A systematic review of silver-releasing dressings in the management of infected chronic wounds

Aim. This paper is a systematic review with the objective of determining the effectiveness of silver-releasing dressing in the management of infected chronic wounds. Background. Chronic wounds exhibit increased bacterial burdens which not only result in a negative physical impact on patients, impairing their quality of life, but also increase treatment costs. Silver dressings are wound products designed to control and inhibit infection and provide a wound environment conducive to healing. However, there is limited evidence on their effectiveness in doing so. Methods. A systematic review of literature from 1950-May 2007 was conducted using the PubMed, CINAHL, Cochrane, MEDLINE, British Nursing Index, EBSCO Host, OCLC, Proquest and PsychInfo databases. The review included randomised or non-randomised control trials, published in English or non-English, of silver-releasing dressings in infected chronic wounds. Results. Of the over 1957 potentially releasing studies examined, 14 pertinent articles involving 1285 participants were identified. Almost all the participants reported one or more statistically significant outcomes. The main points to emerge from this review of studies are that silver-releasing dressings show positive effects on infected chronic wounds. The quality of the trials was limited by the potential for bias associated with inadequate concealment, no detailed description of the outcome measurement and no reported intention-to-treat analysis. Moreover, problems existed in some studies with confounding factors. Conclusion. The review clearly highlights the need for well-designed, methodologically standardised outcome measurement research into the effectiveness of silver-releasing dressings. It also points to the need for a comprehensive assessment of wound bed status in further studies. Relevance to clinical practise. This review strengthens the case for the use of silver dressings when managing infected chronic wounds. They appear more effective and are tolerated well by patients. However, their use should be accompanied by a comprehensive wound assessment.