Der har altid været skurke i sårheling Nu findes der en løsning

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1 Sårvæske INFEKTION Biofilm Der har altid været skurke i sårheling Nu findes der en løsning Ingen bandage kan mere.

2 Ingen bandage kan mere. 3 21Én Tre skurke i sårbehandlingen: Sårvæske, infektion og biofilm To effektive teknologier. NY Ag+ Teknologi En unik teknologi som nedbryder biofilm og dræber infektionsfremkaldende bakterier.* 1-3 Hydrofiber Teknologi Dokumenteret teknologi som absorberer og binder sårvæske og skaber et optimalt sårhelingsmiljø.* 4-8 løsning til sårheling. TEKNOLOGI Fås i AQUACEL Ag+ Extra og AQUACEL Ag+ kavitetsbandager. *Som påvist in vitro Påvist evne til at håndtere sårvæske, infektion og biofilm.

3 Biofilm forsinker sårheling. Biofilm er almindelig. Biofilm dannes, når kolonier af bakterier danner et slimlag for at beskytte sig selv. 9 Den er involveret i omkring 80% af alle infektioner i sundhedsvæsenet. 10 Plakken på dine tænder, urinvejsinfektioner og øjeninfektioner står alle i forbindelse med biofilm Selv om du ikke altid kan se det, indeholder størstedelen af kroniske sår biofilm 14 og den er en vigtig årsag til forsinket sårheling 15 og et forstadium til infektion. 16 Biofilm er stædig. Biofilm er vanskelig at fjerne helt 17 selv med debridering og den gendannes hurtigt. 18 Biofilm tåler: Antimikrobielle stoffer som PHMB** 19, honning 20, jod 21,22 og sølv 23 Antibiotika 24 Kroppens egne forsøg på at rense sårbunden 25 og lukke såret 19 Formodet biofilm Mikroskopisk billede af biofilm Biofilm ** polyhexamethylenbiguanid Alle billeder bruges med deres respektive ejeres tilladelse.

4 To stærke teknologier, der arbejder de vigtigste barrierer for sårheling. TEKNOLOGI Ag+-teknologi er en unik antibiofilmformulering med et indhold af sølv, som: 26 OPLØSER og nedbryder biofilm, så bakterierne eksponeres* 1-3 DRÆBER et bredt spektrum af bakterier, herunder antibiotikaresistente "superbugs", ved hjælp af sit indhold af sølv* 2,3,27 FORHINDRER gendannelse af biofilm* 2,3 Dokumenteret i laboratorieforsøg I en in vitrobiofilmmodel viste AQUACEL Ag+ Extra bandagen større evne til at ødelægge biofilm og forhindre gendannelse AQUACEL Ag+ Extra (n=5) AQUACEL Ag Extra (n=5) Acticoat 7 (n=5) Genpodning Levedygtige bakterier (cfu) Levedygtige bakterier (cfu) Pseudomonas aeruginosa: 30,000,000,000 3,000,000, ,000,000 30,000,000 3,000, ,000 30,000 3, Ingen påvist Tid (timer) MRSA 30,000,000,000 3,000,000, ,000,000 30,000,000 3,000, ,000 30,000 3, Ingen påvist Opløser biofilm / dræber bakterier Dag 9 Tid (timer) Opløser biofilm / dræber bakterier Forhindrer gendannelse af biofilm Forhindrer gendannelse af biofilm I denne in vitro-model blev færdigudviklet biofilm dyrket på et gazesubstrat og bekræftet ved hjælp af mikroskopi. Gazebiofilmsubstrater blev herefter overført til agarplader for at skabe en simuleret sårbiofilmmodel; biofilmoverfladen blev dækket med bandager, hydreret og dækket med en passende sekundær bandage. Efter inkubation blev bandagens dræbende virkning på biofilmindlejrede bakterier vurderet på forskellige tidspunkter hen over et maksimum af 120 timer. Gendannelsen af biofilm blev også vurderet ved at indpode friske bakterier på gazesubstratet under bandagen efterfulgt af en vurdering af tilstedeværelse eller fravær af biofilm over et maksimum af 96 timer. *Som påvist in vitro

5 synergistisk på at håndtere Hydrofiber -teknologi hjælper med at skabe det ideelle miljø til sårheling og til at få Ag+-teknologien til at virke. BINDER sårvæske, bakterier og biofilm med henblik på at minimere krydsinfektioner og forhindre maceration* 4-7,31,32 FORMER SIG PÅ MIKROPLAN efter sårbunden, opretholder en optimal fugtbalance og fjerner dead space, hvor bakterier og biofilm kan vokse* reagerer på sårets tilstand ved at danne en sammenhængende gel og minimerer samtidig smerterne i forbindelse med bandageskift* Ekstra absorptionskapacitet betyder længere bæretid* Ekstra trækstyrke gør det lettere at fjerne bandagen* 39 AQUACEL Ag+ kavitetsbandage AQUACEL Ag+ Extra bandage *Sammenlignet med standard AQUACEL Ag bandage

6 - supporte Dokumenteret ved videnskabeligt kontrollerede sår. I en tilpasset in vivo-biofilmmodel 19 viste Ag+-teknologi i kombination med Hydrofiber -teknologi:* En signifikant større reduktion af biofilm vs. en PHMB-gaze % større reduktion ved dag 6 (p<0,05) Gennemsnitstal af levedygtige bakterier (cfu/sår)(n=6) 100,000,000 10,000,000 1,000, ,000 10, Behandlingsdage PHMB-gaze AQUACEL Ag+ bandage En signifikant større forekomst af epitelialisering og granulation vs. en PHMB-gaze % mere granulationsvæv ved dag 6 (p<0,05) Granulationsareal (mm 2 ) (n=18) PHMB-gaze AQUACEL Ag+ bandage % mere epitelvæv ved dag 6 (p<0,05) Epitelareal (mm 2 ) (n=18) PHMB-gaze AQUACEL Ag+ bandage *AQUACEL Ag+ bandage blev anvendt i dette studie

7 rer sårheling. Påvist sårheling i klinikken 42 I et prospektivt, ikke-komparativt multicenterstudie med 42 patienter med kroniske, venøse bensår, der var eller risikerede at blive inficeret, og hvor mistanke om biofilm eksisterede, viste Ag+-teknologi i kombination med Hydrofiber -teknologi: * 54 % reduktion af sårarealet for alle sår 70 % reduktion af sårarealet for inficerede sår % reduktion af sårstørrelse UGER AQUACEL Ag+ bandage AQUACEL bandage Alle sår Inficerede sår Dag 1 Dag 28 Dag 49 - helet Dag 1 Dag 22 Dag 56 - helet 10 inficerede sår og 32 sår med risiko for at blive inficeret *AQUACEL Ag+ bandage blev anvendt i dette studie Alle billeder bruges med deres respektive ejeres tilladelse.

8 * As demonstrated in vitro Fig. 1 alone. AQUACEL Ag+ bandager Ingen bandage kan mere. Tilføj AQUACEL Ag+ bandager til jeres behandlingsprotokol for kroniske og akutte sår, der er inficerede eller i risiko for at blive inficeret. 3 dressing MONITOR 1 ASSESS 2MANAGE Protocol of Care for Effective Use Wounds that are infected, or at risk of infection Diabetic foot ulcer showing a sloughy wound bed and presence of localised infection. Evidence of devitalised tissue on the wound bed. Cleanse and debride. Cleanse and debride the wound where necessary to remove barriers to healing, e.g. slough, necrosis, biofilm. Dress. Apply an AQUACEL Ag+ dressing to the wound to disrupt biofilm, kill bacteria, and prevent biofilm reformation* 1,2 whilst managing exudate and infection. Cover with an AQUACEL Foam dressing. Extra or Ribbon (with strengthening fibre) dressing + Adhesive or non-adhesive dressing Stage 4 pressure ulcer with a heavily colonised, sloughy wound bed, and a suspected layer of biofilm (right). Images reproduced with kind permission of R Mathison, Stockport NHS Trust, UK (Fig. 1), D Copson, Nottingham University Hopitals NHS Trust, UK (Fig. 2), D Nelson, Derby Hospitals NHS Foundation Trust (Fig 3&4). Evaluate both the patient and the wound. Reassess and document the wound at each dressing change. Fig. 2 Fig. 3 Fig. 4 Dressing Tips AQUACEL Ag+ Extra dressing should overlap at least 1 cm onto the skin surrounding the wound. For cavity wounds AQUACEL Ag+ Ribbon dressing is recommended. When dressing deep wounds only fill to 80% to allow for dressing expansion on contact with wound fluid. When using AQUACEL Ag+ Ribbon dressing, leave 2.5 cm length of ribbon outside of the cavity to aid removal. The absorbent pad of AQUACEL Foam dressing should overlap the wound by at least 1 cm. If the wound remains infected or at risk of infection continue to use AQUACEL Ag+ Extra or AQUACEL Ag+ Ribbon dressing covered with AQUACEL Foam dressing. Infected leg ulcer which is heavily exuding causing maceration to the surrounding skin. Dull red wound bed with areas of slough. Carry out a holistic patient assessment, e.g. co-morbidities, medication etc. Assess the wound: Wound type. Wound bed appearance (tissue type and %: slough, necrosis, granulation, biofilm). Size (length, width, depth). Exudate (colour, consistency, level). Associated pain and/or odour. Peri-wound skin condition (swelling, discolouration, maceration). Signs and symptoms of infection (pain, odour, heat, redness, swelling, purulence). Cleanse and Debride Tips Irrigate with water or cleanse with an appropriate wound cleanser e.g. Irriclens cleanser. Select the appropriate debridement method according to the wound and patient goals: 3,4 Mechanical, e.g. using gauze or cotton pad. Larval therapy. Ultrasonic, hydrosurgical, sharp, surgical. Minor traumatic injury resulting in chronic ulceration and infection. Dehisced surgical wound with suspected biofilm prior to debridement. Wound post debridement using a curette. For a shallow wound infected or at risk of infection and no longer requiring the use of a primary and secondary dressing combination, use AQUACEL Ag Foam dressing. If an antimicrobial dressing is no longer required, use AQUACEL Extra or AQUACEL Ribbon dressing in combination with AQUACEL Foam dressing, or for a shallow wound, AQUACEL Foam Require specialist skills and equipment. Referral to the appropriate specialist may be required. Refer to product pack insert(s) for complete directions for use. Reference: 1. WHRI3850 MA232: Physical Disruption of Biofilm by AQUACEL Ag+ Wound Dressing Data on file, ConvaTec Inc. 2. WHRI3857 MA236: Antimicrobial Activity and Prevention of Biofilm Reformation by Ag+ EXTRA Data on file, ConvaTec Inc. 3. Effective debridement in a changing NHS: a UK consensus. London: Wounds UK,2013. Available from 4. Vowden K, Vowden P. Debridement Made Easy. Wounds UK. 2011;7(4). Available from TM indicates a trademark of ConvaTec Inc. AQUACEL is a registered trademark of ConvaTec Inc. in the US ConvaTec Inc. AP MM Perfekte partnere: og Størrelse Antal/æske Varenummer AQUACEL Ag+ Extra 5 cm x 5 cm cm x 10 cm cm x 15 cm cm x 30 cm cm x 10 cm cm x 20 cm cm x 30 cm AQUACEL Ag+ kavitetsbandage 2 cm x 45 cm cm x 45 cm Størrelse Antal/æske Varenummer AQUACEL Foam klæbende bandage 8 cm x 8 cm cm x 10 cm ,5 cm x 12,5 cm ,5 cm x 17,5 cm cm x 21 cm cm x 30 cm ,8 cm x 14 cm hæl cm x 16,9 cm sakral cm x 21,5 cm sakral AQUACEL Foam ikke-klæbende bandage 5 cm x 5 cm cm x 10 cm cm x 15 cm cm x 20 cm cm x 20 cm Physical Disruption of Biofilm by AQUACEL Ag+ Wound Dressing. Scientific Background Report. WHRI3850 MA232, 2013, Data on file, ConvaTec Inc. 2. Antimicrobial activity and prevention of biofilm reformation by AQUACEL Ag+ EXTRA dressing. Scientific Background Report. WHRI3857 MA236, 2013, Data on file, ConvaTec Inc. 3. Antimicrobial activity against CA-MRSA and prevention of biofilm reformation by AQUACEL Ag+ EXTRA dressing. Scientific Background Report. WHRI3875 MA239, 2013, Data on file, ConvaTec Inc. 4. Newman GR, Walker M, Hobot JA, Bowler PG, Visualisation of bacterial sequestration and bacterial activity within hydrating Hydrober wound dressings. Biomaterials; 27: Walker M, Hobot JA, Newman GR, Bowler PG, Scanning electron microscopic examination of bacterial immobilization in a carboxymethyl cellulose (AQUACEL ) and alginate dressing. Biomaterials; 24: Bowler PG, Jones SA, Davies BJ, Coyle E, Infection control properties of some wound dressings. J. Wound Care; 8: Walker M, Bowler PG, Cochrane CA, In vitro studies to show sequestration of matrix metalloproteinases by silver-containing wound care products. Ostomy/Wound Management. 2007; 53: Assessment of the in vitro Physical Properties of AQUACEL EXTRA, AQUACEL Ag EXTRA and AQUACEL Ag+ EXTRA dressings. Scientific background report. WHRIA3817 TA297, 2013, Data on file, ConvaTec Inc. 9. Bjarnsholt T, The role of bacterial biofilms in chronic infections. APMIS Research on microbial biofilms. National Institute of Dental and Craniofacial Research. Sept. 9, Marsh PD, Bradshaw DJ, Dental plaque as a biofilm. J. Industr. Microbial; 15: Trautner BW, Darouiche RO, Role of biofilm in catheter-associated urinary tract infection. Am J Infect Control; 32: Elder MJ, Stapleton F, Evans E, Dart JK, Biofilm-related Infections in Ophthalmology. Eye (Lond.) 9: James GA, Swogger E, Wolcott R, Pulcini EL, Secor P, Sestrich J, et al, Biofilms in Chronic Wounds. Wound Rep Regen; 16: Metcalf D, Bowler P, Biofilm delays wound healing: A review of the evidence. Burns & Trauma. 1: Percival SL, Bowler PG, Biofilms and their potential role in wound healing. WOUNDS, 16: Wolcott RD, Rumbaugh KP, James G, Schultz G, Phillips P, Yang O, et al, Biofilm maturity studies indicate sharp debridement opens a time-dependent therapeutic window. J Wound Care; 19: Wolcott RD, Kennedy JP, Dowd SE, Regular debridement is the main tool for maintaining a healthy wound bed in most chronic. J Wound Care; 18: Gurjala AN, Geringer MR, Seth AK, Hong SJ, Smeltzer MS, Galiano RA, et al, Development of a novel, highly quantitative in vivo model for the study of biofilm-impaired cutaneous wound healing. Wound Rep Reg. 19: Brackman G, De Meyer L, Nelis HJ, Coenye T, Biofilm inhibitory and eradicating activity of wound care products against Staphylococcus aureus and Staphylococcus epidermidis biofilms in an in vitro chronic wound model. J Appl Miocrobial; 114: Darouiche RO, Mansouri MD, Gawande PV, Madhyastha S. Antimicrobial and antibiofilm efficacy of triclosan and Dispersin B combination. J Antimicrob Chemother Jul;64(1): Thorn RM, Greenman J. A novel in vitro flat-bed perfusion biofilm model for determining the potential antimicrobial efficacy of topical wound treatments. J Appl Microbiol Dec 1;107(6): Bjarnsholt B, Kirketerp-Moller K, Kristiansen S, Phipps R, Nielsen AK, Jensen Po, et al, Silver against Pseudomonas aeruginosa biofilms. APMIS 115: Stewart PS, Costerton JW, Antibiotic resistance of bacteria in biofilms. Lancet; 358: Thurlow LR, Hanke ML, Fritz T, Angie A, Aldrich A, Williams SH, Engebretsen IL, et al, Staphylococcus aureus biofilms prevent macrophage phago-cytosis and attenuate inflammation in vivo. J Immunol; 186: Composition comprising antimicrobial metal ions and a quaternary cationic surfactant. Scientific Background Report. WO A1, 2012, Data on file, ConvaTec Inc. 27. Bowler PG, Welsby S, Towers V, Booth V, Hogarth A, Rowlands V, Joseph A, et al, Multidrug-resistant organisms, wounds and topical antimicrobial protection. Int Wound J. 9: Antimicrobial activity against CA-MRSA and prevention of biofilm reformation by AQUACEL Ag+ EXTRA Dressing and Acticoat 7 Dressing. Scientific Background Report. WHRI3876 MA240, 2013, Data on file, ConvaTec Inc. 29. Antimicrobial Activity and Prevention of Biofilm Reformation by AQUACEL Ag+ EXTRA Dressing and Acticoat 7 Dressing. WHRI3858 MA237, 2013, Data on file, ConvaTec Inc. 30. Antimicrobial Activity and Prevention of Biofilm Reformation by AQUACEL Ag EXTRA Dressing and Silvercel Non Adherent Dressing. WHRI3877 MA241, 2013, Data on file, ConvaTec Inc. 31. Walker M and Parsons D, Hydrofiber Technology: its role in exudate management. Wounds UK; 6: Parsons D, Bowler PG, Myles V, Jones SA, Silver antimicrobial dressings in wound management: A comparison of antibacterial, physical and chemical characteristics. WOUNDS; 17: Jones SA, Bowler PG, Walker M, Antimicrobial activity of silver-containing dressings is influenced by dressing conformability with a wound surface. WOUNDS; 17: Bowler P, Jones S, Towers V, Booth R, Parsons D, Walker M, Dressing conformability and silver-containing wound dressings. Wounds UK; 6: Walker M, Jones S, Parsons D, Booth R, Cochrane C, Bowler P, Evaluation of low-adherent antimicrobial dressings. Wounds UK; 7: Barnea Y, Armir A, Leshem D, Zaretski A, Weiss J, Shafir R, et al, Clinical comparative study of Aquacel and paraffin gauze dressing for split-skin donor site treatment. Ann Plast Surg; 53: Kogan L, Moldavsky M, Szvalb S, Govrin-Yehudain J, Comparative study of Aquacel and Silverol treatment in burns. Ann Burns Fire Disasters; 17: Brunner U, Eberlein T, Experiences with hydrofibres in the moist treatment of chronic wounds, in particular of diabetic foot. VASA; 29: Assessment of the in vitro physical properties of AQUACEL Ag, AQUACEL Ag EXTRA and AQUACEL Ag+ Dressings, Scientific Background Report. WHRI3817 TA297, 2013, Data on file, ConvaTec Inc. 40. Harding K, Ivans N, Cains J, An opened randomized comparative study to evaluate the clinical and economic performance of two absorbent dressings in venus leg ulcers. Poster presented at EWMA; May ; Copenhagen, Denmark. 41. Parsons D, Mustoe T, Seth A. A new anti-biofilm Hydrofiber dressing: an in vivo investigation. Poster presented at Wounds UK; Nov ; Harrogate, UK. 42. Harding K, Ivans N, Cains J, Peters K, Parsons D. A new anti-biofilm dressing a clinical study. Poster presented at EWMA; May ; Copenhagen, Denmark. ConvaTec Denmark Aps Skinderskovvej 32-36, DK Herlev, Denmark Tlf.: , convatec.danmark@convatec.com AQUACEL, Extra, ConvaTec, ConvaTec-logoet, Hydrofiber og Hydrofiber-logoet er varemærker tilhørende ConvaTec Inc. og er registrerede varemærker i USA. Alle andre varemærker tilhører deres respektive ejere ConvaTec Inc. AP MM