Product Categories And Supply Routes 35 Appendix C Wound Care Advice Letter General Information Page 2 of 39

3 1.1 Introduction There are a vast array of wound care products available, however following evaluation and trials and taking into account quality and cost effectiveness the Tissue Viability Service in conjunction with Procurement and Pharmacy have devised this formulary which outlines the wound care products that are recommended for use by all practitioners within the Trust The formulary is designed to be used in conjunction with the Trust s Wound Management Guidelines (current version) which aims to support all registered nurses, medical staff and allied healthcare professionals to implement consistent, high quality, cost effective, first line wound management to patients within the Trust Certain practitioners e.g. physiotherapists working in specialised areas such as hand injury may carry out wound care for their client group as directed by relevant protocols. Complex wounds such as fungating tumours, larger dehisced surgical wounds and burns may require specialist care which is beyond the remit of these guidelines and the relevant specialists should be consulted for advice. Other tissue viability resources are available for information regarding the management of specific wound types e.g. clinical guidelines for management of leg ulcers, pressure ulcers and infected wounds and expanded practice protocols for therapies such as larvae and negative pressure wound therapy all of which can be found on the Trust Intranet The formulary is divided into sections: including sections for formulary products and a specialist use only section which lists products that are available for use in the Trust by specialists who have received training on how to use them or for use within specific clinical areas. If you require products that are not listed in either of these sections, please contact the Tissue Viability Service for further advice. 1.2 Principles of Wound Dressings For a wound dressing to be safe and effective for use in clinical practice it needs to meet the following criteria: Create a moist wound environment at the wound/ dressing interface Allow gaseous exchange Provide thermal insulation Impermeable to micro organisms Non adherent to the wound bed Page 3 of 39

4 Safe to use (non-toxic, non sensitizing, non allergenic) Acceptable to the patient Manage exudate Cost effective Be a carrier for medicaments (antimicrobial/antiseptics) Allow monitoring of the wound Provide mechanical protection Non flammable Sterilisable Conformable and mouldable (especially over awkward, boney areas) Available to the hospital and community in a range of sizes Require infrequent dressing changes (Thomas, 2009). 1.3 Dressing Product Categories Wound Contact Layers Low or non adherent dressing that can be used on lightly exuding granulating wounds that allow exudate to pass through into the secondary dressing. These dressings do not allow the in growth of granulation tissue. They also can be used as carriers for other products such as a hydrogel. The contact layer requires a secondary dressing whilst preventing adhering to the wound Hydrocolloids Adhesive and mouldable dressing that consists of carboxymethalcellulose with a backing made of foam or film. Hydrocolloids are indicated for low to medium exudate wounds and are impermeable to oxygen, water and vapour. These dressings turn to a gel as they absorb and assist in supporting rehydration and autolytic debridement of necrotic and sloughy wounds and provide a moist healing environment Films Page 4 of 39

5 A transparent dressing, permeable to oxygen and water vapour but not water. They allow visual inspection and provide a warm clean environment. Films may also be useful in reducing friction and providing protection. To avoid contamination large sheets of Opsite can be used as a sterile drape in theatre. Films with pad have an absorbent pad in the centre which is designed to reduce blistering and aid comfort (see island dressings) Alginate and Fibrous Dressings Soft white dressings, which are available as flat or rope/ ribbon dressing turn into a gel. Indicated for moderate to high exudating wounds, they absorb exudate, promote autolysis, keep the wound bed moist and promote healing. They maintain their integrity, are easy to remove when irrigated and create lateral wicking to prevent damage to surrounding skin. A secondary dressing is required to contain moisture and aid autolysis Foams Made of polyurethane foam and can be either adhesive or non adhesive. They are an absorbent product for low to moderately exuding wounds of any tissue type. They promote a moist wound healing environment and have a moisture vapour transfer rate (MVTR) which assists in reducing skin and wound maceration Hydrogels Water based dressings which are available in tubes or sheet form and donate fluid when placed in contact with a dry, necrotic/ sloughy wound. They can be used throughout the healing process on low exuding, granulating and epithelising wounds. They require a secondary dressing, which can support autolytic debridement Island Dressings Low adherent primary dressing with an adhesive border. Island dressings with film borders are recommended immediately post operatively to allow post operative inspection of the peri wound area, provide a barrier to external contamination, allow ease of removal, allow showering and maintain a moist healing environment (Roberts et al, 2011, NICE, 2008) Silicone based Dressings Dressings which are coated with a soft silicone which minimises tissue adherence and so reduces wound bed trauma and pain on removal. Silicone dressings are available as wound contact layers and absorbent foams. These types of dressing should only be used when either the wound bed or surrounding skin is fragile or the wound is painful particularly at dressing change. The wound contact layers can be used on skin tears. Page 5 of 39

6 1.3.9 Antimicrobial Dressings These dressings can help to reduce the level of bacteria at the wound bed but will not eliminate a spreading infection. Depending on the product they will either release the antimicrobial into the wound or kill the bacteria once it has been absorbed from the wound. The choice of product will depend on exudate and infection levels. Antimicrobial dressings contain antiseptics. Mupericin and Metronidazole are the only antibiotics recommended for topical use in the UK (Cowan, T ). The most popular antimicrobial dressings are those containing silver, iodine, Polyhexamethlene Biguanide (PHMB) and honey. Further information on the use of antimicrobials is available in the Trust s Wound Infection Guidelines (current version) Absorbent Dressings There are various dressing pads with have different levels of absorbency depending on the consistency of the layers in their composition. Many of these dressings comprise of a soft viscose, polyester bonded pad and may have an external polyethylene contact layer. Some of the products known as superabsorbers contain absorbent polymers Odour Control The carbon layer within these dressings absorbs the odour and withholds it Protease Modulators These dressings can prolong the inflammatory stage of wound healing and delay granulation which can help promote healing. 1.4 Wound Product Selection Wound dressing products should only be selected once a holistic assessment of the patient and their wound has been carried out. Wound assessment must include the cause of the wound, site and shape of the wound, size and depth of the wound, tissue types, appearance of the wound, surrounding skin, factors that may delay healing and identification of infected wounds. Full details on wound assessment and treatment are in the Trust s wound management guidelines (current version). Once the wound has been assessed treatment aims (goals) can be established e.g. to promote granulation, reduce odour, reduce pain, reduce bacterial load. The plan of care MUST be documented on the wound assessment chart and must include an appropriate: Cleansing regime e.g. saline, tap water Skin care regime e.g. barrier film, moisturizer Primary dressing (wound contact layer) e.g. Granugel, Cosmopore Page 6 of 39

7 Secondary dressing (if required) e.g. pad or foam Securing mechanism e.g. tape/bandage if primary or secondary dressings are non adhesive/skin is vulnerable or adhesive dressing The frequency of dressing change will depend on the exudate levels, patient comfort, presence of infection and advised wear time. If strikethrough occurs the dressing MUST be changed as soon as possible. The Wound Product Formulary and Dressing Selection Guide can aid with choosing the most suitable dressing for the patient (see Appendix A). 1.5 Product Availability Wound products are available via two routes into the Trust, pharmacy and supply chain (see Appendix B). If you require products that are not currently on the formulary please contact Tissue Viability to discuss. 1.6 Product Trials All product trials must be registered with procurement, and master indemnity numbers from suppliers provided. (see Trust s Procedure for Trails and Evaluation of Medical Devices, current version) 1.7 Admission and Discharge All patients discharged with a wound must be provided with a letter (Appendix C) and sufficient dressing changes for a week. The Trust formulary is a locally agreed formulary and therefore it may be necessary to arrange a product switch on admission or discharge or arrange for a particular product to be obtained on admission depending on the patient s individual requirements. 2. Formulary Wound Care Products 2.1 Quick Reference Guide to Formulary Wound Care Products Product Name *requires a prescription Description Page 7 of 39 Sizes and forms (in cm unless otherwise stated) ActiForm Cool Sheet hydrogel 10x10/ 10x15 ActivHeal foam Non adhesive foam dressing 10x10 tracheostomy tracheostomy fenestrated for use around Activon Tulle and Activon Tube/Algivon tracheostomy tubes A range of dressings containing 100% Manuka honey Tulle 5x5,10x10 Activon Tube 25g Algivon 5x5, 10x10 Allevyn non adhesive Non adhesive foam sheet 5x5/10x10/10x20/20x20 Heel 10.5x13.5 Allevyn Gentle Border Island foam with an adhesive border 7.5x7.5/10x10/10x20/12.5x12.5/15 x15/17.5x17.5 Allevyn Gentle Border Lite Foam with soft silicone adhesive border in shaped form Oval 8.6x7.7/15.2x13.1

8 Allevyn Gentle border Multisite Anabact* Aquacel Extra Tri-lobed version of Allevyn Gentle Border for use on difficult to dress areas Antimicrobial gel for malodourous fungating wounds Hydrofibre for moderate/heavily exuding wounds e.g. leg ulcers, fungating wounds or tracheostomy wounds 17.1x and 30g tubes Ribbon 2x45 Square 5x5,10x10,15x15 Rectangular 4x10,4x20,4x30 Aquacel Ag+ Extra* Hydrofibre impregnated with silver Ribbon 2x45 Square 5x5,10x10,15x15 Rectangular 4x10,4x20,4x30 Clinisorb Activated charcoal sandwiched 10x10/10x20/15x25 between layers of cloth CosmoporE Adhesive island dressing 5x7.2,8x10,8x15,10x20,10x25,10x 35 CView Vapour permeable transparent film 6x7, 10x12, 12x12, 15x20, 20x30 dressing CView Post Op Vapour permeable transparent film dressing with absorbent pad 6x7, 8.5x9.5, 8.5x15, 10x12, 10x20,10x25,10x35 DuoDERM Signal Thin hydrocolloid Square: 7.5 x 7.5, 10 x 10, 15 x 15cm. Rectangular: 5 x 10, 5 x 20, 9 x 15, 9x25, 9 x 35 Flamazine* Antimicrobial cream for burns and infecte 50g tubes, 250g, 500g tubs wounds Granugel Hydrogel for low exuding wounds 15 g single use tubes Inadine Iodine impregnated gauze 5x5, 9.5x9.5 KerraMax Care A superabsorbent dressing 10x10,10x22, 20x22, 20x30 Mepitel One L-Mesitran Hydro and Border Non-adherent wound contact layer with silicone on one side only An anti-bacterial honey dressing which debrides and has anti-inflammatory properties available with or without an adhesive border 6x7,9x10,13x15,24x27.5 L-Mesitran border 10x10 L-Mesitran hydro 10x10,20x15 Sorbsan range Alginate sheet and cavity dressings for Flat 5x5,10x10,10x20 Packing 2g moderate to heavy exuding wounds 30cm long. Ribbon 40cm long Telfa Clear Transparent, non adherent wound 7.5x7.5,10x12.5,30x30,30x60 contact layer UrgoTul Low adherent, hydrocolloid dressing 5x5,10x10, 10x40,15x15,15x20,20x30 Urgotul Ag/ Silver* Low adherent, antibacterial 10x12,15x20 hydrocolloid dressing Wound pad (Premier/Xupad) Sterile, absorbent, dressing pad 10x12 10x20 20x20 20x Wound Care Products Details ACTIFORM COOL A sheet hydrogel held in a blue mesh with a top liner. The liner should be left in place on dry wounds and removed on moderately exuding wounds to increase the moisture Page 8 of 39

9 vapour transmission rate. Hydrates necrotic or sloughy tissue to facilitate debridement. It can improve the condition of surrounding skin by re-hydrating it. Has a cooling effect which can provide pain relief. Leg ulcers, burns, scalds, radiation therapy damage (post treatment), diabetic wounds unless evidence of irreversible arterial disease. It is also useful to use when dressing awkward areas such as heels. Can be used prior to larvae therapy as it does not contain the preservative Propylene Glycol, which is harmful to maggots. Cavity wounds How to use it Can be cut to size if required or overlapped onto surrounding skin if this is dry or irritated. Place onto wound and remove top layer if wound is wet or leave insitu if wound is dry. Secure in place using tape or a bandage. The dressing becomes transparent initially then as the fluid is absorbed it becomes cloudy and will fall apart when saturated. The dressing should be checked daily initially as fluid absorption can be rapid. Can be left in place up to a week dependant on exudate levels. Can be removed in one piece if the gel has not formed or removed by irrigation if in gel form. ACTIVHEAL FOAM NON ADHESIVE/TRACHEOSTOMY Consists of three layers: a low friction backing, an absorbent and a perforated wound contact layer. Fenestrated to fit around tracheostomy tube. Absorbs low to moderate amounts of exudate. Around tracheostomy tubes Anything else How to use it Can apply around tracheostomy tube. Change daily or more frequently if saturated. If stoma site is becoming macerated consider changing to Aquacel Foam. ACTIVON TUBE/ACTIVON TULLE/ /ALGIVON Medical grade honey is filtered, gamma irradiated and produced under controlled hygiene standards. Activon tube is 100% medical grade honey which can be used directly on the wound or on top of other Activon honey dressings to top them up. Page 9 of 39

10 Activon Tulle is a knitted viscose mesh containing 100% manuka honey. Algivon is an alginate dressing impregnated with 100% manuka honey. Honey provides a moist healing environment due to its high sugar, low water content which promotes osmosis by drawing fluid into the dressing away from surrounding tissues. Honey has antimicrobial properties against bacteria and fungi. It promotes autolytic debridement through facilitating a moist environment and provides a deodorising action. It is also effective at reducing biofilms (Wounds UK, 2014). It is indicated for use on all wound types including infected, acute and chronic wounds and oncology related wounds. Patients who are sensitive to any additives or agents in the honey, bee stings or bee products. Patients blood sugars must be monitored if they are diabetic. May cause stinging when first applied. How to use it Activon tube can be used directly on the wound or on top of other Activon honey dressings to top them up if they are drying out. Activon Tulle is suitable for shallow low exuding wounds. Algivon can be used on cavity wounds or those that have moderate to heavy exudate levels. Apply appropriate size to wound and use a secondary dressing depending on exudate levels and select an appropriate method of securing dependant on location of wound. ALLEVYN NON ADHESIVE A hydrophilic polyurethane dressing with three layers; a nonadherent wound contact layer, a highly absorbent central layer and a bacteria-proof, waterproof outer layer. Manages moderate amounts of exudate. Can absorb up to 10 times its own weight in exudate. Moderately exuding granulating wounds where an adhesive dressing is not suitable. Non infected external fixator pinsites Infected wounds. Wounds with high levels of exudate. Wounds with a dry necrotic eschar. How to use it Select an appropriate size of Allevyn non adhesive which leaves a 2-3cm margin around wound. Can be cut to shape for use on awkward areas e.g. heels. Place white side of Allevyn non adhesive over the wound. Secure in place with bandage, tape to edges or tubular bandage. Page 10 of 39

11 Do not use occlusive film as secondary dressing. May be left in place for up to 7 days depending on the degree of exhudate. Leakage will occur sideways when dressing change is necessary. ALLEVYN GENTLE BORDER A sterile polyurethane foam dressing with a soft silicone adhesive border. Manages moderate amounts of exudate. Can absorb up to 6 times its own weight in exudate. Moderate to heavily exuding wounds where an adhesive border is required to keep the dressing in place. Infected wounds. Wounds with a dry necrotic eschar. How to use it Select an appropriate pad size of Allevyn Gentle Border which leaves a 2-3cm margin of adhesive around wound. Remove backing and apply to wound. May be left in place for up to 7 days depending on the degree of exhudate. Leakage will occur sideways when dressing change is necessary. ALLEVYN GENTLE BORDER LITE Same as Allevyn Gentle Border but available in an oval shape for ease of application/wear time. See Allevyn Gentle Border See Allevyn Gentle Border See Allevyn Gentle Border How to use it See Allevyn Gentle Border ALLEVYN GENTLE BORDER MULTISITE Same as Allevyn Gentle Border but available in a tri-lobed for use on difficult to dress areas. See Allevyn Gentle Border See Allevyn Gentle Border See Allevyn Gentle Border How to use it See Allevyn Gentle Border Page 11 of 39

12 ANABACT Colourless, transparent gel containing 0.75% metronidazole. Requires an approved prescription. Can be used on its own or with systemic antibiotic therapy to combat infection and odour in malodourous wounds. Effective against anaerobic and aerobic bacteria. Malodorous fungating tumours. Malodorous wounds e.g. pressure ulcers and leg ulcers - when other methods have failed e.g. charcoal dressing. However the widespread and indiscriminate use of Anabact in these wounds is not recommended. Individuals who have a known hypersensitivity to metronidazole. Women in stages of pregnancy or lactation. How to use it Apply gel thickly to wound surface. Cover with a non-adherent secondary dressing for wet wounds or film for dry wounds. Anabact gel can be used alone in small cavity wounds. Secure with tape or bandage. Apply once or twice daily depending on exudate levels and condition of wound. AQUACEL EXTRA A non-woven dressing composed of hydrofiber fibres. Absorbs exudate and create a gel. As it absorbs exudate vertically, protecting the peri wound skin. As it absorbs the exudate it forms a soft gel, providing a moist healing environment. The gel will retain its integrity allowing ease of removal. Easy to remove does not breakdown when saturated, safe in wounds close to the trachea. Capable of managing large quantities of exudate. May cause wounds to desiccate if inadequate amounts of exudate. Moderate to heavily exuding wounds including: Leg ulcers Pressure ulcers Neck wounds that connect to the trachea Fungating tumours Deep, narrow cavity wounds removal of dressing in one piece required Traumatic wounds. Dry or low exuding wounds. Narrow sinuses. How to use it Flat apply over the wound with 1cm overlapping the surrounding skin. Ribbon insert loosely into the wound. Can be cut to size. Page 12 of 39

13 Cover with absorbant pad and tape, film or hydrocolloid depending on exudate levels. Frequency of dressing change is dependent on secondary dressing and exudate. Usually 1-2 days, however can be left for up to 7 days if occlusive dressing applied. AQUACEL AG+ Extra Ionic Silver containing anti- biofilm, hydrofiber dressing. Absorbs exudate and create a gel. Requires a prescription. Disrupts biofilm. The ionic silver kill bacteria. Prevents biofilm reformation. Can be cut to any size without shedding fibres. Forms a gel sheet in presence of exudate. May cause wounds to desiccate if inadequate amounts of exudate. Moderate to heavily exuding acute or chronic wounds, requiring a dressing with an antimicrobial effect. Effective against pseudomonas aeruginousa, staphylococcus aureus, MRSA, and VRE. Patients with known sensitivities to silver. Dry or low exuding wounds. Narrow sinuses. How to use it Flat - apply directly to the wound overlapping the skin by at least 1cm. Ribbon - insert loosely into the wound. Can be cut to size. Cover with absorbent pad and secure film, tape or bandage. May be left in place for up to 7 days depending on exudate levels. Should be used for 2 weeks then reviewed. CLINISORB Activated charcoal sandwiched between layers of nylon/viscose rayon cloth. Activated charcoal is produced by heating carbon which leads to small pores Management of malodourous such as fungating wounds, pressure ulcers, leg ulcers and diabetic foot ulcers. Exudate will reduce the effectiveness of the dressing. How to use it Can be used as a primary or secondary dressing. Can be cut to size. Page 13 of 39

14 COSMOPORE Low adherent, absorbent perforated dressing with a hypoallergenic adhesive border. Provides a low adherent, dressing pad with an adhesive border for minor wounds. Post operative wounds healing by primary intention and minor, low exuding wounds. Heavily exuding wounds. Patients with sensitization to components. How to use it Select appropriate size. Peel backing. Stick to wound ensuring low adherent pad covers wound surface. Change prior to occurrence of strike through. C VIEW How does it work? A vapour permeable transparent film dressing which allows the wound bed to be inspected without having to remove the dressing. Maintains moist healing environment and prevents scab formation. Impermeable to fluids and bacteria. Low exuding superficial wounds. Moderate to highly exuding wounds. Wounds with necrotic tissue or thick adherent slough. Cavity wounds. Patients with thin, friable intact skin. Infected wounds. How to use it Select most appropriate size. Peel off backing and apply to wound. Can be used as a primary or secondary dressing. Stretch and release to remove. Can leave in place for up to 7 days unless wound exuding. Patients can shower with dressing insitu. C VIEW POST-OP Low adherent absorbent pad with polyurethane vapour permeable film, providing a waterproof adhesive island dressing. Minimal exudate is absorbed into pad and dressing is held in place by an adhesive border. As this is a film early signs of inflammation are visible through the dressing without removal. Surgical wounds closed by primary intention. Superficial low exuding wounds. Wounds with necrotic tissue or thick adherent slough. Cavity wounds. Page 14 of 39

15 Patients with thin, friable intact skin. Infected wounds. Heavily exuding wounds. How to use it Choose the correct size of dressing to ensure the absorbent pad will cover the wound. Remove the first backing strip, apply to wound, then remove the second backing strip. Can be left for up to seven days, however leakage will occur rapidly in heavily exuding wounds. DUODERM SIGNAL DuoDERM signal is an adhesive, hydrocolloid wound dressing with a tapered edge and a change indicator. The indicator helps to determine when to change the dressing and the tapered edge helps to prevent rucking up. The adhesive hydrocolloid matrix contains sodium carboxymethylcellulose, gelatin, pectin and adhesive polymers which create a moist environment that can help facilitate autolytic debridement. The outer film on DuoDERM Signal is permeable to moisture vapour and provides an occlusive waterproof barrier. Lightly exuding superficial wounds. Deep, heavily exuding wounds. How to use it Cleanse and dry wound. Select a suitable size of dressing, ensuring it extends 3cm beyond the wound margin. Remove backing paper, line centre of dressing with centre of wound and apply. As exudate is absorbed, the hydrocolloid layer liquefies into a gel. This looks like pus and has a distinctive odour. This is normal, but patients should be told in advance. Change as clinically indicated but maximum of 7 days. The green line indicator identifies when the dressing needs changing. To remove press down gently on the skin and lift one corner of the dressing, stretching each edge until free. FLAMAZINE A hydrophilic cream containing silver sulphadiazine 1% w/w. Requires an approved prescription. Effective anti-bacterial cream. May cause skin maceration. Relatively expensive. Burns (usually under supervision of Burns Team). Infected wounds especially if Pseudomonas Aeruginosa Page 15 of 39

16 present. Impairment of renal or hepatic function. Sensitivity may occur but lower than in other sulphonamides. Heavily exudating ulcers. How to use it Apply cream to wound with finger using sterile glove Take care not to spread onto surrounding skin as this will cause maceration Cover with non adherent dressing and/or absorbent pad Secure with tape or bandage. Reapply cream at least daily. Keep refrigerated when not in use. Change dressing at least daily or more frequently if strike through occurs. GRANUGEL A sterile Hydrogel composed of hydrocolloids (pectin and sodium carboxymethyl-cellulose) containing 80% water. The dressing has the ability to absorb excess exudate from exuding wounds but donate moisture to dry necrotic tissue or slough. Granugel maintains a moist environment which can facilitate the formation of granular tissue. Necrotic tissue. Sloughy wounds - deep or shallow. Granulating wounds - deep or shallow. Epithelialising wounds. Sinuses. Known sensitivity to the gel or its components (propylene glycol). Appropriate antibiotic therapy should be initiated where infection is suspected or develops during the use of Granugel. How to use it Unscrew the tube cap and remove the white safety ring. Replace the cap to puncture the tube membrane. Apply Granugel directly into the wound. The sterile applicator nozzle may be used to apply the gel into deeper wounds. Apply to a depth of 1cm on necrotic tissue and 0.5cm on other wounds. Cover with low adherent dressing e.g. Dressing pad or Foam. Change daily on necrotic tissue, or every seven days on granulating wounds. NB: Do not use gauze over top as this will absorb the gel making it ineffective. INADINE A knitted viscose fabric dressing impregnated with an ointment containing 10% Povidone Iodine. This is equivalent to 1% available iodine. Page 16 of 39

17 In the presence of exudate the povidine- iodine is released from the ointment and has a broad spectrum antimicrobial effect. The dressing is low adherent and water soluable. At risk diabetic feet Prophylaxis and treatment of infected wounds. Shallow infected wounds. Contaminated traumatic injuries. Superficial burns (under supervision of Burns Team). Known allergy to povidone iodine or iodine. Before and after use of radio iodine If the patient is being treated for kidney problem s In cases of Duhrings herpetiformdermatitis(rare skin condition) Heavily exuding wounds. Pregnant or lactating mothers. Cavity wounds. Must be under supervision: In patients with thyroid disease How to use it Remove backing strips. Apply Inadine dressing to wound. No more than 4 dressings may be used to cover the surface area of a large wound. Cover with an absorbent pad and secure with tape or bandage. Dressing needs changing when Inadine becomes white, daily initially, then every 2-3 days depending on degree of exudate. KERRAMAX CARE A superabsorbent dressing. Exudate and matrix metalloproteinases (MMPs) are pulled into absorbent polymers and stay within the dressing preventing leakage. This helps to prevent maceration and maximises comfort. Moderate to heavily exuding wounds. Dry or minimally exuding wounds. How to use it Select appropriate size and apply to wound. Can be used as a primary or secondary dressing. Do not cut/tear MEPITEL One A porous, semi-transparent net which is silicone coated on one side. It is non-absorbent but will allow the passage of wound exudate through to a secondary dressing. It will adhere to intact skin but not to the wound surface. The silicone coating is slightly tacky which allows the dressing to be retained by the periwound area. However it will not adhere to Page 17 of 39

18 the wound surface allowing dressing changes with minimum discomfort and the prevention of trauma to fragile tissue. Wounds where adherence of the dressing to the underlying tissue may cause trauma or pain on removal e.g. skin tears, abrasions, extensive blistering, lacerations, grafts, burns, skin damage following radiotherapy. Can also be used under or over topical steroids and antimicrobials. Should not be used if allergic to silicone. How to use it The dressing is supplied between 2 layers of plastic film which require removal. Select an appropriate size of Mepitel One that allows at least 2cm margin of intact skin around the wound can be cut to size before film removed. Apply with sterile gloves, moistened with saline reduces tackiness of Mepitel One. Remove one of the outer films from the Mepitel One and place the Mepitel One onto the wound Remove the second outer film. Cover with appropriate secondary dressing and secure with tape, or retention bandage. Can be left in place up to seven-ten days but the secondary dressing can be changed as often as necessary. If more than one piece is used the dressings can be partially overlapped ensuring that the pores are not blocked. Imprints can occur in areas where pressure is exerted therefore if used following facial resurfacing the Mepitel One should be lifted and repositioned alternate days. L-MESITRAN HYDRO AND BORDER A hydro active gel dressing containing medical grade honey available without or with an adhesive film border. L-Mesitran has anti-bacterial properties and can debride and reduce malodour. Contains digested sugars, vitamins, minerals and enzymes. The high osmotic action draws fluid into the wound to aid autolytic debridement, softening and lifting of dead tissue. Does not support bacteria due to high osmotic pressures and presence of hydrogen peroxide. Acts as a stimulant for growth of new capillaries, fibroblasts and epithelial cells. Burns. Chronic wounds. Necrotic/sloughy wounds. Surgical wounds. Diabetic wounds with caution and regular monitoring of blood sugars. Donor sites. Page 18 of 39

19 Fungating wounds. Honey can cause maceration to surrounding tissue therefore frequent observation and protect of surrounding tissue is essential. Caution must be exercised when applying honey to the diabetic patient, blood sugars must be frequently monitored. Hayfever sufferers should not use honey risks associated with pollen gathered by bees in the content of the honey. How to use it L-Mesitran hydro has film backing but is non adhesive and requires a secondary dressing. L Mesitran border has an adhesive film border. SORBSAN RANGE What sizes are available? A biodegradable dressing consisting of calcium salt of alginic acid derived from seaweed. Flat (sheet) dressing - 5 x 5cm, 10 x 10cm, 10 x 20cm Packing 2g - 30cm long with probe Ribbon - 40cm long with probe The calcium alginate forms a hydrophilic gel at the wound surface in the presence of exudate which facilitates wound healing. Sorbsan also has haemostatic properties. Sorbsan flat can be used on exuding wounds e.g. leg ulcers, pressure ulcers, donor sites. Packing and ribbon is generally indicated for use in cavity wounds or sinuses as the packing is wider this should be used on larger cavities and the ribbon used for smaller cavity wounds. Dry, necrotic wounds. Narrow sinuses. Neck wounds close to the trachea. How to use it Flat - apply over surface of wound. Packing or Ribbon - insert loosely into wound. Cover with pad and Mefix to allow moisture to evaporate or film to keep moisture in. Irrigate with saline to remove. Change every 1-3 days depending on exudate levels/ condition of wound. TELFA CLEAR A low cost low adherent, non absorbent dressing consisting of a polyester mylar film, available as a sterile dressing or a non sterile bulk roll. Clear perforated polyester film, low adherent plus allows the clinician to view the wound without removing the dressing therefore not disturbing the wound bed. Burns, skin grafts, donor sites, abrasions, surgical incisions and chronic wounds Can be used as a liner for wounds underneath foam in Topical Page 19 of 39

20 Negative Pressure Therapy to prevent adherence. Can be used with ointments. Can also be used as a membrane for larvae therapy to secure maggots within the wound. Highly exuding wounds. How to use it Apply appropriate sized Telfa Clear directly to wound bed. Can be cut to size. A secondary dressing is required to absorb exudate, secure and act as a barrier to infection. NB: Product must be fully opened or may cause maceration URGOTUL A non occlusive, low adherent, hydrocolloid dressing. Comprises of a polyester mesh impregnated with hydrocolloid particles dispersed in a petroleum jelly matrix (lipido-colloid technology). The mesh has an open diameter of 0.5mm. Non greasy to touch. On contact with wound exudate hydration of the hydrocolloid particles occur producing a lipido-colloid interface. This creates a moist environment to promote healing and prevents adhesion to the wound so that it can be easily and painlessly removed. Has continuous threads, so there no risk of microfibres being shed into the wound creating a foreign body reaction. Has non-deformable links so that the mesh is permanently open. This helps prevent maceration and the small size helps prevent migration of granulation tissue through the mesh. Stimulates fibroblast proliferation. Acute and chronic non infected wounds eg burns, donor sites, dermabrasions, traumatic wounds, post operative wounds, leg ulcers, pressure ulcers, diabetic foot ulcers, stump wounds and epidermolysis bullosa. Infected wounds. How to use it Apply Urgotul straight onto a cleaned wound surface and shape to contours of wound. Cover with a secondary absorbent dressing and tape or bandage in place. Urgotul can sometimes stick to surgical gloves making application difficult. Consequently the wetting of the gloves with saline prior to the handling of Urgotul is recommended to make it easier. Can be left in place for up to 7 days depending on the wound. URGOTUL Ag A non occlusive, low adherent, antibacterial, hydrocolloid dressing Page 20 of 39

21 Comprises of a polyester mesh coated with hydrocolloid, Silver sulphadiazine (0.45mg/cm 2 ), petroleum jelly and cohesion polymer. The mesh has an open diameter of 0.5mm Non greasy to touch. Has a broad spectrum antibacterial activity On contact with wound exudate hydration of the hydrocolloid particles occur producing a lipido-colloid interface. This creates a moist environment to promote healing and prevents adhesion to the wound so that it can be easily and painlessly removed. Has continuous threads, so there no risk of microfibres being shed into the wound creating a foreign body reaction. Has non-deformable links so that the mesh is permanently open. This helps prevent maceration and the small size helps prevent migration of granulation tissue through the mesh. Stimulates fibroblast proliferation. The bactericidal effect occurs from Sulphadiazine aiding the movement of the silver ion through the bacteria membrane. The silver ion then reacts with the bacteria s DNA, replacing the hydrogen atom and blocking duplication and replication of the bacteria. This dressing is suitable for any wound that is infected or contaminated or where there is a high risk of this occurring and a protective non/low adherent dressing is required e.g. superficial and partial thickness burn wounds, donor sites, graft sites. The use of Urgotul Ag is contraindicated if patient has a known sensitivity to silver. How to use it Apply Urgotul Ag straight onto a cleaned wound surface. Apply an absorbent secondary dressing over the top. Can be left in place up to seven days depending on exudate levels and wound type. WOUND PAD PREMIER/XUPAD A sterile absorbent dressing pad. Absorbs exudate into wadding. Can be used as a primary or secondary dressing. Wet wounds to absorb exudates. Dry wounds as padding. Wounds where it is likely to stick and cause trauma on removal. How to use it Select appropriate size. Apply as a primary or secondary dressing. Secure with loose bandage, tape or Mefix. 3. Specialist Use Only Wound Care Products Page 21 of 39

22 3.1 Quick Reference Guide to Specialist Use Only Wound Care Products Product Name Description Sizes and Forms Allevyn Ag Non adhesive foam dressing with 5x5,10x10,15x15,20x20 silver sulphadiazine- used for pin sites Aquacel Foam non adhesive Hydrofibre foam with waterproof outer layer and absorbent pad- used for 10x10cm Drawtex Flaminal Forte and Hydro Granuflex tracheostomies A hydroconductive that is very absorbant dressing that wicks away the exudate Alginate gel containing two antimicrobial enzymes. Forte is for wetter wounds. An outer waterproof polyurethane foam, bonded to a matrix of hydrocolloid particles 5x5,7.5x7.5,10x10,15x20,20x20,7.5x1 m,10x1m,20cmx1m,10cmx1.3m 15g and 50 gram tubes Square 10x10cm, 15x15cm, 20x20cm Haelan Tape Adhesive, waterproof, occlusive tape 7.5x50 cm, 7.5x200cm impregnated with a topical steroid Kytocel Gelling fibre dressing 5x5,10x10,15x15,4x10,4x20,4x30,2.5 x45cm (ribbon) Medihoney Barrier Barrier cream containing medihoney 2g sachet or 50g tube Cream antibacterial honey Mepilex Absorbent soft silicone dressing for 10x11/11x20/15x16/20x21cm patients with fragile skin Opsite Flexigrid Semi-occlusive film dressing for superficial wounds or as secondary dressing 10x12 PolyMem Range Suprasorb X Suprasorb X + PHMB Urgostart contact Thin foam containing a cleanser and moisturiser- for radiotherapy reactions Bio-cellulose dressing designed to regulate moisture levels in the wound Bio-cellulose dressing with broad spectrum antimicrobial Polyester mesh with hydrocolloid and a healing accelerator 3.2 Specialist Use Only Wound Care Products Details 8x8cm,10x10cm,13x13cm,17x 19cm,10x61 cm roll. Also finger/toe dressings 5x5, 9x9, 14x20, 2x21(rope) 5x5, 9x9, 14x20, 2x21(rope) 5x7, 10x10, 15x20 ALLEVYN Ag A non adherent foam dressing impregnated with silver sulphadiazine that can be cut to suit the patient. Used round infected pin sites of metal work to help prevent bacterial contamination Infected pin sites under advice of specialist nurse. It is not recommended for any other wound types in the Trust unless advised by a specialist practitioner. How to use it Cut to allow application around the metalwork Page 22 of 39

23 AQUACEL FOAM A non adhesive hydrofibre foam pad. Absorbs fluid into the multilayer pad and wicks away preventing maceration of the skin. Tracheostomy sites when cut to shape and where Activheal tracheostomy dressing is not providing sufficient absorbency. Any other wound types in the Trust unless advised by specialist practitioner. How to use it Cut a slit in the dressing and place around the tracheostomy tube. Change as clinically indicated. DRAWTEX A hydroconductive dressing that is very absorbent and wicks away the wound exudate. Manages and controls excessive wound exudate Facilitates removal of wound debris Draws bacteria from the wound bed into the dressing Draws out harmful MMPs from the wound bed into the dressing Moderate to heavily exuding wounds Wounds at risk of bleeding How to use it Cut Drawtex to conform to the wound shape if required Apply Drawtex directly to the wound surface. For heavy exudate, apply additional layers as necessary Cover with a dressing or bandage of choice Change Drawtex every 1 3 days as clinically indicated. Once volume of exudate is under control, dressing may be changed less frequently (not to exceed 7 days). FLAMINAL HYDRO/FORTE Alginate gel containing 2 antimicrobial enzymes, glucose oxidase and lactoperoxidase. Debrides the wound and manages moisture balance. Wide range of wounds a most stages of healing. Useful for cavity wounds e.g pilonidal sinuses. Forte is for wetter wounds as contains a higher proportion of alginate than the Flaminal Hydro. Full thickness burns. Patients with a sensitivity to alginate dressings or polyethylene glycol How to use it Select either Flaminal Hydro or Flaminal Forte Page 23 of 39

24 depending on exudate levels Clean and rinse the wound as you would normally and dry carefully. Apply a thick layer (5mm) of either Flaminal Hydro or Flaminal Forte to the wound in a sterile manner. Flaminal does not need to spill over the wound edge. Cover with a suitable secondary dressing either an absorbent dressing for wetter wounds or on drier wounds, use a dressing that reduces evaporation and prevents the wound from drying out. The dressing can stay in place for as long as the gel structure is intact: 1-4 days, depending upon the amount of exudate.for wounds treated with Flaminal Hydro, i.e., lower exudate wounds, this generally means every 3-4 days. Flaminal Forte wounds, being higher in exudate, are usually changed every 1-2 days. Change from Flaminal Forte to Flaminal Hydro as exudate reduces. When using Flaminal Hydro, if the gel becomes too liquid, the wound is too wet for Flaminal Hydro. Use Flaminal Forte. When using Flaminal Forte, if dry flakes of alginate appear in the wound, the wound is too dry for Flaminal Forte. Use Flaminal Hydro. During Flaminal treatment, dry whitish alginate flakes may appear on the wound border. They should not be removed as the flakes will prevent border maceration. GRANUFLEX An outer waterproof polyurethane foam, bonded to a matrix of hydrocolloid particles (gelatin, pectin and methylcellulose) and a hydrophobic polymer. Waterproof so patient can bathe or shower. Hydrocolloid layer may squeeze out of wafer if applied to weight bearing areas. Necrotic wounds, sloughy wounds, granulating wounds, epithelialising wounds. Bordered Granuflex shaped for more difficult areas such as the sacrum or heels. Wounds with exposed tendon or bone - only use under medical supervision. Ulcers resulting from tuberculosis, syphilis and deeper fungal infections. Third degree/full thickness burns greater than 2% body surface area. How to use it Select a suitable type and size of dressing, ensuring it extends 2-3cm beyond wound margin. When cutting large wafers to size, curve corners. Warm dressing between gloved hands, remove backing Page 24 of 39

25 paper and apply to wound in a rolling motion. Smooth into place, particularly edges. Adhesion improves as the dressing warms. Change every 3-7 days depending on exudate levels. N.B. As exudate is absorbed, the hydrocolloid layer liquefies into a gel. This looks like pus and has a distinctive odour. This is normal, but patients should be told in advance. HAELAN TAPE A thin, adhesive, waterproof, occlusive tape impregnated with a topical steroid, fludroxycortide. The steroid tape is used as an adjunctive therapy for chronic, localised, recalcitrant dermatosis that may respond to topical corticosteroids. Each square centimetre contains 4 micrograms of the steroid. It is waterproof and makeup can be applied on top. Overgranulation tissue Chicken pox Hypersensitivity to any of the components How to use it Clean and dry skin Cut a piece large enough to cover the affected area with a 0.5 cm border onto unaffected skin. Round off corners to prevent catching. Remove the paper backing and apply the adhesive to the skin Do not use a secondary dressing Should not be used for long term use. KYTOCEL A highly absorbent conformable, gelling dressing composed of natural biodegradable chitosan fibres. Can be removed in one piece. It has a natural antimicrobial action that makes it effective against wound pathogens including Candida albicans, Pseudomonas Aeruginosa and MRSA. The fibres bond with the wound exudate and transform into a gel that locks the fluid away. The positive charge allows it to interact with negatively charged molecules such as gram- positive bacteria, blood cells, proteins, metals and lipids. Moderately to heavily exuding chronic and acute wounds. Can be used to control minor bleeding insuperficial wounds. Not indicated for surgical implantation, third degree burns or to control heavy bleeding. Should not be used on patients who are sensitive to chitin. How to use it Select appropriate size, apply to wound as a primary Page 25 of 39

26 dressing. Cover with suitable secondary dressing and secure using tape, film or bandage. MEDIHONEY BARRIER CREAM Barrier cream containing 30% sterile manuka honey with antibacterial and anti-inflammatory properties. Helps to reduce inflammation, prevent maceration, excoriation and irritation effects of incontinence and diarrhoea. Wound edges to protect skin from exudate. For treatment of incontinence associated dermatitis and atopic eczema. Prevention and treatment of maceration and excoriation. Can be used on broken skin Patients allergic to honey How to use it Clean and dry the area Apply 3 times a day or as required. MEPILEX An absorbent dressing with a soft silicone wound contact layer, a polyurethane foam pad and an outer film that is vapour permeable and waterproof. Minimises the pain to the patient and trauma to the wound bed at dressing changes as the soft silicone layer prevents adherence to the wound bed. Will gently adhere to the surrounding skin but can be removed with no epidermal stripping. A wide range of low to moderately exuding wounds such as leg and foot ulcers/pressure ulcers/ painful wounds/wounds with compromised/fragile surrounding skin. Indicated for use on patients receiving radiotherapy. Heavily exuding wounds. How to use it Select correct size. Cut to shape to fit difficult to dress areas. OPSITE FLEXIGRID Vapour permeable transparent film dressing with a 1cm grid marked on it to aid wound management. Maintains moist healing environment Superficial, low exuding wounds See C View How to use it See C View. Can also use large rolls of Opsite Flexifix in theatre as a Page 26 of 39

27 drape. POLYMEM PolyMem is a hydrophilic polyurethane thin foam that contains a wound cleanser (F68 surfactant) and a moisturiser (glycerine). Available with or without an adhesive border and in various shapes. Polymen Max is a more absorbent version. The wound cleanser is constantly released from the dressing minimising the need for cleansing at dressing changes. The combination of the surfactant and glycerine works on the nociceptors to reduce pain and inflammation. Low to moderately exuding wounds including skin tears, superficial and partial thickness wounds, burns, donor and graft sites, and radiotherapy- induced skin reactions. Full thickness burns and in conjunction with solutions containing hypochlorite. How to use it Choose relevant size/shape. Apply to wound. Fix in place using appropriate securing mechanism. Can cut slits along the edge of the dressing to help with conformability. The outer layer of the dressing is printed with a 1cm grid which can help with fitting the dressing to the patient. SUPRASORB X Bio-cellulose dressing designed to regulate moisture levels in the wound Creates hydro balance by absorbing surplus exudate from the wound into the dressing and releasing moisture from the dressing into the wound. Light to moderately exuding wounds Superficial and deep Infected wounds. If the dressing dries out rehydrate with saline until it is soft enough to remove. This can take up to 30 minutes. How to use it Clean and dry the wound Position the dressing over the wound If using the rope, fold this several times and place it gently into the wound leaving 2-3cms visible to ensure it can be removed easily. Hold in place with an appropriate secondary dressing. SUPRASORB X + PHMB Bio-cellulose dressing with broad spectrum antimicrobial (PHMB)designed to regulate moisture levels in the wound Creates hydro balance by absorbing surplus exudate from the wound into the dressing and releasing moisture from the dressing Page 27 of 39

28 into the wound. Microorganisms are killed by the PHMB. Light to moderately exuding wounds Superficial and deep infected wounds If the dressing dries out rehydrate with saline until it is soft enough to remove. This cantake up to 30 minutes. How to use it Clean and dry the wound Position the dressing over the wound If using the rope, fold this several times and place it gently into the wound leaving 2-3cms visible to ensure it can be removed easily. Hold in place with an appropriate secondary dressing. URGOSTART CONTACT UrgoStart Contact is a contact layer with TLC-NOSF (Technology lipido- colloid). It consists of a polyester mesh impregnated with hydrocolloid, petroleum jelly and particles of the healing accelerator NOSF.UrgoStart Contact is a contact layer with TLC-NOSF (Technology lipido- colloid). It consists of a polyester mesh impregnated with hydrocolloid, petroleum jelly and particles of the healing accelerator NOSF. Promotes faster healing and improves patients quality of life Neutralises excess proteases (MMPs) Re-establishes wound equilibrium With all the benefits of TLC: pain-free dressing changes, moist wound-healing, good tolerance, stimulation of fibroblast proliferation Non to low exuding leg ulcers, pressure ulcers, diabetic foot ulcers and recurring wounds Can be combined with an absorbent layer Can be used in cavity wounds Minimum duration of treatment 4-5 weeks Infected or critically colonised wounds. Known sensitivity to any components of the dressing How to use it Select an appropriate size Secure with a retention bandage or a secondary dressing Can be left in place for up to 7 days 4. Skin Care Products 4.1 Quick Reference Guide to Skin Care Products Product Name Description Sizes Appeel A no sting silicone fluid that can help Sachet 5ml/wipes 30/foam applicator facilitate the easier removal of adhesive dressings Cavilon* No Sting Barrier Film/Durable Barrier Cream No sting barrier film/ Durable barrier cream 1ml/3ml applicators/28ml spray 2g sachets/28/92g tubes Page 28 of 39

29 Dermol 500 Fifty:50 ointment Proshield Plus Skin Protectant Tena wash cream An antimicrobial emollient for the management of dry and pruritic skin conditions Emollient containing white soft paraffin and liquid parafin A skin protectant to protect intact and skin damaged from incontinence A creamy 3-in-1 formula that should be used in place of soap and water to cleanse skin contaminated with urine and faeces Emollient cream contains liquid paraffin which can moisturise dry skin Zerobase Emollient Cream * see specialist formulary for Medihoney Barrier Cream 500ml 250g 500g 115g 150ml 50g tube 500g pump APPEEL 4.2 Skin Care Products Details Appeel Sterile Medical Adhesive Remover facilitates the quick and easy removal of dressings, tapes and other medical adhesives. When the silicone comes into contact with the adhesive of the dressing it temporarily changes the surface energy of the skin, disrupting the adhesive properties between skin and device. This facilitates gentle removal of the dressing. Use of Appeel Medical Adhesive Remover helps to protect skin, whilst reducing the risk of damaging skin or experiencing pain from repeated dressing changes. Can be used on intact and broken skin. Any patients with a known sensitivity to any of the ingredients. How to use it Spray: Skin should be clean and dry prior to application Spray cm from the skin Spray onto a permeable dressing/tape to release If impermeable, spray under one edge and repeat for complete removal For single patient use. Can be used at any angle Wipes: Skin should be clean and dry prior to application To open the sachet, tear along notch across the top Wear sterile gloves to maintain sterility when using this product Remove wipe from sachet. Lift a corner of the dressing/tape and gently wipe under the dressing/tape to release the adhesive from the skin Appeel Sterile Medical Adhesive Remover dries quickly, leaving no residue. Once dried, it will not affect any further adhesion Use additional sachets if required for larger areas Foam applicator: Skin should be clean and dry prior to Page 29 of 39

30 application To open the sachet, tear along either notch across the top Wear sterile gloves to maintain sterility when using this product Remove the foam applicator from the sachet and gently wipe the applicator over a permeable tape/dressing or under the edges of an impermeable tape/dressing to release it from the skin Appeel Sterile Medical Adhesive Remover dries quickly, leaving no residue. Once dried, it will not affect any further adhesion of tapes/dressings Use additional sachets if required for larger tapes/dressings Also available as a sterile liquid sachet. CAVILON NO STINGBARRIER FILM / DURABLE BARRIER CREAM Cavilon No Sting Barrier Film is an alcohol-free liquid barrier film that when dry forms a breathable, transparent coating on the skin. It lasts for up to 72 hours, and will not sting when applied to broken skin. Cavilon Durable Barrier Cream provides protection from bodily fluids whilst moisturising the skin. It is both fragrance and parabens free. Contains silicone which has a water repellent property. Applying too many layers of product may make the area feel stiff. Film: Designed to protect intact, damaged or 'at-risk' skin from urine, faeces, other body fluids, adhesive trauma and friction. Cream: Recommended to prevent skin breakdown on intact skin and is safe for use on injured skin. Use of the product with other barrier ointments, creams or lotions may significantly reduce its effectiveness Not to be used on infected areas of the skin - for example fungal infections How to use it Barrier cream Use on clean, dry skin. Apply a small amount of Cavilon Durable Barrier Cream to the affected area, gently smoothing it into the skin. Page 30 of 39

31 Re-apply following every 3rd episode of incontinence. Apply sparingly. If the after-feel is oily, you have applied too much. Barrier film Skin should be clean and dry prior to application Apply a uniform coating of film over the entire treatment area when using the foam applicator or stoma wipe. When using the spray bottle, hold the spray nozzle 10 to 15cm from the skin and apply in a smooth, even coating over the entire treatment area, whilst moving the spray in a sweeping motion. If an area is missed, re-apply to that area only after the first application has dried (approximately 30 seconds). If applied to an area with skin folds or other skin-to-skin contact, make sure that the skin contact areas are separated and allow the coating to dry before returning to normal positions. Re-application is recommended at least every hours (under normal use) or more frequently if needed DERMOL 500 An antimicrobial emollient for the management of dry and pruritic skin conditions, especially eczema and dermatitis. The lotion is suitable for direct application, and for use as a soap substitute. The active ingredients are presented in an aqueous lotion and so are readily absorbed into the stratum corneum when the product is gently massaged over the areas of dry skin. The antiseptic ingredients are in intimate contact with the skin, and as they are in solution, their availability is optimal. Dry and pruritic skin conditions Do not use in cases of known sensitivity (especially generalised allergic reaction) to any of the ingredients. How to use it For application to the skin: apply the lotion to the affected areas as required. Massage into the skin, until absorbed. For use as a soap substitute: use as a cleanser in the bath or shower, or for other toiletry purposes, instead of ordinary soap or shower gel. Fifty:50 Liquid Paraffin, White Soft Paraffin An emollient ointment for the symptomatic relief of dry skin conditions Moisturises the skin Page 31 of 39

32 Dry skin conditions Most people will not have problems, but some may get some of these: Rarely, allergic reactions (e.g. skin rash, red or itchy skin) Irritation of hair follicles if used for a long period of time This ointment is greasy, and so if you apply it to your hands, be careful if you drive or use machines. NB: patients using these products should be advised not to smoke: use naked flames (or to be near people who are smoking or using naked flames) or go near anything that may cause a fire whilst emollients are in contact with their medical dressings or clothing. Clothing and bedding should be changed daily to prevent emollients soaking into fabric (Drug Safety Update, 2016). How to use it Apply a thin layer of ointment to the affected area. Apply in the direction of hair growth to help prevent irritation of hair follicles. Apply when you need to, at least twice a day or ideally three or four times a day. If you are an adult treating a large area of your body you may use up to one tub a week. For use on the skin only. PROSHIELD PLUS SKIN PROTECTANT A greaseless, fragrance free dimethicone based skin protectant to protect intact and damaged skin from incontinence. Moisturises the skin leaving it supple and hydrated. Intact and damaged skin up to grade 2 damage. To be used when Cavilon has been ineffective Under dressings as the adhesive will not stick. Wounds greater than partial thickness. How to use it Smooth gently over the area of damaged skin Do not rub as this may cause friction. A thin layer is sufficient for protection of intact skin. TENA WASH CREAM A creamy 3-in-1 formula that should be used in place of soap and water to cleanse skin contaminated with urine and faeces. Dermatologically tested. Helps to maintain the skin s natural ph. Alcohol-free and soap-free. Helps to leave the skin feeling fresh, clean and free from unpleasant odours. Eliminates cross contamination through sinks and washcloths. Primarily used for frequent perineal skin care of incontinent Page 32 of 39

33 individuals when changing absorbent products, but can also be used for full body cleansing when soap and water may otherwise dry the skin. Known sensitives to any of the ingredients How to use it Unlike soap and water there is no need to rinse off. ZEROBASE EMOLLIENT CREAM An emollient containing liquid paraffin Moisturises dry skin Dry skin Broken skin How to use it Apply to dry skin 5. Others 5.1 Quick Reference Guide to Other Products Product Name Description Sizes Comfifast Tubular retention bandage blue, yellow or beige line Blue - 7.5x1m,7.5x3m,7.5x5m Yellow 10.75x1m,10.75x3m,10.75x5m, Viscopaste/Ichthopaste COMFIFAST 5.2 Other Products Details Bandages impregnated with zinc paste/ichthammol Page 33 of 39 Beige 17.5 x1m 7.5cmx6m An elasticated viscose tubular retention bandage available in a variety of sizes. Blue line 7.5 x 1,3, & 5m roll (most commonly used for venflons). Yellow line x 1,3 & 5m roll (most commonly used for legs). Beige line 17.5 x 1m roll (for trunks). Easier to apply than conventional bandages therefore may save nursing time. Holds primary and secondary dressings securely in place. May cause trauma if a size that is too small is used and is ineffective if too big a size used. Leg, arms, trucks for the retention of dressings when unadvisable/unable to use adhesives to secure dressings. Patients with discomfort/ allergy to product. How to use it Must be applied from joint to joint (e.g. toe to knee) to avoid oedema above and below bandage line. Change when contaminated with exudate/or soiled.

34 VISCOPASTE/ICHTHOPASTE Cotton fabric, plain weave bandage impregnated with a zinc oxide paste. Requires additional banding over the top. The zinc paste will help dry out and soothe irritated skin around ulcers. Used in the treatment of a variety of skin conditions associated with leg ulcers e.g. inflammation, eczema. Can be used under 4 layer compression bandaging to act as a buffer between fragile skin and the compression bandage. Patients with known sensitivity to paste. How to use it As a bandage - from base of toes to below knee in a spiral covering heel. Apply using a pleat at each turn or cut leaving overlap on each turn. Cover with Soffban (one of the layers of the K Four system see section 3.4.3) applied toe to knee in a spiral and secure with toe to knee retention bandage. Can be left on for up to a week but in warm hospital environment change every 2-3 days to prevent drying out. 6. References and Bibliography Cowan, T. (ed) ( ) Wound Care Handbook (9 th edn). Mark Allen Healthcare, Mahoney, K (2015) How to choose the correct dressing. Wound Care Today. 2015,Vol 2, No1. Medicines and Healthcare products Regulatory Agency (2016) Parafin-based skin emollients on dressings or clothing: fire risk Drug Safety Update Volume 9 issue 9, April 2016:9. National Institute for Clinical Excellence (2008a) Prevention and Treatment of Surgical Site Infection. Clinical Guideline 74. National Institute for Health and Clinical Excellence, London National Institute for Clinical Excellence (2014) The prevention and management of pressure ulcers Clinical Guideline 179. National Institute for Health and Clinical Excellence, London Roberts,N. Sorrell,J. Bielby,A.Searle, R. (2011) A survey of post operative wound dressing practice before and after implementing national guidelines. Wounds UK, 2011, Vol 7. No Page 34 of 39

35 Thomas, S (2009) Formulary of Wound Management Products. A Guide for Healthcare Staff, Tenth Edition. Euromed Communications Ltd, Hampshire. 7. Associated Policy and Procedural Documentation Guidelines for urinary continence care for adults patients aged 16 years or above Guidelines for the Prevention, Detection, Treatment and Management of Infected Wounds Guidelines for the Management of Patients with Leg/Foot Ulceration Infection Prevention and Control Policy Expanded Practice Protocol for the Use of sterile larvae Expanded Practice Protocol for the Application of Negative Pressure Wound Therapy Procedure for the Decontamination of Reusable Medical Devices prior to patient use, inspection, servicing, repair or return to departments or organisations Wound Management Guidelines Page 35 of 39

36 Appendix A Page 36 of 39

37 Appendix B Wound Dressing Product Categories and Supply Routes PICS = obtain from pharmacy via Prescription only/ S = obtain from supplies/stores / TV = obtain from Tissue Viability FORMULARY WOUND CARE PRODUCTS ALGINATES and FIBRES FOAMS ANTIMICROBIALS OTHERS Sorbsan Flat (S) Sorbsan Ribbon (S) Sorbsan Packing (S) Aquacel Extra Ribbon (S) Aquacel Extra Sheet (S) Allevyn Gentle Border(S) Allevyn Non Adhesive (S) Allevyn Cavity (S) Allevyn Multisite(S) Allevyn Heel (S) Allevyn Gentle Border Lite Oval (S) Activheal trachy (S) Dressing for IV and Central Lines and some products used in Podiatry and Dermatology are not included For further advice please contact the Tissue Viability Team via PICs or refer to the Wound Management Guidelines/Wound Product Formulary Page 37 of 39 Inadine (PICS) Aquacel Extra Ag+ Ribbon/Sheet (PICS) L-Mesitran hydro and border (S) Activon Tulle & Ointment (S) Algivon (S) Flamazine (PICS) Anabact (PICS) Urgotul Ag (PICS) SKIN PROTECTION/ADHESIVE REMOVER Proshield Plus(S) Cavilon No sting barrier film and Cavilon Durable Barrier Cream (S) Tena wash (S) Appeel Adhesive Remover(S) SILICONE ODOUR CONTROL HYDROGELS PASTE BANDAGES Mepitel One(S) /Silflex (S) Anabact (PICS) Granugel (S) Viscopaste /Ischthopaste (PICS) Clinisorb (S) Actiform Cool (S) HYDROCOLLOID FILMS ABSORBENT DRESSINGS TUBULAR BANDAGES DuoDERM Signal(S) CView (S) Xupad or Premier Dressing Pad (sterile) (S) KerraMax Care(S) Comfifast(S) Various sizes: 5/7.5cm width for arms/10cm for legs/beige line 17.5x1m for trunks (S) WOUND CONTACT ISLAND DRESSINGS MOISTURISER/SOAP LAYER Telfa Clear (S) Urgotul (S) CosmoporE (S) CView Post OP (S) SUBSTITUTE Dermol 500 (PICS)/ Fifty:50 Zerobase Emollient Cream(PICS) SPECIALIST USE ONLY WOUND CARE PRODUCTS Drawtex/Granuflex/Kytocel (TV)/Mepilex (S)/Suprasorb X & Suprasorb X +PHMB (TV)/ Polymem (Radiotherapy OP)/ /Silver Nitrate (PICS)/Haelan Tape (PICS/Allevyn Ag (Trauma)/Aquacel Foam (ITU)/Medihoney Barrier Cream (TV)/Urgostart TV)/Flaminal Forte/Hydro(TV) Any other non formulary /specialist use only products can ONLY be obtained after consultation with Tissue Viability and approval by the relevant supply route

38 Appendix C Document Number 359 Version 6 Wound Product Formulary Page 38 of 39

39 Document Number 359 Version 6 Wound Product Formulary Page 39 of 39