Enhanced Hydro˜ ber Technology Post-Operative Dressing

Prevention is better than cure:The � rst step in the treatment of SurgicalSite Complications is their prevention.

Enhanced Hydro� ber® Technology Post-Operative Dressing

22

Surgical Site ComplicationsAn ongoing problem

Consequences of wound complicationsRecognizing the potential for Surgical Site Infection (SSI) and complications may be the most importantissue to address when discharging a post-surgical patient.6

AQUACEL™ Ag Advantage Surgical post-op dressing could help you, your hospital and your patients reduce...

Despite increasing infection control practices and advanced preventative steps, like ventilation, surgical technique and sterilization methods, post-operative Surgical Site Complications (SSCs) have a huge impact across all surgeries and remain a signi� cant cause of morbidity, prolonged hospitalization and death.1

The best way to treat SSCs is to prevent themAvoiding healthcare-associated conditions such as surgical site infections, medical errors, and other preventable complications are an increasing focus within our health systems.2,3

Increased awareness has contributed to greater scrutiny from regulators, purchasers, and the public.4

In addition, the Centers for Medicare & Medicaid Services (CMS) is placing additional pressure on preventing negative outcomes.5

The right dressingThe right post-op dressing at the right timereduces complication and plays an integral rolein successful recovery.

AQUACEL™ Ag Advantage Surgical 3

Tackling SSI risk factorsSteps can be taken to reduce bacterial colonization, thus minimize the risk of super� cial SSI. AQUACEL™ Ag Advantage Surgical can be an e� ective way to address known risk factor for SSIs and associated complications.

Certain patient factors are known to increase the risk of surgical site complication7

Patient factors are part of 3 core groups of factors that contribute to the risk of SSIs7,8

The role of bio� lm in SSIsBio� lms are microbial communities within a matrixof extracellular polymeric substances (EPS), aimedto protect microorganisms from outside attack such as9

the immune system, antiseptics and antibiotics10 – meaning they’re very di� cult to reduce or remove once in situ.Bio� lm on the surface of the surgical wound may explain why our simple antimicrobials and strategies fail to prevent the wound from dehiscing and delay healing.Data from the studies of marker organisms suggestthat the infecting bacteria are present at the incisionsite at the time of surgery.No current skin preparation regimen will kill all thebacteria on the epidermis nor kill the organisms.11

Wound complications

such as dehiscence

and SSI related complications

Extended length of stay

Patient readmission

Additionalsurgical

intervention

Community nursing times

following discharge

Improved Clinical Outcome

Improved Clinical Cost E� ectiveness

Improved, complication free Patient Recovery and Rehabilitation

Patient Factors

ASA* score

Previous history

of wound breakdown

Skin problems that will impact healing

BMI, obesity or

malnutrition

Comorbidities

Smoking history

Steroids or other

adjunctive therapy

Surgical Procedure

Micro-organisms

Endogenous(≤90% SSIscaused by

patient own skin microbiome)

Operating time

Incisionlocation

Exogenous(surgical team,

tools, environment)

Implant (foreign body)

Biomaterial

Antibiotic Prophylaxis

Antibiotice� cacy reduces

Bacterialadhesion

Bio� lm formation

Bio� lm maturation

Bio� lmdispersal

In 70%-90% of SSI cases, the pathogen source is the native � ora of the patient’s skin.12

4

Challenges of Surgical Wound CareSurgical site complications result in serious medical and � nancial burdens for your hospital and your patients.

SSIs occur across ALL surgical specialties

Rates of surgical site infections (SSI) by type of surgery15

Inpatient SSI Rate Outpatient SSI Rate (Overall SSI rate at top of bars)

12%

2.7%

3.7%

6.4%

1.9%0.5%

2.4%

6.5%

5.5%

1.2%

4.4%

5.6%

2.5%

8.5%

11%

4.5%

6.3%

10.8%

1.9%

3.6%

5.5%4.5%

6.2%

10.7%

OrthopaedicsHernia Repair

Colorectal Surgery

C-Section CABGCardiothoracic Surgery

Appendectomy Vascular Surgery

Patients with SSIs are:

5xmore likely to be

readmitted14

7–11additional days,

hospitalized13

2xas likely to die1

Increased use of antibiotics

and other medications14

The challenges of SSIs:

Number 1:reason for hospital readmission after

surgery.9

~20%of all healthcare-

acquired infectionsin the US.13

$3.5 to $10 billion

in annual healthcare

expenditures.13

of deaths in patients with SSI

are directly attributable

to SSI.13

77%


Impact of Surgical Wound Dehiscence7

In outpatient and community settings, the instance and costsof SWD continue to be signi� cant.Technical issuesFailure, e.g. unravelling of suture knots, poor closure technique.Mechanical stressCoughing can cause suture breakage or incisional rupture. Incisional Mechanical Stress may result in SWD.• Closure over tension – minimal tissue mobilization• Oedema (in� ammatory response to infection)• Incisional haematoma or seroma15

• External traumaDisrupted healingComorbidities or treatments impacting healing, or as a result of a SSI.

SSI can be a cause, of and a risk factor, for SWD7

If we can’t solve the problem of bio� lms with antibiotics, we need an earlier intervention to reduce bioburden.

The dangers of the patient's own skin 80% of SSIs (S. aureus) originate from the patients' own � ora16-18. Prophylactic reduction of this bioburden can reduce risk of associated surgical wound complications such as SSIs and SWD. (Image: polymicrobes located on skin)

SSI

Incisional hernia SWD

Delayed healingPoor quality/

abnormal scarringNegative patient

outcomes

• Seroma • Haematoma • Blistering

TECHNICALISSUES

MECHANICALISSUES

SSSSSSSSSSURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALURGICALWOUNWOUNWOUNWOUNWOUNWOUNWOUNWOUNWOUNWOUNWOUNWOUNWOUNWOUNWOUNWOUNWOUNWOUNWOUNWOUNWOUND

DEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCEDEHISCENCE

DISRUPTEDHEALING

66

ImprovedAntimicrobial

E� cacy

ClinicalHeritage

Improve Costs &

E� ciency

Why you need AQUACEL™

Ag Advantage Surgical Building on the AQUACEL™ Ag Surgical platform is a next generation post-op dressing.AQUACEL™ Ag Advantage Surgical, powered by MORE THAN SILVER™ Technology, is a unique antimicrobial formula which enhances the power of ionic silver.

Protect your patientsEnhance patient satisfaction and comfort through:• Easier self-care• Less pain at removal19

• Less frequent need for dressing changes20

• Shower immediately after a procedure, if directed by their healthcare practitioner


ImproveQuality of Life

PromoteHealing

OcclusiveBarrier

Your post-op dressing selection can be the di� erence between healthy healing and an infected surgical site.8

AQUACEL™ AgAdvantage Surgical with

MORE THAN SILVER™ Hydrocolliod

Adhesive

Hydro� ber®

TechnologyWound Contact

Layer

PolyurethaneFilm

MORE THAN SILVER™ Technology provides:• Reduction of bacteria21

• Broad spectrum e� cacy22-24

• Sustained antimicrobial activity against SSI causing pathogens22-24

Clinically Proven and Trusted:• Reduced SSI19,25

• Reduced PJI26,27

• Reduced blistering20,28

• Reduced costs8,19-21,23-31

• Improved patient satisfaction8,19-21,23-31

• Improved wear time8,19-21,23-31

• E� ective total � uid management reducing dressing changes vs Standard Of Care28

• Durable and reliable hydrocolloid adhesive30

• Reduced nursing time28

• Hydrocolloid moves with the skin – matches the range of motion of the joint38

• Aids in patient rehabilitation regime protocol• Reduces risk of dehiscence through design• Minimizes peri-wound blistering and allows

patients to undergo physiotherapy programs to aid recovery

• Extends along the incision line to reduce the risk of dehiscence and aid skin movement

• Hydro� ber® Technology locks in bacteria, micro-contours and gels creating a moist wound environment for healing

• Proven to optimize healing environment39,40

• Clinically proven wound interface for over 20 years

• Exudate is managed through vertical wicking which enables monitoring of the incision

• Bacterial, viral and waterproof construct• Polyurethane � lm is bacterial-proof,

viral-proof and water-proof which prevents contamination and improves patient satisfaction

Protect the incision siteOptimum management of the incision environment promotes healing with fewer complications.• Managing bacterial balance is essential for

decreasing SSI risk and SWD.• Prophylactic antibiotics can e� ectively decrease

bacterial load and infection risk. However, they need to be used responsibly against the rise of antibiotic-resistant bacteria such as MRSA and VISA/VRSA.

Preventing bacteria from entering and critically32-36

colonizing incision tissue in the � rst instance is key. This is where advanced wound products have an advantage over wet gauze dressings, which don’t prevent bacterial penetration of the wound as well.37

Gelled Hydro� ber® Technology

Wound bed

Fibrin layer

AQUACEL™ Surgical portfolio applied to the simulated wound surface

AQUACEL™ Surgical portfolio forms an intimate contact with the simulated wound surface and around staples, limiting spaces where bacteria thrive

Gelling commences as AQUACEL™ Surgical portfolio absorbs exudate

Image of S. Aureus trapped withinthe gelled Hydro� ber® Technology

8

AQUACEL™ Ag Advantage Surgical has a critical di� erence: The Hydro� ber® Di� erence.Hydro� ber® Technology is an interactive wound contact layer specially engineered to optimize moist wound healing, which is combined with MORE THAN SILVER™ Technology.

Locks inwound exudate and traps bacteria39,41-45

Contoursto the wound bed which

reduces dead spacebetween the dressing

and the incision46-48

Respondsto wound conditions by forming cohesive gel49-51

Extendsalong the incision line

during movement

Mode of Action Technology Feature Clinical Bene� t

Fast GellingContours and responds

Swells into available spaces45,46,52 • Reduced risk of infection10,54

• Moist wound healing42,55

• Reduced risk of maceration27,56

• Less pain in-situ40,49,50,57,58

• Non-traumatic removal40,56,59-63

Removes free � uid1,2

Resists wicking � uid45,52

Non-adherent in gelled form52-55

Retentive GelLocks in

Locks in � uid45,52• Reduced risk of infection42,43,50,55

• Reduced risk of maceration56,63

• Removal of in� ammatory agents55,57Traps enzymes39

Traps bacteria39,41-43,53


AQUACEL™ Ag Advantage Surgical o� ers more than other post-op dressings

Engineered to reduce bioburden In-vitro studies show Hydro� ber®

Technology dressings retain 68%-70% of S. aureus and P. aeruginosa through sequestration42. As the � bers gel, they lock in wound � uid and bacteria, which can reduce the risk of SSCs.

Proven to support the healing processHydro� ber® Technology speci� c mode of action is proven to bene� t healing.The physical properties of Hydro� ber® Technology help change the in� ammatory reaction, resulting in a much more gentle healing process without excess in� ammation. The separation of cells necessary for defense (granulocytes) and for repair (macrophages) is crucial for improving the quality of the wound-healing process and scar formation.

When Hydro� ber® Technologyis used, a layer of � brin builds up between the dressing and the wound, but � brin absorption by the dressing is minimal. Therefore,tissue ingrowth does not occur, resulting in pain free removal and greater patient satisfaction.

Hydro� ber® Technology is proven to demonstrate limiting levels of in� ammation, which improves the healing process, resulting in good scar quality.57

Hydro� ber® Technology makes up the wound contact layer within AQUACEL™ Ag Advantage Surgical

Not all post-op dressings are created equal-get the post-op Advantage

10

Stopping SSIs at the source Did you know?Polymicrobial bio� lms are found to be presentin surgical incision wounds within 4-6 hours.Antibiotics alone will rarely be successful against bio� lms – in the US, 39-51% of SSI pathogens are resistant to standard prophylactic antibiotics3.Surgical antiseptics such as skin preparation solution have been shown to disrupt bio� lm on obese patients pre-op rather than reduce bioburden. Bio� lm can be present at the time of incision, especially for obese patients.73

Type of surgery 74 Common pathogenscausing SSIs

Placement of graft, prothesis or implant Staphylococcis aureus; CoNS

Cardiac S. aureus; CoNS

Neurosurgery S. aureus; CoNS

Breast S. aureus; CoNS

Ophthalmic S. aureus; CoNS; streptococci; Gram-negative bacilli

Orthopedic S. aureus; CoNS; Gram-negative bacilli

Non-cardiothoracic S. aureus; CoNS; streptococci; pneumoniae; Gram-negative bacilli

Vascular S. aureus; CoNS

Appendectomy Gram-negative bacilli; anaerobes

Biliary tract Gram-negative bacilli; anaerobes

Colorectal Gram-negative bacilli; anaerobes

GastroduodenalGram-negative bacilli; streptococci; oropharyngeal anaerobes (e.g. peptostreptococci)

Head and neckS. aureus; CoNS; streptococci; oropharyngeal anaerobes (e.g. peptostreptococci)

Obstetric and gynaecological S. aureus; CoNS; enterococci; Group B streptococci; anaerobes

Urological Gram-negative bacilli

a CoNS, coagulase-negative staphylococci.

The antimicrobial power of MORE THAN SILVER™ Technology

1. BEC: A surfactant 2. EDTA: Metal chelating agent 3. Ionic Silver

• BEC reduces the surface tension and enhances the action of EDTA.

• BEC and EDTA work together to aid the absorption and removal of bioburden by the dressing.64-68

• Chelating agents are compounds that strongly attract and bind certain metal ions.

• Metal ions hold together the protective layers within the bioburden.

• By binding to these metals, EDTA weakens the bioburden structures allowing for a more e� cient delivery of ionic silver.31,65,66,68-70

Silver is a safe, broad-spectrum antimicrobial that is only e� ective in its ionic form. Attracted to sites on bacterial cell walls, it accumulates and then enters the cell, where it:

• Damages the DNA

• Denatures proteins and enzymes,

• Interferes with protein synthesis 71,72

E� ective against SSI-associated pathogens

AQUACEL™ Ag Advantage Surgical is highly e� ective against the most common SSI-associated pathogens, including:

Staphylococcus aureus (S. aureus) Methicillin-resistant S. epidermidis (MRSE)Methicillin-resistant S. aureus (MRSA) Escherichia coli (E. coli)

Staphylococcus epidermidis (S. epidermidis) EnterbacteriacaeKlebsiella pneumoniae (K. pneumoniae)

Developed to reduce bioburden, MORE THAN SILVER™ Technology is a unique formulation of three components.21


Proven – AQUACEL™ Ag Advantage Surgical with MORE THAN SILVER™ Technologyenables a faster reduction in SSI causing bacteria when compared to just ionic silver.76

Support antibiotic stewardship One-third of antibiotic prescriptions in hospitals involve potential prescribing errors such as giving an antibiotic without proper testing or evaluation, prescribing an antibiotic when it is not needed, or giving an antibiotic for too long.75

Staples and sutures – lower the infective thresholdStudies show that sutures and staples can decrease the dose of bacteria necessary to cause an SSI, from >100,000 per gram of tissue to 100 per gram of tissue.61

Bio� lm formation increases the di� culty of treatingan infection, even in the presence of antibiotics

Comparative Time to Eradication> 6 log reduction (limit of detection - 40cfu/mL)

Exposure Time (hours)

0 24 48 72 96 120 144 168 192

Gram +ve

Community-associated Methicillin Resistant Staphyloccocus aureus (CA-MRSA) USA300

Vancomycin Resistant Enterococcus faecalis (VRE) (NCTC 12201)

Staphylococcus epidermidis (NCTC 11047)

Streptococcus pyogenes (NCTC 10872)

Gram -ve

Pseudomonas aeruginosa (NCTC 8506) (streptomycin and cephalosporin resistant)

Klebsiella pneumoniae blaCTX-M group 25 gene (ESBL) (NCTC13465)

Carbapenem-resistant Klebsiella pneumoniae (NCTC13439)

Acinetobacter baumannii (NCTC 13421) Sequence Type 2

Escherichia coli (NCIMB 10544)

Carbapenem-resistant Escherichia coli (NCTC 13919)

Fungi

Fluconazole resistant Candida krusei (NCPF 3876)

AQUACEL™ Ag SurgicalAQUACEL™ Ag Advantage Surgical

AQUACEL™ Ag Advantage Surgical post-op dressings reduces the risk of surgical site complications and supports existing

SSC reduction care prevention measures.

Carbapenem-resistant Enterobacteriaceae Bio� lm of antibiotic resistant bacteria Bacteria Staphylococcus aureus

They work synergistically to enhance the antimicrobial e� cacy of ionic silver for: • Faster reduction of bacteria21

• Broad spectrum e� cacy23,24,31

• Sustained antimicrobial activity23,24,31

12

The design of a dressing plays an important role in patient outcomes. Especially regarding reducing risk of delicate incisions from mechanical strain.AQUACEL™ Ag Advantage Surgical is engineered to reinforce the tissues and closure mechanism more than other dressings, to achieve a balance between longitudinal extension and mediolateral extension. This reduces the risk of mechanical force-induced SWD in linear incisions.Highly conformable to the incision area, AQUACEL™ Ag Advantage Surgical also helps reduce the rate of blistering, especially over mobile areas of high tension (e.g. abdomen) and mobility (e.g. joints).

Your post-op dressing choice can reduce blistering AND reduce surgical wound dehiscence - reduced risk through engineered design77

Engineered to reduce riskmechanical force - related SWD

12

PROVEN combination of Hydrocolliod adhesive and Hydro� ber® Technology wound contact layer results in a post-op dressing engineered to reduce

the rate of blistering and surgical wound dehiscence


In-vitro studies have shown that AQUACEL™ Ag Surgical o� ers distinct advantages over other silver-impregnated dressings. The Hydro� ber® Technology locks in wound exudate and safely removes it from the wound bed and surrounding area.45,52 This protects those surfaces from potential maceration.56,63

Hydro� ber® Technology transforms into a clear, soft gel once it absorbs � uid, allowing it to micro-contour to the wound bed and � ll space where bacteria can proliferate.45,46,52,55,57,59-62 This gelling feature also allows AQUACEL™ Ag Advantage Surgical to respond e� ectively to di� erent wound conditions, maintaining a favorable wound-healing environment and providing increased silver ion availability “on demand (AQUACEL™ Ag Advantage Surgical).”

Competitor review

0.00AQUACEL™ Ag

SCD

Exte

nsib

ility

(N/c

m)

Mepilex Border Post-Op

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.80

Conformability across the length of dressing

1.45 1.54

Reduces the risk of SWD through design

Examples of SWD rates7

Surgical domain Incidence

Laparotomy 0.4%–3.8%

Cardiothoracic (sternotomy) 0.65%–2.1%

Orthopaedic surgery 1.1%–3.6%

Caesarean section 1.9%–7.6%

Oncoplastic breast reconstruction 4.6%–13.3%

Saphous vein harvesting 8.9%

Pilonidal sinus (primary closure) 16.9%–41.8%

Abdominoplasty following bariatric surgery 18.7%–21.5%

Tissue strength during healing7

Time after incision % of pre–incision breaking strength

1 week 3

2 weeks 30

3 months 80Ex

tens

ibili

ty (N

/cm

)

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

Conformability across the width of dressing

3.0

6.9

AQUACEL™ Ag SCD

Mepilex Border Post-Op

0.0

6.96.9

57% protection

Against the competition

AQUACEL™ Ag AdvantageSurgical

Mepilex®Border Post-Op Ag

Silverlon®

Antimicrobial Island Dressing

Acticoat® 7 Dermabond Prineo

Silver-impregnated

Sustains antimicrobial activity for up to 7 days

Sustains microbial barrier for 72 hours

Waterproof

Fully occlusive

Hydro� ber® Technology

Micro-contours to wound bed, locking in � uid and sequestering bacteria

Responds to changing wound conditions by forming a cohesive gel

Hydrocolloid adhesive manages moisture from skin transpiration

Protection against mechanical induced SWD duringweek 1 is a key consideration when trying to reduceSWD incidence across a variety of surgical procedures.

14

The clinical evidenceProven to help surgeons treat their patients betterOver the past 20 years, more than 30 randomized trials have been conducted, and 365 pieces of evidence have been collated to demonstrate the bene� ts of Hydro� ber® Technology family of surgical dressings. Research indicates that AQUACEL™ Ag Advantage Surgical dressing plays an important role in reducing the Surgical Site Complications, optimizing healing and improving post-op patient outcomes.

14

Reduce complications and improve outcomes

No.

of p

atie

nts

200

400

600

800

1000

1200

1400

1600

2000

1800

2200

2400

1778

1173

240

711

230262

A. G.B. H.C. I.D. J.E. K.F. L.0

100124166 40

428

Key

Author

Therapy area Key � ndings

A.

Cai et al, 201426

– Ortho - TJA

4x decrease in acute PJI

B.

Grosso et al, 201727

– Ortho - TKA

4x decrease in acute PJI speciality

C.

Clarke et al, 200978

– Ortho - TJA

3x decrease in SSI

9x decrease in blistering

Increase in wear time

D.

Springer et al, 201520

– Ortho - TJA

8x decrease in blistering reduction in dressing changes

E.

Kuo et al, 201719

– Ortho - TKA

10x decrease in SSI

Wear time increased from 1.7 to 5.2 days

Decreased pain

F.

Burke et al, 201279

– Ortho - TJA

73% reduction in blistering

Reduction in dressing changes

3x reduction in dressing leakage

Key

Author

Therapy area Key � ndings

G.

Hopper et al, 201228

– Ortho - TJA

80% reduction in blister rate

Increased wear time

Reduced number ofdressing changes

Quicker discharge rate

H.

Gregson, 201180

– Obs & gynae - C section

Reduction in SSI rate by 3.3% – 3.8%

Further reductionby 1.3% with use of AQUACEL™ Surgical in addition to NICE guidelines implementation

I.

Schubach et al, 201529

– Cardiac

No wound infections

J.

Struik et al, 201825

– Breast reconstruction

6x lower rate of SSI

K.

Siah and Yatim, 2011 81

– Colorectal / Abdominal

Reduction in mean length of hospital stay

Reduction in colonization of swab culture

L.

Bocchiotti et al, 201630

– Plastics - thigh lifts

Less traumatic to remove

Easier to apply

Improved adherence

A-F = AQUACELTM Ag Surgical

2382


OrthoCarolina comparative dressing study of patients undergoing TKA5

150 total knee arthroplasty patients at the OrthoCarolina Hip & Knee Center were randomized to receive either the AQUACEL™ Ag Surgical dressing or a standard surgical dressing.*

Rate

of F

requ

ency

(%)

2

4

6

8

Frequency of Skin Blisters

p=0.15

6%

1%StandardDressing*

AQUACELTM AgSurgical Dressing

0

83% reduction

Num

ber o

f Dre

ssin

g C

hang

es

1

2

3

4

Number of Dressing Changes

p<0.001

2.8

.17

StandardDressing*


0

94% reduction

Hyg

iene

Sat

isfac

tion

Scor

e

80

85

90

95

100

Patient Hygiene Satisfaction

p<0.002

StandardDressing*


75

10% increase

85.5

94.9

2nd International Consensus on Periprosthetic Joint Infection. Philadelphia, 2018.82

81%of delegates agree

silver dressings helpprevent Surgical Site

Infection82

Silver-based dressings have been proven time and again to reduce wound complication, SSI and PJI compared with standard gauze. They should therefore be considered for routine use after surgery.

3 out of 4 clinical studies that support silver dressings were conducted with AQUACEL™ Ag Surgical.

Silver helps prevent Surgical Site Infections

890 delegates from 98 countries represented 200+ societies with 98 presidents reviewed clinically important topics and research to provide published consensus.

Rothman Institute comparative dressing study of patients undergoing TJA4

A retrospective study of 1778 patients was conducted at the Rothman Institute by performing chart reviews to compare the overall incidence of Periprosthetic Joint Infection in 2 groups of patients who had undergone Total Joint Arthroplasty (TJA).903 patients who received the AQUACEL™ Ag Surgical dressing were compared to 875 patients who received the standard dressing.*

Rate

of I

nfec

tion

(%)

1.0

2.0

3.0

Incidence of Acute PJI

p=0.005

1.7%

0.4%0.4%0.4%StandardDressing*


0.00

76% reduction

* The standard dressing consisted of sterile gauze secured with adhesive tape

* The standard surgical dressing used was Primapore, Smith and Nephew, Memphis, TN.

16

Indication guideChoosing the right dressing

AQUACEL™ Ag Advantage Surgical is indicated for managing surgical incisions resulting from a vast variety of surgical procedures.

From orthopedic surgery to C-sections, vascular surgery to cardiothoracic surgery and more, you can rely upon AQUACEL™ Ag Advantage Surgical to manage bacteria, minimize the risk of infection, and create an optimal healing environment.


Application & removal guideSimple steps for e� ective incision treatment

Choosing the right surgical dressing

Cardiac Implantable Devices Sternum Vein Harvesting

Shoulder Spine Hip Fracture

Abdomen Caesarean Section Hip

It is simple, quick, and painless to apply and remove AQUACEL™ Ag Advantage Surgical.Just follow the steps below:

Application1. Remove the large backing � lm (leaving the

secondary � lm in place). Avoid � nger contact with the pad and adhesive.

2. Remove half of the remaining backing, and place the dressing directly over the incision line, making sure the adhesive does not come into contact with the incision line. Do not stretch the dressing.

3. Mould the dressing into place to secure adhesion.

Removal1. Press down on the skin with one hand and

carefully lift an edge of the dressing with your other hand.

2. Stretch the dressing to break the adhesive seal and remove.

Key points to note

The dressing can be left in place for up to seven days subject to regular clinical assessment and local dressing protocol.

The translucent hydrocolloid backing

allows monitoring of the Hydro� ber®

Technology pad.

The dressing will absorb some blood and � uid

initially post-operation. The dressing will require changing.

Remove the dressing when clinically indicated

(leakage, excessive bleeding, suspicion of infection, or at

seven days).

7DAYS

18

ConvaTec Surgical SolutionsMeeting the needs of our surgeons and their patients.

References

1. Centers for Disease Control and Prevention (CDC). Surgical Site Infection (SSI) Event: Procedure-associated Module [Internet]. CDC; 2020 [cited 2020 Feb 26]. Available from: www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. 2. Thompson KM, Oldenburg WA, Deschamps C, Rupp WC, Smith CD. Chasing zero: The drive to eliminate surgical site infections. Ann Surg. 2011;254:430-7. 3. Anderson DJ, Kirkland KB, Kaye KS, Thacker PA 2nd, Kanafani ZA, Auten G, et al. Underresourced hospital infection control and prevention programs: penny wise, pound foolish? Infect Control Hosp Epidemiol. 2007 Jul;28(7):767-73. 4. American College of Healthcare Executives. The healthcare executive’s role in ensuring quality and patient safety [Internet]. ACHE; 2017 [cited 2020 Feb 26]. Available from: https://www.ache.org/about-ache/our-story/our-commitments/policy-statements/healthcare-executives-role-in-ensuring-quality-and-safety. 5. Centers for Disease Control and Prevention. The Role of Policy in HAI Reporting and Prevention. CDC; [cited 2019 Jan 31]. Available from: https://www.cdc.gov/hai/pdfs/toolkits/hai-policy-case-studieslesssons-learned.pdf.3814_ 6. Orsted HL, McNaughton V, Whitehead C, Krasner DL, Rodeheaver GT, Sibbald RG. Management and care of clients with surgical wounds in the community. Chronic Wound Care (4th edition). 2007:701–10. 7. World Union of Wound Healing Societies (WUWHS) Consensus Document. Closed surgical incision management: understanding the role of NPWT. Wounds International, 2016. 8. National Institute for Health and Clinical Excellence (NICE). Surgical Site Infection:Evidence Update June 2013. Available from: www.nice.org.uk/guidance/cg74/evidence/evidenceupdate-241969645. 9. Merkow RP, Ju MH, Chung JW, Hall BL, Cohen ME, Williams MV, et al. Underlying reasons associated with hospital readmission following surgery in the United States. JAMA. 2015 Feb 3;313(5):483-495. 10. Costerton JW, Stewart PS, Greenberg EP. Bacterial bio� lms: a common cause of persistent infections. Science. 1999 May 21;284(5418):1318-22. 11. Oliver JD. Recent _ ndings on the viable but nonculturable state in pathogenic bacteria. FEMS Microbiol. 2010 Jul;34(4):415-25. 12. Wenzel RP. Surgical site infections and the microbiome: An updated perspective. Infect Control Hosp Epidemiol. 2019 May;40(5):590-596. 13. Anderson DJ, Podgorny K, Berrios-Torres SI, Bratzler DW, Dellinger EP, Greene L, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014 Jun;35(6):605-27. 14. de Lissovoy G, Fraeman K, Hutchins V, Murphy D, Song D, Vaughn BB. Surgical site infection: incidence and impact on hospital utilization and treatment costs. Am J Infect Control. 2009 Jun;37(5):387–97. 15. Woelber E, Schrick EJ, Gessner BD, Evans HL. Proportion of Surgical Site Infections Occurring after Hospital Discharge: A Systematic Review. Surg Infect (Larchmt). 2016 Oct;17(5):510-9.16.Kluytmans JA, Mouton JW, Ijzerman EP, Vandenbroucke-Grauls CM, Maat AW, Wagenvoort JH, et al. Nasal carriage of Staphylococcus aureus as a major risk factor for wound infections after cardiac surgery. J Infect Dis. 1995 Jan;171(1):216-9. 17. von Ei_ C, Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. New Engl J Med. 2001 Jan 4;344(1):11-6. 18. Wertheim HF, Vos MC, Ott A, van Belkum A, Voss A, Kluytmans JA, et al. Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers. Lancet. 2004 Aug;364(9435):703-5. 19. Kuo FC, Chen B, Lee MS, Yen SH, Wang JW. AQUACEL® Ag Surgical Dressing Reduces Surgical Site Infection and Improves Patient Satisfaction in Minimally Invasive Total Knee Arthroplasty: A Prospective, Randomized, Controlled Study. Biomed Res Int. 2017;2017:1262108. 20. Springer BD, Beaver WB, Gri_ n WL, Mason JB, Odum SM. Role of Surgical Dressings in Total Joint Arthroplasty: A Randomized Controlled Trial. Am J Orthop (Belle Mead NJ). 2015 Sep;44(9):415-20. 21. Bowler PG, Parsons D. Combatting wound bio_ lm and recalcitrance with a novel anti-bio� lm Hydro� ber® wound dressing. Wound Medicine. 2016;14:6–11. 22. Jenks PJ, Laurent M, McQuarry S, Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted � nancial consequences of elimination of SSI from an English hospital. J Hosp Infect. 2014 Jan;86(1):24-33. 23. Antimicrobial activity and prevention of bio_ lm reformation by AQUACELR Ag+ Extra™ dressing. Scienti� c Background Report. WHRI3857 MA236, 2013, Data on _ le, ConvaTec Inc. 24. Antimicrobial activity against CA-MRSA and prevention of bio_ lm reformation by AQUACELR Ag+ Extra™ dressing.Scienti� c Background Report. WHRI3875 MA239, 2013, Data on _ le, ConvaTec Inc. 25. Struik GM, Vrijland WW, Birnie E, Klem TMAL. A randomized controlled trial on the e_ ect of a silver carboxymethylcellulose dressing on surgical site infections after breast cancer surgery. PLoS One. 2018 May 23;13(5):e0195715. 26. Cai J, Karam JA, Parvizi J, Smith EB, Sharkey PF. Aquacel surgical dressing reduces the rate of acute PJI following total joint arthroplasty: a case-control study. J Arthroplasty. 2014 Jun;29(6):1098-100. 27. Grosso MJ, Berg A, LaRussa S, Murtaugh T, Trofa DP, Geller JA. Silver-Impregnated Occlusive Dressing Reduces Rates of Acute Periprosthetic Joint Infection After Total Joint Arthroplasty. J Arthroplasty. 2017 Mar; 32(3):929-932. 28. Hopper GP, Deakin AH, Crane EO, Clarke JV. Enhancing patient recovery following lower limb arthroplasty with a modern wound dressing: a prospective, comparative audit. J Wound Care. 2012 Apr; 21(4):200-3. 29. Schubach S., a.M.J. Aquacel Ag dressing reduces deep sternal wound infection after cardiac surgery. in International Society for Minimally Invasive Cardiac Surgery. 2015. Lippincott Williams andWilkins. 30. Bocchiotti MA, Baglioni EA, Spaziante L, Frenello A, Ruka E. Aquacel Surgical Dressing after Thigh Lift: A Case-Control Study. Plast Reconstr Surg Glob Open. 2016 Sep;4(9):e863.31. Parsons, D. Composition comprising antimicrobial metal ions and a quaternary cationic surfactant [Internet]. World Intellectual Property Organisation; 2012 Oct [cited 2020 Feb 27]. Available from: https://patentimages.storage.googleapis.com/3e/76/a9/bdb48938fa0afe/WO2012136968A1.pdf. 32. Okan D, Woo K, Ayello EA, Sibbald G. The role of moisture balance in wound healing. Adv Skin Wound Care. 2007 Jan;20(1):39–53. 33. Sibbald RG, Orsted HL, Coutts PM, Keast DH. Best practice recommendations for preparing the wound bed update 2006. Adv Skin Wound Care. 2007 Jul;20(7):390–405. 34. Sibbald RG, Orsted HL, Schultz GS, Coutts P, Keast D. Preparing the wound bed 2003: focus on infection and in_ ammation. Ostomy Wound Manage. 2003 Nov;49(11): 24–51. 35. Gray M, Black JM, Baharestani MM, Bliss DZ, Colwell JC, Goldberg M, et al. Moisture associated skin damage: overview and pathophysiology. J Wound Ostomy Continence Nurs. 2011 May-Jun;38(3):233–41. 36. Sibbald RG, Williamson D, Orsted HL, Campbell K, Keast D, Krasner D, et al. Preparing the wound bed – debridement, bacterial balance, and moisture balance. Ostomy Wound Manage. 2000 Nov;46(11):14–22. 37. Ovington LG. Hanging wet-to-dry dressings out to dry. Home Healthc Nurse. 2001 Aug;19(8):477-83. 38. Dillon JM, Clarke JV, Deakin AH, Nicol AC, Kinninmonth AWG. Correlation of total knee replacement wound dynamic morphology and dressing material properties. Journal of Biomechanics. 2007;40(Supp 2):S61. 39. Walker M, Bowler PG, Cochrane CA. In-vitro studies to show sequestration of matrix metalloproteinases by silver-containing wound care products. Ostomy Wound Manage. 2007 Sep;53(9):18–25. 40. Armstrong SH, Brown DA, Hill E, Ruckley CV. A randomized trial of a new Hydro_ ber dressing, AQUACEL, and an alginate in the treatment of exuding leg ulcers. Presented at: 5th European Conference on Advances in Wound Management; Harrogate, UK: November 1995. 41. Newman GR, Walker M, Hobot JA, Bowler PG. Visualization of bacterial sequestration and bactericidal activity within hydrating Hydro_ ber™ wound dressings. Biomaterials. 2006 Mar; 27(7):1129-39. 42. Walker M, Hobot JA, Newman GR, Bowler PG. Scanning electron microscopic examination of bacterial immobilisation in a carboxymethyl cellulose (AQUACEL™) and alginate dressings. Biomaterials. 2003 Feb;24(5):883-90. 43. Bowler PG, Jones SA, Davies BJ, Coyle E. Infection control properties of some wound dressings. J Wound Care. 1999 Nov;8(10): 499-502. 44. Walker M, Parsons D. Hydro_ ber Technology: its role in exudate management. Wounds UK. 2010;6(2):31-38. 45. Parsons D, Bowler PG, Myles V, Jones SA. Silver antimicrobial dressings in wound management: A comparison of antibacterial, physical and chemical characteristics. WOUNDS. 2005;17(8): 222-32. 46. Jones SA, Bowler PG, Walker M. Antimicrobial activity of silver-containing dressings is in_ uenced by dressing conformability with a wound surface. WOUNDS. 2005;17(9):263-70. 47. Bowler P, Jones S, Towers V, Booth R, Parsons D, Walker M. Dressing conformability and silver-containing wound dressings. Wounds UK. 2010;6(2):14-20. 48. Walker M, Jones S, Parsons D, Booth R, Cochrane C, Bowler P. Evaluation of low-adherent antimicrobial dressings. Wounds UK. 2011;7(2):32-45. 49. Barnea Y, Armir A, Leshem D, Zaretski A, Weiss J, Sha_ r R, et al. Clinical comparative study of Aquacel and para_ n gauze dressing for split-skin donor site treatment. Ann Plast Surg. 2004 Aug;53(2): 132-6. 50. Kogan L, Moldavsky M, Szvalb S, Govrin-Yehudain J. Comparative study of AQUACEL® and Silverol treatment in burns. Ann Burns Fire Disasters. 2004;17(4):201-7. 51. Brunner U, Eberlein T. Experiences with hydro� bers in the moist treatment of chronic wounds, in particular of diabetic foot. VASA. 2000 Nov;29(4):253-7. 52. Waring MJ, Parsons D. Physicochemical characterisation of carboxymethylated spun cellulose bres. Biomaterials. 2001 May;22(9):903–12. 53. Tachi M, Hirabayashi S, Yonehara Y, Suzuki Y, Bowler PG. Comparison of bacteria-retaining ability of absorbent wound dressings. Int Wound J. 2004 Sep;1(3):177–81. 54. World Health Organization. WHO Guidelines for Safe Surgery [Internet]. WHO; 2009 [cited 2020 Feb 27]. Available from: https://apps.who.int/iris/bitstream/handle/10665/44185/9789241598552_eng.pdf?sequence=1. 55. Richters CD, DuPont JS, Mayen L, Kamperdijk EWA, Dutriex PR, Kreis RW, et al. E_ ects of a Hydro� ber dressing on in_ ammatory cells in rat partial-thickness wounds. WOUNDS. 2004 Feb;16(2):63–70. 56. Coutts P, Sibbald RG. The e_ ect of a silver-containing Hydro_ ber dressing on super� cial wound bed and bacterial balance of chronic wounds. Int Wound J.2005 Dec;2(4):348–56. 57. Hoeskstra MJ, Hermans MHE, Richters CD, Dutrieux RP. A histological comparison of acute in� ammatory responses with a Hydro_ ber or tulle gauze dressing. J Wound Care. 2002 Mar;11(3):113–7. 58. Caruso DM, Foster KN, Blome-Eberwein SA, Twomey JA, Herndon DN, Luterman A, et al. Randomized clinical study of Hydro_ ber dressing with silver or silversulfadiazine in the management of partial-thickness burns. J Burn Care Res. 2006 May-Jun;27(3):298–309. 59. Kwon Lee S. Clinical experiences with technologies: case reports on the use of two Hydro_ ber™ dressings. Ostomy Wound Manage. 2003;49 Suppl 8:6-9. 60. Jurczak F, Dugre T, Johnstone A, O_ ori T, Vujovic Z, Hollander D. Randomised clinical trial of Hydro_ ber dressing with silver versus povidone-iodine gauze in the management of open surgical and traumatic wounds. Int Wound J. 2007 Mar;4(1):66–76. 61. Harding KG, Price P, Robinson B, Thomas S, Hofman D. Cost and dressing evaluation of Hydro_ ber and alginate dressings in the management of community-based patients with chronic leg ulceration. WOUNDS. 2001 Dec;13(6):229–36. 62. Vanscheidt W, Lazareth I, Routkovsky-Norval C. Safety evaluation of a new ionic silver dressing in the management of chronic ulcers. WOUNDS. 2003 Nov;15(12):371–8. 63. Robinson BJ. The use of a hydro_ ber dressing in wound management. J Wound Care. 2000 Jan;9(1):32–4. 64. Bowler PG, Welsby S, Towers V, Booth V, Hogarth A, Rowlands V, Joseph A, et al, 2012. Multidrug-resistant organisms, wounds and topical antimicrobial protection. Int Wound J. 9: 387-396. 65. Banin E., Brady K.M. & Greenberg E.P. (2006). Chelator-Induced Dispersal and Killing of Pseudomonas aeruginosa Cells in Bio� lm. Appl. Environ. Microbiol. 72. 2064-2069. 66. Chen X, Stewart PS, 2000. Bio� lm removal caused by chemical treatments. Wat. Res.,34: 4229-4233 37. Seth AK, Zhong A, Nguyen KT, Hong. 67. SJ, Leung KP, Galiano RD, Mustoe TA. Impact of a novel, antimicrobial dressing on in vivo, Pseudomonas aeruginosa wound bio� lm: quantitative comparative analysis using a rabbit ear model. Wound Repair Regen.2014; 22: 712–719. DOI:10.1111/wrr.122. 68. Said J, Walker M, Parsons D, Stapleton P, Beezer AE, Gaisford S. An in vivo test of the e� cacy of an anti-bio� lm wound dressing. Int J Pharmaceutics. 2014; 474: 177–181.DOI: 10.1016/j.ijpharm.2014.08.03439. 69. Sutherland I.W. (2001) The bio� lm matrix, an immobilized but dynamic microbial environment. Trends in Microbiology, 9 (5), 222-227. 70. Flemming HC, et al. (2007) The "house of bio� lm cells" J. Bacterial , 189 (22) 7945-7947. 71. Hobot JA, Walker M, Newman GN, Bowler PG, 2008. E� ect of Hydro� berR wound dressings on bacterial ultrastructure. J Electr Micro; 57: 67-75. 72. Beveridge T, Fyfe W. Metal � xation by bacterial cell walls. Canadian Journal of Earth Sciences, 1985, 22(12): 1893-1898, https://doi. org/10.1139/e85-204. 73. Rood KM, Buhimschi IA, Jurcisek JA, Summer_ eld TL, Zhao G, Ackerman WE, et al. Skin Microbiota in Obese Women at Risk for Surgical Site Infection After Cesarean Delivery. Sci Rep. 2018 Jun;8:8756. 74. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control. 1999 Apr;27(2):97-132. 75. Hecker MT, Aron DC, Patel NP, Lehmann MK, Donskey CJ. Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis onthe anti-anaerobic spectrum of activity. Arch Intern Med. 2003 Apr;163(8):972–8. 76. Convatec data on � le. 77. Al-Houraibi RK, Aalirezaie A, Adib F, Anoushiravani A, Bhashyam A, Binlaksar R, et al. General Assembly, Prevention, Wound Management: Proceedings of International Consensus on Orthopedic Infections. J Arthroplasty. 2019 Feb;34(2):S157–S168. 78. Clarke JV, Deakin AH, Dillon JM, Emmerson S, Kinninmonth AWG. A prospective clinical audit of a new dressing design for lower limb arthroplasty wounds. J Wound Care. 2009 Jan;18(1):5-11. 79. Burke NG, Green C, McHugh G, McGolderick N, Kilcoyne C, Kenny P. A prospective randomised study comparing the jubilee dressing method to a standard adhesive dressing for total hip and knee replacements. J Tissue Viability. 2012 Aug;21(3):84–7. 80. Gregson H. Reducing surgical site infection following caesarean section. Nurs Stand. 2011 (Aug);25(50):35-40. 81. Siah CJ, Yatim J. E_ cacy of a total occlusive ionic silver-containing dressing combination in decreasing risk of surgical site infection: an RCT. J Wound Care. 2011 Dec;20(12):561-8. 82. Al-Houraibi,Reema K. et al. General Assembly, Prevention, Wound Management: Proceedings of International Consensus on Orthopedic Infections. The Journal of Arthroplasty, Volume 34, Issue 2, S157 - S168.

For every risk level

ASA ASSESSMENT*

ASA≥III3ASA<III3

Does your patient have any of the following risk factors for Surgical Site Complications?• Previous history of wound breakdown• Skin problems that will impact healing• High BMI (≥40)• Malnutrition• Smoker• Lung Disease• Autoimmune Disease• Steroids• Adjunctive Therapy• Renal Failure

High Risk

YES

NO

ConvaTec: your � rst choice in post-operative wound management powered by Hydro� ber® Technology and MORE THAN SILVERTM Technology.

Add AQUACEL™ Ag Advantage Surgical to your practice to reduce the risk of infection and complication due to bacterial colonization.

+/-

Low-medium Risk

®/™ 2020, Hydro� ber® and AQUACEL® are trademarks of ConvaTec Inc. All other trademarks are the property of their respective owners. ©2020 ConvaTec Inc. AP-020991-US

Ordering information

To � nd out more about the ConvaTec portfolio:www.convatec.com

AQUACEL™ Ag Advantage Surgical

DressingSize

IncisionsLength

Total Fluid Management in vitro (g/24hr)

Dressings Per box

ProductCode

3.5" x 4"(9cm x 10cm) 1.5" (4cm) 21.7 10 422603

3.5" x 6"(9cm x 15cm) 3.5" (9cm) 37.2 10 422604

3.5" x 10"(9cm x 25cm) 6.5" (17cm) 62.0 10 422605

3.5" x 12"(9cm x 30cm) 8.5" (22cm) 77.5 10 422606

3.5" x 14"(9cm x 35cm) 10.5" (27cm) 93.0 10 422607

AvelleTM Negative Pressure Wound Therapy System

Dressing Size Pad Size Max. Incision

Length Pack Size Product Code

4.7 in x 8.3 in 12 cm x 21 cm

1.6 in x 5.1 in 4 cm x 13 cm 6 cm / 2.4 in 5 421554

4.7 in x 12.2 in 12 cm x 31 cm

1.6 in x 9.1 in 4 cm x 23 cm 16 cm / 6.3 in 5 421555

4.7 in x 6.1 in 12 cm x 41 cm

1.6 in. x 13 in 4 cm x 33 cm 26 cm / 10.2 in 5 422155

6.3 in x 6.3 in 16 cm x 16 cm

3.2 in x 3.2 in 8 cm x 8 cm 5 421552

6.3 in x 8.3 in 16 cm x 21 cm

3.2 in x 5.1 in 8 cm x 13 cm 5 421553

8.3 in x 10.2 in 21 cm x 26 cm

5.1 in x 7.1 in 13 cm x 18 cm 5 422156

10.2 in x 10.2 in 26 cm x 26 cm

7.1 in x 7.1 in 18 cm x 18 cm 5 422157

Pump Unit N/A 1 422285

Pump Carrying Case N/A 1 446650

All dressing pouches include x6 Adhesive Film Fixation Strips

Documents

Enhanced Hydro˜ ber Technology Post-Operative Dressing