Srebro jest pierwiastkiem o właściwościach antybakteryjnych w stosunku do dużej liczby patogenów Gram-dodatnich i Gram-ujemnych, zarówno tlenowych, jak i beztlenowych. Obecnie na rynku znajduje się wiele produktów (opatrunki, kremy, pianki i inne) zawierających srebro w różnej postaci i w różnych związkach chemicznych.
Działanie opatrunku zawierającego srebro jest związane z ilością, rodzajem i rozkładem srebra w opatrunku.1-3
Nanotechnologia w medycynie
Nanotechnologia to ogólne określenie metod i technik tworzenia rozmaitych struktur o wymiarach nanometrycznych, czyli na poziomie pojedynczych atomów i cząsteczek. Nanotechnologię postrzega się jako niezwykle cenne narzędzie w technologii materiałowej. Struktury w skali nano już na stałe wniknęły do medycyny, umożliwiając modyfikację struktury farmaceutyków lub wyrobów medycznych (np. nośników leków, nanomateriałów pokrywających protezy, cewników lub implantów i innych).
Produkty nanotechnologii (nanocząsteczki) zachowują właściwości fizykochemiczne charakterystyczne dla skali makro, a ponadto posiadają dodatkowe cechy, które odróżniają je od jonów o „normalnej” wielkości. Jedną z bardzo ważnych zalet nanocząstek jest stosunek powierzchni do objętości, który jest tym większy, im mniejsza jest średnica nanocząsteczek, przez co znacznie wzrasta ich aktywność chemiczna. Silnie rozwinięta powierzchnia właściwa ma znaczący wpływ na własności adsorpcyjne, reaktywność oraz inne właściwości, w tym na zwiększoną aktywność przeciwdrobnoustrojową.
Moc srebra nanokrystalicznego
Nanocząsteczki srebra charakteryzują się średnicą nieprzekraczającą 100–200 nm i składają się z około 20–15000 atomów. Ich wyjątkowe właściwości fizykochemiczne związane są ze wspomnianym powyżej bardzo wysokim stosunkiem powierzchni aktywnej do objętości. Dzięki wykorzystaniu tej zależności możliwe jest osiągnięcie wysokich stężeń srebra (podawanych w jednostkach ppm) i dzięki temu uzyskanie silnego działania przeciwdrobnoustrojowego. Nowoczesna technologia materiałowa umożliwiła umieszczenie znacznej ilości srebra na niewielkiej powierzchni przy jednoczesnym podniesieniu jego aktywności biologicznej. Gram srebra rozdrobniony do skali nano ma powierzchnię czynną liczoną w setkach metrów kwadratowych i wykazuje dużo większy potencjał biobójczy w porównaniu z tradycyjnie stosowanymi formami srebra. W literaturze można spotkać liczne doniesienia świadczące o skutecznym działaniu przeciwbakteryjnym, przeciwwirusowym i przeciwgrzybiczym nanosrebra.
Wykorzystanie nanocząsteczek srebra pozwala uzyskać dobre relacje ceny do efektywności przeciw drobnoustrojom. Srebro w takiej formie może być wykorzystywane w dużo szerszym zakresie, szczególnie że przy stosowaniu zewnętrznym nanosrebro jest produktem relatywnie bezpiecznym dla organizmu ludzkiego. Jedyne szerzej znane zagrożenie ze strony srebra to choroba o nazwie srebrzyca (argyria), która może wystąpić u osób z nadwrażliwością na ten pierwiastek lub w przypadkach długotrwałego przyjmowania preparatów srebra.
Szybka kontrola infekcji
Gdy kolonizacja rany osiągnie poziom krytyczny, należy działać szybko i skutecznie. Priorytetem jest powstrzymanie zakażenia przed rozprzestrzenieniem się i przekształceniem w infekcję ogólnoustrojową. Zakażenie rany może wydłużać cierpienie pacjenta i zagrażać życiu, jeżeli nie będzie leczone szybko.4 Bez odpowiedniego leczenia koszt opieki nad raną może wzrosnąć bardzo szybko, zwłaszcza jeżeli pacjent zostanie poddany hospitalizacji.4
Opatrunki specjalistyczne z rodziny ACTICOAT z nanokryształami srebra SILCRYST stanowią skuteczną barierę przeciwko patogenom. Ich działanie antybakteryjne ma miejsce zarówno wewnątrz opatrunku, jak i w łożysku rany. Srebro jonowe Ag + występuje również w innych opatrunkach ze srebrem dostępnych na polskim rynku. Jednakże ACTICOAT jest opatrunkiem, który zawiera srebro nanokrystaliczne.
Wysoka skuteczność opatrunku jest uwarunkowana tym, że srebro nanokrystaliczne SILCRYST uwalnia zarówno jony srebra Ag+, jak i srebro metaliczne Ag0. Po zużyciu wyjściowej porcji szybko działającego (po 30 min) srebra jonowego Ag+ srebro metaliczne Ag0 zaczyna przekształcać się w aktywną postać jonową Ag+, dzięki czemu działanie antybakteryjne jest długotrwałe. W przypadku opatrunku ACTICOAT Flex 3 utrzymuje się ono do 3 dni. Jony Ag+ są uwalniane przez wszystkie opatrunki srebrowe, natomiast jony Ag0 są uwalniane wyłącznie ze srebra nanokrystalicznego, co daje dodatkowy „magazyn” jonów Ag+, zwiększając tym samym właściwości antybakteryjne opatrunku.
Skuteczność potwierdzona badaniami
Opatrunek ACTICOAT zabija bakterie w zaledwie 30 minut (in vitro).9-12 W badaniu klinicznym wykazano, że opatrunek ACTICOAT eliminuje wszystkie objawy przedmiotowe i podmiotowe zakażenia w 60% ran w ciągu dwóch tygodni.13 Opatrunek wykazuje szerokie spektrum skuteczności. Jest skuteczny przeciw ponad 150 gatunkom patogenów, w tym przeciw bakteriom Gram-dodatnim, Gram-ujemnym, drożdżom i grzybiczym patogenom ran (in vitro).
Przedłużone uwalnianie srebra powoduje, że opatrunek zachowuje aktywność antybakteryjną przez:
- 3 dni (ACTICOAT Flex 3 , ACTICOAT ) 14-16
- 7 dni (ACTICOAT Flex 7, ACTICOAT 7)17-19
Z punktu widzenia pacjentów rzadsze zmiany opatrunków zmniejszają stres i traumę. Ograniczenie czynności dokonywanych przy ranie może także prowadzić do jej szybszego gojenia się.20
Opatrunek ACTICOAT zastosowany wcześnie w ramach protokołu leczenia zakażenia może zmniejszać ryzyko progresji do ogólnoustrojowego zakażenia.21
Dzięki wysokiej wytrzymałości na rozciąganie ACTICOAT można z łatwością zdjąć w jednym kawałku i bez urazu łożyska rany. Zapewnia to szybsze i łatwiejsze zmiany opatrunków. 22-24
Artykuł powstał we współpracy z firmą Smith&Nephew.
Pobierz materiał edukacyjny w PDF:
- Tomaselli N. Rola miejscowych preparatów srebra w leczeniu ran. J Wound Ostomy Continence Nurs. 2006;33(4):367-380.
- Leaper DJ. Opatrunki ze srebrem: ich rola w leczeniu ran. Int Wound J. 2006;3(4):282-294.
- Ovington LG. Prawda o srebrze. Ostomy Wound Manage. 2004;50(9A Suppl):1-10.
- ’Efficacy of topical silver against fungal burn wound pathogens’, American Journal of Infection Control (1999); 27(4): 344-350
- Wright et al, (1998) 'Efficacy of topical silver against fungal burn wound pathogens’, American Journal of Infection Control; 27(4): 344-350
- West P and Gunning P (2006) Visualisation of silver levels in 2 silver dressings using scanning electron microscopy and energy dispersive X ray microanalysis. Poster przedstawiony podczas SAWC meeting San Antonio
- Woodmansey (2006) A visual demonstration of the antimicrobial efficacy of silver-based dressings against key pathogenic bacteria using confocal laser scanning microscopy.
- Roberts (2008) Use of interventional approaches to controlling healthcare-acquired infections in wounds. The role of silver, Journal of Wound Technology, No.2: 58-60
- Wright et al, (1998) 'Efficacy of topical silver against fungal burn wound pathogens’, American Journal of Infection Control; 27(4): 344-350
- Wright et al (1998) ‘Wound management in an era of increasing bacterial antibiotic resistance: A role for topical silver treatment’, American Journal of Infection Control: 26(6):572-577.
- Driffield, K; ACTICOAT Flex 7 has antimicrobial activity in 30 minutes, Dane z badań własnych 0810014, Smith & Nephew.
- Driffield, K; ACTICOAT Flex 3 has antimicrobial activity in 30 minutes, Dane z badań własnych 0810018, Smith & Nephew.
- Gago et al (2008) A comparison of Three Silver – containing Dressings in the Treatment of Infected, Chronic Wounds 20(10): 273-278.
- Westaim Report Ref. #010322 ‘Seven Day Efficacy of ACTICOAT 7 Dressings Against Multiple Organisms’.
- Driffield, K; Antimicrobial activity of ACTICOAT Flex 7 against a broad spectrum of wound pathogens, Dane z badań własnych 0810012, Smith & Nephew.
- Driffield, K; Antimicrobial activity of ACTICOAT Flex 7 dressings in a seven-day repeat challenge, Dane z badań własnych 0810013, Smith & Nephew.
- Westaim Report Ref: # 971030 'The Antimicrobial Activity of Westaim’s ACTICOAT Silver Coated Dressing against Clinically Relevant Organsisms over an Extended Period of Time’.
- Driffield, K; Antimicrobial Activity of ACTICOAT Flex 3 against a Broad Spectrum of Wbund Pathogens, Dane z badań własnych, ref. 0810016.
- Driffield, K; Antimicrobial activity of ACTICOAT Flex 3 in a three-day repeat challenge, Dane z badań własnych 0810017, Smith & Nephew 12. Upton D (2010) Pain and stress as contributors to delayed wound healing. Wound Practice and Research.
- Upton D (2010) Pain and stress as contributors to delayed wound healing. Wound Practice and Research.
- Newton (2010) Reducing MRSA bacteraemias associated with wounds. Wounds uk, tom 6, nr1
- Walton G: Wound Healing Study Summary Report.
- Daubney L: Wet Tensile Strength – ACTICOAT Flex, report reference DS/11/058/R1 (in vitro).
- Myers D: ACTICOAT Dressing: Wound bed prep and wound trauma.
- Lumb,H; The Antimicrobial Activity of ACTICOAT and ACTICOAT Flex 3 while Under Negative Pressure, DOF 0810010
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