Download Date of issue: June 2015 Review date: June 2017

Dressings Formulary
Date of issue: June 2015
Review date: June 2017
st
Dressings Formulary, 1 edition 2015. Review date: June 2017
Page 1 of 21
Introduction
This formulary is based on the CREST Guidelines for Wound Management, 1998 and the NHSSB Wound Care Formulary, January 2004 and was originally developed by a
sub-group of community and primary care based professionals involved in wound care. The group included Tissue Viability Nurse Specialists, Podiatrists, Community Nurses
and Primary Care Prescribing Advisers. A full review of this formulary was undertaken in March 2015 and shared with stakeholders covering community, primary and
secondary care in Coastal West Sussex.
All healthcare professionals within Coastal West Sussex that prescribe or request dressings for patients are expected to adhere to this formulary. Primary care practitioners
should note that these guidelines do not replace clinical judgement. There may be some occasions when you consider a non-formulary dressing may be appropriate, this
however should not be the norm. Products in red text within this formulary are for hospital use only; primary care health care professionals are not expected to prescribe
these products.
Feedback on the formulary
The group who developed this formulary is keen to have your feedback and would genuinely welcome any comments you may have. If there are products you feel should
be considered for inclusion when the guidelines are next reviewed, please send them at any time, along with associated evidence-based literature supporting the product(s)
to one of the Tissue Viability Nurse Specialists or CWS Medicines Management Team members listed below:
Jane Saunders (TVNS, Coastal West Sussex)
[email protected]
01243 812587
Coralia Wukovich (Technician, CWS Medicines Management Team)
[email protected]
01903 708672
Louise Scarborough (TVNS, Coastal West Sussex)
[email protected]
01273 696011 ext 6095
Julie Sadler (Pharmacist, CWS Medicines Management Team)
[email protected]
01903 708500
Pauline Stevens (TVNS, Horsham and Chanctonbury)
[email protected]
01403 227000 ext 7644
Electronic copies of the formulary and order forms
These are available on the CWS Local Health Economy Formulary website at: http://www.coastalwestsussexformulary.nhs.uk/docs/formulary/
Disclaimer
The information contained within is intended for use by healthcare professionals within Coastal West Sussex. We have made every effort to check that the information is
correct at the time of publication. Coastal West Sussex does not accept any responsibility for loss or damage caused by reliance on this information. Please read dressing
instructions before use. All costs are taken from the March/April 2015 Drug Tariff.
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Dressings Formulary, 1 edition 2015. Review date: June 2017
Page 2 of 21
A GUIDE TO WOUND MANAGEMENT
Adapted from CREST Wound Management Guidelines, 1998 and NHSSB Wound Care Formulary, January 2004
DESCRIPTION OF WOUND
Necrotic
Dead/ischaemic tissue, e.g.
eschar and slough.
In wound care this term tends
to be used to describe dead
tissue which is black/brown in
colour.
TREATMENT OBJECTIVES
NB: Keep necrotic toes and heels
dry
EXUDATE LEVEL
None – Low
EXUDATE LEVEL
Moderate to High
Hydrogel (p 6) and Semi-Permeable
Film (p 8)
(not to be used on ischaemic feet)
OR
Low/Non Adherent Dressing (p 8)
OR
Hydrocolloid (p 6)
Alginate (p 6)
OR
Hydrofibre (p 6) with secondary
absorbent dressing (p 7)
Be aware of vascular status
before any form of debridement
is considered on lower limb.
Seek podiatry/surgical opinion for
necrotic digits.
Seek podiatry/surgical opinion for
necrotic digits.
Debridement and management
of exudate.
Hydrogel (p 6) and Semi-Permeable
Film (p 8) /Low/Non Adherent
Dressing (p 8)
OR
Hydrocolloid (p 6)
Hydration of eschar,
debridement and management
of exudate.
Treat underlying cause of exudate.
Slough
Dead tissue.
N.B. Yellow tissue may be
tendon or bone.
Granulating
Keep warm and moist.
Process by which the wound is
filled with highly vascular
fragile connective tissue.
Red in colour.
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Dressings Formulary, 1 edition 2015. Review date: June 2017
Manage exudate.
Protect/promote granulation.
Low/Non Adherent Dressing (p 8)
OR
Hydrocolloid (p 6)
Alginate (p 6)
OR
Hydrofibre (p 6) with secondary
absorbent dressing (p 7)
Treat underlying cause of exudate.
Alginate (p 6)
OR
Hydrofibre (p 6) with secondary
absorbent dressing e.g. Foam (p 7)
OR
Absorbent Dressing Pad
OR
Low/Non Adherent Dressing (p 8)
Treat underlying cause of exudate.
Page 3 of 21
A GUIDE TO WOUND MANAGEMENT (continued)
DESCRIPTION OF WOUND
Epithelialising
Cavity
TREATMENT OBJECTIVES
Process by which the
wound is covered with new
skin cells.
Keep warm and moist.
Tissue will be pink in
colour.
Protect from further damage.
A loss of continuity of the
skin or mucous membrane
with associated tissue loss
(epidermal covering) and
which involves the dermal
layer of the skin.
Allow to granulate from bottom
up.
Macerated skin
Manage exudate.
Infected
Low/Non Adherent Dressing (p 8)
OR
Hydrocolloid (p 6)
EXUDATE LEVEL
Moderate to High
Alginate (p 6)
OR
Hydrofibre (p 6) with secondary
absorbent dressing or Foam (p 7)
OR
Low/Non Adherent Dressing (p 8)
Treat underlying cause of exudate.
If sloughy debride. Manage
exudate. Do not overpack cavity
wounds as this delays healing.
Check if present dressing regime
is absorbing the exudate.
A softening or sogginess of
surrounding tissue.
EXUDATE LEVEL
None – Low
Protect with a barrier ointment
e.g. liquid/white soft paraffin
mix. Barrier film applicator.
Hydrogel (p 6) and semi permeable
film (p 8)
Alginate (p 6)
OR
Hydrofibre (p 6) with secondary
absorbent (p 7) or foam dressing
Treat underlying cause of exudate.
Macerated skin does not tend to
occur in non- or low exuding wounds
unless the dressing has been left in
place too long!
Alginate (p 6)
OR
Hydrofibre (p 6) and secondary
absorbent dressing (p 7)
Treat underlying cause of exudate.
Consider more frequent dressing
changes.
To free patient from infection,
pain and discomfort.
Occurs when organisms in
the wound evoke a reaction To promote wound healing.
from the host, i.e. antigenantibody response.
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Dressings Formulary, 1 edition 2015. Review date: June 2017
See management information below (p 5)
Page 4 of 21
INFECTED WOUNDS
Adapted from CREST Wound Management Guidelines, 1998 and NHSSB Wound Care Formulary, January 2004
Classic signs and symptoms of infection:
Pus, exudate increasing, pyrexia >38°C, heat (new or increasing), redness (new or
increasing), swelling (new or increasing), tenderness or pain (new or increasing),
wound deterioration. Systemic antibiotics and swabs for bacteriology ONLY
indicated for INFECTION (exception: admission MRSA screening in bedded units).
NOTE Infection may produce different signs and symptoms in wounds of different
types and aetiologies. Diabetic patients may not display the usual signs and
symptoms of infection.
The risk of wound infection is increased by any factors that debilitates the
patient, impairs immune resistance or reduces tissue perfusion. (ref. WUWHS
2008).
Aseptic technique is essential in acute and chronic wound care. Bacteria are
increasingly able to transmit antimicrobial resistance information from one species
to another. This incidence of “cross infection” is increased in chronic wounds.
Wound swabbing:
Presence of bacteria in a wound alone does not indicate that it is infected. Clinical
signs of infection indicate the presence of pathogenic organisms and justify the
need for wound swabbing.
Technique: If a wound swab is required:
 Clean the wound first by irrigating with sterile normal saline to remove surface
contamination and debris.
 Moisten the swab with sterile normal saline or sterile water if the wound
surface is dry.
 Using a zigzag motion and simultaneously rotating the swab between the
fingers, sample the whole wound surface, to include the deepest part, avoiding
the surrounding tissue.1 Avoid areas of necrosis and slough.
Where infection is suspected:
 Adhere to Standard Infection Control Principles, i.e. hand washing with liquid
soap and water, appropriate PPE.
 Swab wound for ‘organisms and sensitivities’ and record all appropriate
information on microbiology form.
 Use appropriate SYSTEMIC ANTIBIOTICS.
 Ensure the prescribed antibiotic is appropriate to the pathogen identified.
 Avoid occlusive dressing if anaerobic bacteria are suspected.
 Dress infected wounds as appropriate.
 Choose wound dressing according to type of tissue on wound bed and level of
exudate.
Review antimicrobial dressings use after two weeks.
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Dressings Formulary, 1 edition 2015. Review date: June 2017
FIRST LINE: IODINE
Only use if infection or overload of bacteria is suspected.
Not recommended:
 For prophylaxis or routine use in chronic wounds.
 During pregnancy/lactation.
 As a standard non-adherent dressing if there is NO infection.
Caution:
 Monitor thyroid function in patients with known thyroid disease.
 Contra-indicated in patients on lithium.
Do:
 Change dressing when distinctive orange-brown changes to white.
 Leave on for 3-5 days depending on exudate.
Iodoflex 5g, 10g, 17g (use for wounds with increased exudate level).
OR Iodosorb ointment 10g
Iodosorb powder 3g sachet (only on wet, infected and difficult to access wounds).
OR Povidone-Iodine dressing (Inadine®) – on toes only
OTHER OPTIONS: Contained within the “specials list” in this formulary (p12).
 SILVER2,3
Dressings containing silver should only be used when infection is suspected as a result of
clinical signs and symptoms. They should not be used on acute wounds or routinely for the
management of uncomplicated ulcers (as there is some evidence that they delay healing).
Prescriptions for silver dressings should not be written unless documentary evidence of
individual patient recommendation by a senior nurse or podiatrist. All prescribing of silver
dressings will be closely monitored and audited.
Aquacel Ag Extra: 5cm x 5cm, 10cm x 10cm, 15cm x 15cm, 20cm x 30cm (hospital only)
Aquacel Ag Ribbon 1cm x 45cm, 2cm x 45cm
Atrauman Ag 5cm x 5cm, 10cm x 10cm, 10cm x 20cm
Aquacel Ag Foam Non-Adhesive 15cm x 15cm (hospital only), 20cm x 20cm (hospital only)
 HONEY
Activon Tulle: 5cm x 5cm, 10cm x 10cm (Impregnated with manuka honey)
Activon Medical Grade Manuka Honey 25g tube
Algivon Plus Ribbon (with probe) 2.5cm x 20cm
 DACC COATED DRESSINGS – Antimicrobial ONLY - to be used if iodine, silver or honey is
not suitable. To be used under moist wound conditions. NOT to be used with ointments
or creams.
Cutimed Sorbact Ribbon 2.5cm x 50cm
Cutimed Sorbact Swab 4cm x 6cm, 7cm x 9cm
Page 5 of 21
PRODUCT CHOICE
DRESSING TYPE AND COMMENTS ON PRESCRIBING
Alginate Cavity
Do not pack tightly into wound.
Change every 2-3 days.
If infected change as appropriate.
PRODUCT NAME
Sorbsan Ribbon (with probe)
(1st line)
Kaltostat packing rope
(2nd line)
2g
£3.81
Alginate
Kaltostat has haemostatic properties – reduces bleeding in 10 minutes.
Cut to size of wound.
Irrigate wound to remove.
Sorbsan flat
(1st line)
5cm x 5cm
10cm x 10cm
10cm x 20cm
£0.81
£1.71
£3.20
Kaltostat
(2nd line)
5cm x 5cm
7.5cm x 12cm
£0.95
£2.07
Hydrogels
Not recommended for heavily exudating wounds. Contra-indicated in anaerobic
infection.
IntraSite conformable
10cm x 10cm (7.5g)
£1.80
Aquaform hydrogel
8g
£1.66
IntraSite gel
8g
£1.80
Hydrocolloids
Occlusive dressing. Overlap wound by at least 2cm. Can be left in place for up to 7
days. Avoid in wounds with anaerobic infection and diabetic feet unless under specialist
advice.
Minimal exudate: Duoderm Extra Thin
7.5cm x 7.5cm
10cm x 10cm
£0.79
£1.31
5cm x 7cm
10cm x 10cm
£0.66
£1.26
Hydrofibre/cellulose dressings
No lateral wicking.
Overlap wound by 1cm.
Can be left in place for up to 7 days.
For highly exuding wounds only:
Durafiber (cellulose based)
5cm x 5cm
10cm x 10cm
15cm x 15cm
£0.90
£2.15
£4.05
Aquacel Extra
5cm x 5cm
10cm x 10cm
15cm x 15cm
£1.00
£2.38
£4.48
Aquacel Ribbon
1cm x 45cm
2cm x 45cm
£1.83
£2.44
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Dressings Formulary, 1 edition 2015. Review date: June 2017
Light exudate: Comfeel Plus
Transparent Dressing
SIZE
40cm
COST/ITEM
£2.04
Page 6 of 21
PRODUCT CHOICE
DRESSING TYPE AND COMMENTS ON PRESCRIBING
Foams
Change when lateral strike through occurs.
Can be left in place for up to 7 days.
Very occasionally patients react to Allevyn/Biatain bordered dressings. Please refer to a
TVNS (contact details on p2) if you need to use an alternative product.
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Dressings Formulary, 1 edition 2015. Review date: June 2017
PRODUCT NAME
Biatain Non-adhesive
SIZE
5cm x 7cm
10cm x 10cm
15cm x 15cm
10cm x 20cm
COST/ITEM
£1.30
£2.37
£4.36
£6.47
Biatain Adhesive
10cm x 10cm
12.5cm x 12.5cm
£1.74
£2.54
Biatain Soft-Hold
10cm x 10cm
10cm x 20cm
15cm x 15cm
£2.75
£3.91
£4.28
Biatain Adhesive Sacral
23cm x 23cm
£4.39
Biatain Adhesive Heel
19cm x 20cm
£5.13
Allevyn Non Adhesive
5cm x 5cm
10cm x 10cm
10cm x 20cm
£1.25
£2.48
£3.99
Allevyn Adhesive
7.5cm x 7.5cm
10cm x 10cm
12.5cm x 12.5cm
12.5cm x 22.5cm
£1.48
£2.17
£2.66
£4.14
Allevyn Gentle
5cm x 5cm
10cm x 10cm
15cm x 15cm
10cm x 20cm
£1.26
£2.49
£4.18
£4.01
Allevyn Gentle Border
7.5cm x 7.5cm
10cm x 10cm
12.5cm x 12.5cm
£1.48
£2.18
£2.67
Allevyn Anatomically Shaped Sacral
Dressing
17cm x 17cm
22cm x 22cm
£3.94
£5.68
Tegaderm Foam Adhesive Circular
(Heel)
13.9cm x 13.9cm
£4.22
Page 7 of 21
PRODUCT CHOICE
DRESSING TYPE AND COMMENTS ON PRESCRIBING
Films
Stretch film parallel to skin to release adhesive and prevent trauma to skin on removal
PRODUCT NAME
Tegaderm Film
(1st line)
Opsite Flexigrid
(2nd line)
Opsite Plus
(with absorbent pad)
Tegaderm IV with securing tapes
SIZE
6cm x 7cm
12cm x 12cm
15cm x 20cm
6cm x 7cm
12cm x 12cm
15cm x 20cm
6.5cm x 5cm
8.5cm x 9.5cm
10cm x 15.5cm
COST/ITEM
£0.39
£1.11
£2.41
£0.40
£1.12
£2.84
£0.32
£0.88
£1.67
Intravenous/Sub-cutaneous Therapy
IV3000
10cm x 12cm
£1.39
N-A Ultra
(1st line)
9.5cm x 9.5cm
19cm x 9.5cm
£0.33
£0.63
Atrauman
(2nd line)
5cm x 5cm
7.5cm x 10cm
10cm x 20cm
20cm x 30cm
£0.26
£0.28
£0.62
£1.71
Profore Wound Contact Layer
CliniSorb
(1st line)
14cm x 20cm
10cm x 10cm
10cm x 20cm
15cm x 25cm
£0.32
£1.88
£2.50
£4.03
Carboflex
(2nd line)
8cm x 15cm (oval)
10cm x 10cm
£3.82
£3.18
Iodoflex (1st line)
5g
10g
17g
£4.06
£8.12
£12.86
Iodosorb ointment (1st line)
10g
£4.49
Iodosorb powder (only to be used on
infected wounds)
3g sachet
£1.92
Inadine (only to be used on toes)
5cm x 5cm
9.5cm x 9.5cm
£0.33
£0.49
Intravenous/Sub-Cutaneous Therapy
Low/Non Adherence
Simple low adherent dressings are recommended for venous leg ulcer dressings under
compression bandaging.
Odour absorbing
Charcoal dressing: Change daily in clinically infected wounds. Change when malodour is
noted. Carboflex is indicated as a primary dressing for shallow wounds or as a
secondary dressing over wound filler for deeper wounds.
Metronidazole gel (3rd line - see specials list p12 - for anaerobic infection)
Charcoal is not effective when wet.
Not indicated as a primary dressing for dry wounds.
Povidone Iodine
See notes in infection section.
N.B. Inadine dressings – the antimicrobial effect from one dressing may not last long enough
and may require up to four layers of dressings. Best to use Iodosorb (ointment) or Iodoflex
(paste) and cover with N-A Ultra so iodine can stay on wound for longer (up to 7 days).
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Dressings Formulary, 1 edition 2015. Review date: June 2017
Page 8 of 21
MISCELLANEOUS PRODUCTS
DRESSING TYPE AND COMMENTS ON PRESCRIBING
Absorbent cellulose dressing (sterile)
Primary or secondary dressing for medium to heavily exuding wounds
PRODUCT NAME
Zetuvit E (sterile)
(1st line)
Zetuvit Plus
(use if higher absorbency required)
Mesorb
(for moderate exudate)
Superabsorbent for very high exudate
Kliniderm superabsorbent
KerraMaxCare
Absorbent simple dressing
Low adherence dressing
Mepore
(1st line)
Cosmopor E
(2nd line)
Cleansing agent
For irrigating ulcers or wounds, but warm tap water is often appropriate (BNF).
Irripod
Dressing packs
Used to provide a sterile working surface. Contains apron, gauze, forceps and tray.
Nurse It
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Dressings Formulary, 1 edition 2015. Review date: June 2017
Stericlens spray
SIZE
10cm x 10cm
10cm x 20cm
20cm x 20cm
20cm x 40cm
10cm x 10cm
10cm x 20cm
20cm x 25cm
20cm x 40cm
10cm x 10cm
10cm x 20cm
20cm x 25cm
20cm x 30cm
COST/ITEM
£0.21
£0.24
£0.39
£1.09
£0.63
£0.87
£1.36
£2.09
£0.62
£1.00
£2.24
£2.54
10cm x 10cm
10cm x 15cm
20cm x 20cm
20cm x 30cm
10cm x 10cm
10cm x 22cm
20cm x 22cm
20cm x 30cm
7cm x 8cm
10cm x 11cm
11cm x 15cm
9cm x 35cm
£0.49
£0.69
£0.99
£1.49
£1.27
£1.67
£2.95
£3.37
£0.11
£0.22
£0.36
£0.76
5cm x 7.2cm
8cm x 10cm
8cm x 15cm
10cm x 35cm
25 x 20ml
£0.08
£0.17
£0.28
£0.77
£5.84
100mls
240mls
s/m, m/l
£2.06
£3.13
£0.54
Page 9 of 21
MISCELLANEOUS PRODUCTS continued
DRESSING TYPE AND COMMENTS ON PRESCRIBING
PRODUCT NAME
Gauze
Gauze Swab Type 13 Light BP 1988, Non
A secondary dressing – see notes above under low/non adherence dressings.
Sterile
Tape
Clinipore
For securing dressings together. Hypafix – the apertured structure allows it to be more
extensible and conform to the body.
Scanpor
Micropore
Hypafix
Barrier preparation
Cavilon cream can be used on very superficial skin breaks/mild excoriation.
Cavilon barrier foam applicator
Cavilon durable cream
Proshield - For use on intact or injured skin associated with incontinence. Do not use a Proshield Plus Skin Protective
dressing over the product. Can be used on partial thickness wounds, moisture lesions
and up to a category 2 pressure ulcer.
BANDAGES
COMPRESSION (Only health care staff who have undergone the specific training should apply compression bandaging)
Wool (1st layer)
K-soft long
Flexi-Ban
Crepe (2nd layer)
K-Lite
K-Lite long
K-Plus
Ko-Flex
Actico (cohesive)
K-Four multi-layer compression
bandage kit
3rd layer
4th layer
Short stretch
Kits
K-ThreeC (for larger limbs)
K Two multi-layer compression bandage
kit
K Two Reduced multi-layer compression
bandage kit
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Dressings Formulary, 1 edition 2015. Review date: June 2017
SIZE
10cm x 10cm
2.5cm x 5m
5cm x 5m
2.5cm x 5m
5cm x 5m
1.25cm x 5m
5cm x 10m
10cm x 10m
15cm x 10m
1ml x 5 applicators
28g
92g
115g
COST/ITEM
£1.43 for 100
pads
£0.59
£0.99
£0.68
£1.18
£0.62
£2.65
£4.63
£6.86
£5.00
£3.98
£8.92
£9.78
10cm x 4.5m
10cm x 3.5m
10cm x 4.5m
15cm x 4.5m
10cm x 5.25m
10cm x 8.7m
10cm x 6m
10cm x 6m
< 18cm ankle
18-25cm ankle
25-30cm ankle
> 30cm ankle
10cm x 3m
0 (short)
18-25cm (8cm)
25-32cm (10cm)
£0.56
£0.50
£0.99
£1.44
£1.14
£2.26
£3.00
£3.33
£7.11
£6.80
£6.80
£9.36
£2.81
£6.79
£7.60
£8.80
18-25cm
25cm-32cm
£8.05
£8.80
Page 10 of 21
OTHER BANDAGING
Securing bandages
A secondary dressing – see notes above under low/non adherence dressings
Knit-band (4m stretched)
5cm x 4m
7cm x 4m
10cm x 4m
15cm x 4m
£0.10
£0.15
£0.17
£0.30
Paste bandages
Impregnated woven bandage.
Viscopaste PB7 (10%)
7.5cm x 6m
£3.63
Steripaste
7.5cm x 6m
£3.24
Elasticated viscose stockinette
Lightweight plain-knitted elasticated tubular bandage.
One 5m length of the relevant width is sufficient to provide two sets of dressing for a
pair of limbs or a trunk.
Comfifast blue line large limb
7.5cm x 1m
7.5cm x 5m
10.75cm x 1m
10.75cm x 5m
£0.77
£3.74
£1.20
£6.04
7.5cm x 5m
10cm x 5m
15cm x 5m
£3.36
£4.44
£6.40
Small
Medium
Large
Extra large
£22.56
£22.56
£22.56
£22.56
Activa compression liner pack (closed
toe)
Pack contains 3 liners -10 mmHg
Small
Medium
Large
Extra large
Extra extra large
£16.92
£16.92
£16.92
£16.92
£16.92
Elastic hosiery (Activa) Class I
Below knee
£7.41
Elastic hosiery (Activa) Class II
Below knee
£10.83
Acti-glide hosiery applicator
For open/closed toe
One size
£14.40
Easy-Slide stocking applicator
Open toe hosiery only
Medium
Large
£12.22
£12.22
Comfifast yellow line
Eesiban Ribbed Cotton Surgical Tubular
Stockinette
COMPRESSION HOSIERY
Venous ulcer compression systems treatment stockings
Activa leg ulcer kit
N.B. Made-to-measure hosiery should be obtained through your usual route
Pack contains 1 stocking and 2 liners 40mmHg
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Dressings Formulary, 1 edition 2015. Review date: June 2017
Page 11 of 21
SPECIALS LIST
The products contained in the table below are for specialist use only. Patients must have had a full wound assessment documented. You must know the indications
and contraindications of the products used. Please consult the tissue viability service or senior colleague before use or if you need any further advice.
PRODUCT
Antimicrobial
See notes in infection section (p 5)
PRODUCT NAME
Metronidazole 0.75% gel:
Silver:
Atrauman Ag
Aquacel Ag Extra
Aquacel Ag Ribbon
Aquacel Ag Foam Non-adhesive – only for hypergranulated PEG sites and super pubic
catheter sites
Aquacel Ag Foam Non-Adhesive
Honey:
Activon Tulle
Activon Medical Grade Manuka
Honey
Algivon Plus Ribbon (with probe)
DACC coated dressings – Antimicrobial ONLY - to be used if iodine, silver or honey is
not suitable. To be used under moist wound conditions. NOT to be used with ointments
or creams.
DACC coated dressings:
Cutimed Sorbact Ribbon
Cutimed Sorbact Swab
Irrigation – for sloughy infected wounds – NOT for routine use
Irrigation:
Prontosan pod
Prontosan bottle
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Dressings Formulary, 1 edition 2015. Review date: June 2017
SIZE
15g
30g
COST/ITEM
£4.47
£7.89
5cm x 5cm
10cm x 10cm
10cm x 20cm
£0.51
£1.24
£2.43
5cm x 5cm
10cm x 10cm
15cm x 15cm
20cm x 30cm
(hospital only)
1cm x 45cm
2cm x 45cm
£1.97
£4.68
£8.82
£21.89
15cm x 15cm
(hospital only)
20cm x 20cm
(hospital only)
£11.30
5cm x 5cm
10cm x 10cm
25g
£1.80
£2.97
£2.05
2.5cm x 20cm
£3.36
2cm x 50cm
4cm x 6cm
7cm x 9cm
£4.00
£1.63
£2.72
24 x 40ml
350ml
£14.12
£4.75
£3.06
£4.67
£16.54
Page 12 of 21
PRODUCT
Physical Debridement Pad
For debridement of wounds. Use after cleansing. Remove/wash all creams/emollients
from wound and skin. Moisten with tap water or saline. Use light finger pressure and
circular motion on the wound. Do not soak, overwet, wring out.
Note the unit price. Use weekly or twice weekly maximum.
Refer to TVN service if advice needed on debridement.
Debrisoft should not be used for the routine removal of hyperkeratotic skin plaques.
Do NOT use for routine wound cleaning.
Foams
Change when lateral strike through occurs.
Can be left in place for up to 7 days.
Note: Biatain adhesive and Allevyn Gentle are the 1st choices.
Biatain Silicone only to be used for patients with fragile skin.
Hydrogels
Not recommended for heavily exudating wounds. Contra-indicated in anaerobic
infection.
Consider ActiFormCool when pain is a significant factor.
Hydrocolloids
Occlusive dressing. Overlap wound by at least 2cm. Can be left in place for up to 7
days. Avoid in wounds with anaerobic infection and diabetic feet unless under
specialist advice.
Soft polymer (for patients who cannot tolerate N-A Ultra, Atrauman or Profore)
Soft silicone
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Dressings Formulary, 1 edition 2015. Review date: June 2017
PRODUCT NAME
DebriSoft
SIZE
10cm x 10cm
COST/ITEM
£6.35
Biatain Silicone
7.5cm x 7.5cm
10cm x 10cm
12.5cm x 12.5cm
15cm x 15cm
17.5cm x 17.5cm
£1.44
£2.11
£2.59
£3.84
£5.10
Aquacel Foam Adhesive
(hospital only)
10cm x 10cm
12.5cm x 12.5cm
£2.14
£2.65
Aquacel Foam Adhesive Sacral
(hospital only)
ActiFormCool
20cm x 16.9cm
£4.87
10cm x 10cm
£2.63
Granugel Hydrocolloid Gel
(hospital only)
15g
£2.32
15cm x 15cm
£2.84
£3.06
£6.50
Mepitel One
10cm x 10cm
15cm x 15cm
(hospital only)
6cm x 7cm
9cm x 10cm
24cm x 27.5cm
(hospital only)
Mepilex Transfer (hospital only)
15cm x 20cm
Minimal exudate:
Duoderm Extra Thin
(hospital only)
Urgotul
£1.59
£3.19
£17.38
£10.64
Page 13 of 21
PRODUCT
Barrier preparation
For cleaning and moisturising intact and broken skin associated with incontinence.
PRODUCT NAME
Proshield Foam & Spray skin
cleanser
Gauze dressing (impregnated)
For use following Podiatry recommendation only
Chlorhexidine Gauze Dressing
BP (Syn: Chlorhexidine Tulle Gras)
5cm x 5cm
£0.29
Topical Negative Pressure dressings
Patients must be referred for Renasys pump or PICO through the TVN service.
Renasys G Gauze dressing kit with
soft port
Small
Medium
Large
£19.51
£24.47
£31.05
PICO is a negative pressure wound therapy pump connected to a dressing. The dressing
may improve blood flow to the wound which will help it to heal.
Renasys Go canister kit
300ml with solidifier
£19.82
PICO
10cm x 20cm
10cm x 30cm
15cm x 15cm
15cm x 20cm
£124.55
£124.55
£124.55
£124.55
Foam wound dressing (pack of 5)
10cm x 12.5cm x 1.5cm
£7.63
Gauze wound dressing (pack of 2)
15cm x 17cm
£10.78
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Dressings Formulary, 1 edition 2015. Review date: June 2017
SIZE
235ml
COST/ITEM
£6.51
Page 14 of 21
TREATMENT FOR HYPERGRANULATION10,11
Please note: This is a very brief guide; please contact the Tissue Viability Service if further information is needed.
Hypergranulation (overgranulation) or proud flesh presents as a raised mass of granulation tissue beyond the height of the wound surface. It can occur in a wide range of
wounds such as leg ulcers, pressure ulcers and burns.
Hypergranulation can be a problem because it impedes wound healing by preventing the migration of epithelial cells across the wound surface.
Causes of hypergranlation
Little is known about the causes of hypergranulation.
The following factors have been identified as being as possible causes:
 Inflammation: Wound infection, irritants from foreign bodies, friction from external devices such as gastrostomy tubes, allergies and sensitivities.
 Use of occlusive dressings such as hydrocolloids
 Cellular imbalance of some kind
Treatment
There is no consensus on the best way to manage hypergranulation and often the clinician’s anecdotal experience is used. You must exclude malignancy and infection as a
cause. Sometimes a ‘wait and see’ option is helpful and the problem resolves without any interventions.
If the cause can be identified, one or more of the following approaches may be helpful:
 For inflammation: Treat any infection (consider antimicrobials), consider removal of irritants, secure external devices, consider use of topical steroids (i.e.
fludroxycortide/Haelan® tape to treat the inflammation. Licensed usage of steroids must be checked.
 Occlusive dressings: Change to a more permeable product (i.e. foam dressings), apply moderate pressure to the wound (don’t constrict blood supply).
 Cellular imbalance: If you feel that external factors are the cause, then exclude inflammation and occlusion as above. However, if you feel that internal factors are
the cause then this can be more difficult; seeking further advice may be necessary.
Fludroxycortide / Haelan® 4mcg/cm2 tape
7.5cm x 0.5m = £9.27
7.5cm x 2m = £24.95
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Page 15 of 21
FOOT CARE - Management of diabetic foot ulcers:
These should be referred immediately to the local diabetic foot team. They require specialist intervention as per NICE and NSF guidelines on diabetic management.
 Staff should be aware of local diabetic foot care pathways (see links on page 16)
If ulceration is discovered it should be dressed with a non-adhesive foam dressing and hypafix or miropore used to secure. Do not use hydrogels or hydrocolloids unless
specifically under the guidance of the diabetic foot team or a TVNS. NB: Arterial ulcers and diabetic foot ulcers are not to be washed unless under specialist advice. For
further information on types of diabetic foot ulcers, see link on page 16.
Contact details for diabetic podiatric leads in Coastal West Sussex:
Mark Ashby
Tel: (01243) 831614 – Diabetes Centre, St Richard’s Hospital, Spitalfield Lane, Chichester, PO19 6SE
Email: [email protected]
Alison Hesling
Tel: (01903) 843611 ext 85539 – Diabetes Centre, Worthing Hospital
Or: (01903) 843625 – Podiatry Department, Littlehampton Health Centre, Fitzalan Road, Littlehampton
Email: [email protected]
____________________________________________________________________________________________________________________________________________
MANAGEMENT OF VARICOSE ECZEMA
Objective is to return skin to normal through excellent skin care using the following steps:
1. Bath in a bath oil
2. Use of topical steroids
3. Emollients
1. Bath in bath oil – wash legs using bath oil with added anti-microbial. NB: Arterial ulcers and diabetic foot ulcers are not to be washed unless under specialist advice.
 Dermol® 600 bath emollient
 Dermol® 500 (this may be used as soap substitute but is not intended as a bath additive)
2. Use of topical steroids - if skin is showing signs of redness (erythema), warmth as well as dryness (xerosis) and itching consider using a topical steroid, prescribed by a
GP. Remember to consider differential diagnosis such as cellulitis first.
 Betamethasone 0.025% cream/ointment (Betnovate RD®), or
 Clobetasone 0.05% cream/ointment (Eumovate®).
3. Emollients - if skin is very dry consider using:
 50/50 white soft paraffin/liquid paraffin
If emollients other than the above products are to be used under bandages consider using:
 Cetraben® cream first-line, or
 Doublebase® gel.
If the varicose eczema is not controlled by group 2 topical steroids refer to community dermatology nursing service for further advice on management (where available).
Apart from 50/50 WSP/LP and Dermol® 600, all product choices on this page are in line with the current Coastal West Sussex Dermatology Formulary available at:
http://www.coastalwestsussexformulary.nhs.uk/
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Page 16 of 21
OTHER USEFUL INFORMATION AND LINKS
ORGNISATION /
INFORMATION
European Wound
Management
Association
DESCRIPTION
LINK / WEB ACCESS
The European Wound Management Association (EWMA) was founded in 1991, and
the association works to promote the advancement of education and research into
native epidemiology, pathology, diagnosis, prevention and management of wounds
of all aetiologies.
http://www.ewma.org/english.html
Wounds UK
Provides general, very helpful, wound care information including access to journals,
best practice statements and lots more.
http://www.wounds-uk.com/
World Wide Wounds
The premier online resource for dressing materials and practical wound
management information.
www.worldwidewounds.com
Wound Infection
Institute
Up-to-date clinical information on international developments in wound care
infection.
http://www.woundinfection-institute.com/
European Pressure
Ulcer Advisory Panel
Started in 1996 to lead and support all European Countries in the effort to prevent
and treat pressure ulcers.
www.epuap.org
Leg Ulcer Forum
Provides a forum for healthcare professionals working within the field of leg ulcer
management.
www.legulcerforum.org
National Institute of
Health and Clinical
Excellence (NICE)
Types of diabetic foot
ulcers
An independent organisation responsible for providing national guidance on
promoting good health and preventing and treating ill health.
www.nice.org.uk
Summary of types of diabetic foot ulcers including appearance, common sites and
management.
http://www.coastalwestsussexccg.nhs.uk/formulary
World Union of Wound
Healing Societies
Co-ordinates a world-wide exchange of information between wound societies and
other relevant stakeholders, including international and global agencies as well as
personal-level friendship exchanges.
http://www.wuwhs.org/
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Page 17 of 21
GLOSSARY OF TERMS
Anaerobes
organisms which do not need oxygen to survive
Debridement
the removal of devitalised tissue and foreign matter from a wound
Epithelialisation
the process by which the wound is covered with epithelial cells
Eschar
dead tissue that is hard, black and dehydrated
Exudate
a fluid produced in wounds, made up of serum, leucocytes and wound debris
Granulation
the process by which the wound is filled with highly vascular connective tissue. Granulation tissue is red and moist and has an uneven,
granular appearance
Haemostasis
arrest of haemorrhage
Infection
damage to body tissues by micro-organisms or by poisonous substances released by the organism
Maceration
a softening or sogginess of the tissue surrounding a wound edge
Necrosis
the death of previously viable tissue
Pus
a fluid produced in infections, made up of exudate, bacteria and phagocytes which have completed their work
Slough
accumulation of dead cellular debris on the wound surface, which tends to be yellow in appearance due to the presence of leukocytes
Strike through
exudate visible on the outer surface of the dressing
Strike through (lateral)
exudate visible at the edges of the dressing
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REFERENCES
1. Cooper, R. (2010). Assessment and diagnosis, Infection, Ten top tips for taking a swab. Wounds International. Accessed on 25/05/10 at
http://www.woundsinternational.com/article.php?issueid=303&cont
2. International consensus. Appropriate use of silver dressings in wounds. An expert working group consensus. London: Wounds International, 2012. Accessed on
25/03/13 at: www.woundsinternational.com
3.
British National Formulary. 64th Edition. London: BMJ Group &RPSGB; September 2012. Available online at http://bnf.org/bnf/index.htm
4. Thomas, ST. (2009). Formulary of wound management products. A guide for health care staff. 10th Edition. UK, Euromed Communications Ltd.
5. Surgical Dressing Manufacturers Association (SDMA) 2009. Includes the Code of practice for promotion of surgical dressings to healthcare. Available at
www.sdma.org.uk
6. Palfreyman SSJ, Nelson EA, Lochiel R, Michaels JA. Dressings for healing venous leg ulcers. Cochrane Database of Systematic Reviews 2006, Issue 3. Available at:
http://mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001103/abstract.html <accessed on 30/06/10>
7. Chaby G, Senet P, Vaneau M, Martel P, Guillaume J, Meaume S, Teot L, Debure C, Dompmartin A, Bachelet H, et al. Archives of Dermatology. Dressings for acute and
chronic wounds: a systematic review 2007, 143 (10), pp1297-1304. Available at: http://archderm.ama-assn.org/cgi/content/abstract/143/10/1291 <accessed on
30/06/10>
8. East & South East England Specialist Pharmacy Services. Medicines Use and Safety. Top Tip QIPP messages for prescribing dressings.
9. Surgical Dressings and Wound Management. Stephen Thomas. Medetec 2010 Elsevier.
10. McGrath, A. Overcoming the challenge of overgranulation. Wounds UK 2011, Volume 7, No. 1. Accessed on 22/03/13 at: http://www.woundsuk.com/pdf/content_9839.pdf
11. Vuolo J. Hypergranulation: exploring possible management options. British Journal of Nursing 25th March-7th April 2010 7:19(6):S4, S6-8. Accessed on 22/03/13 at:
http://www.ncbi.nlm.nih.gov/pubmed/20335928#
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INDEX OF PRODUCTS
Actico 10
ActiFormCool 13
Acti-glide hosiery applicator 11
Activa compression liner pack 11
Activa leg ulcer kit 11
Activon Medical Grade Manuka Honey 5,12
Activon-tulle 5, 12
Algivon Plus Ribbon 5,12
Allevyn adhesive 7
Allevyn Anatomically Shaped Sacral Dressing 7
Allevyn gentle 7
Allevyn gentle border 7
Allevyn non adhesive 7
Aquacel Ag Extra 5, 12
Aquacel Ag Foam Non-Adhesive 5,12
Aquacel Ag Ribbon 5, 12
Aquacel Extra 6
Aquacel Foam Adhesive 13
Aquacel Foam Adhesive Sacral 13
Aquacel ribbon 6
Aquaform hydrogel 6
Atrauman 8
Atrauman Ag 5,12
Betnovate RD 15
Biatain adhesive 7
Biatain adhesive heel 7
Biatain adhesive sacral 7
Biatain non adhesive 7
Biatain Silicone 13
Biatain soft hold 7
Carboflex 8
Cavilon barrier foam applicator 10
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Cavilon durable cream 10
Cetraben 15
Chlorhexidine Gauze Dressing BP 14
Clinipore 10
CliniSorb 8
Comfeel plus 6
Comfifast 11
Cosmopore E 9
Cutimed Sorbact Ribbon 5,12
Cutimed Sorbact Swab 5,12
Debrisoft 13
Dermol 500 15
Dermol 600 15
Doublebase 15
Duoderm extra thin 13
Durafiber 6
Easiband stockinette 11
Easy-slide stocking applicator 11
Elastic hosiery Class I 11
Elastic hosierY Class II 11
Eumovate 15
Flexi-Ban 10
Fludroxycortide 4mcg/cm2 tape 15
Foam Wound Dressing 14
Gauze Wound Dressing 14
Granugel Hydrocolloid Gel 13
Hypafix 10
Inadine 5, 8
Intrasite conformable 6
Intrasite gel 6
Iodoflex 5, 8
Iodosorb ointment 5, 8
Dressings Formulary, 1 edition 2015. Review date: June 2017
Iodosorb powder 5, 8
Irripod 9
IV 3000 8
Kaltostat flat 6
Kaltostat packing rope 6
KerramaxCare 9
K-Four kit 10
Kliniderm superabsorbent 9
K-Lite 10
K-Lite long 10
Knit-Band 11
Ko-Flex 10
K-Plus 10
K-Soft long 10
K-ThreeC 10
K-Two kit 10
K-Two Reduced 10
Mepilex Transfer 13
Mepitel One 13
Mepore 9
Mesorb 9
Metronidazole gel 0.75% 12
Micropore 10
N-A ultra 8
Non-sterile gauze swabs 10
Nurse It 9
Opsite Flexigrid 8
Opsite Plus 8
PICO 14
Povidone-iodine 5, 8
Profore Wound Contact Layer 8
Prontosan 12
Proshield plus 10
Proshield Foam & Spray skin cleanser 14
Renasys G Gauze dressing kit with soft port 14
Renasys Go canister kit 14
Scanpor 10
Sorbsan flat 6
Sorbsan packing ribbon 6
Stericlens spray 9
Steripaste 11
Tegaderm Film 8
Tegaderm Foam Adhesive Circular (Heel) 7
Tegaderm IV 8
Urgotul 13
Viscopaste PB7 11
50/50 WSP/liquid paraffin 15
Zetuvit E (sterile) 9
Zetuvit Plus 9
Page 20 of 21
RECOMMENDATIONS FOR SUSSEX COMMUNITY NHS TRUST STAFF ON MANAGING CONTACT WITH COMPANY REPRESENTATIVES

Staff must only see companies with products on the formulary and must rotate these companies.

Community teams must only see one company per month.

Staff should not see the same company representative more than once a year.

Do not allow cold calling by company representatives.

Please ask company representatives to talk only about their products on the formulary and make them aware that they should not discuss other
company’s products.
Please refer to Sussex Community NHS Trust policy on managing contact with company representatives
All other staff are reminded to refer to their local organisational policy on managing contact with company representatives
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