How does antibiotic ointment work?

Antibiotic Ointment & Keeping Bandages in Place

• Please provide evidence that proves (or disproves) the following: Antibiotic ointment applied to a wound site reduces the adherence of bandages or dressings. This is due to the oily nature of the petrolatum base in the ointment. As a result, surgeons/staff may utilize 1 of 2 strategies in post op wound care, cosmetic surgery, etc. 1)forgo the application of antibiotic ointment knowing the bandage will fall off 'too soon', or 2) redress the wound more often and reapply the ointment more often then if the dressing stayed in place. An excellent tip will be provided for an excellent response received in the next 2-3 days. Thanks.

• Answer:

  Hello Jaleva, I?m afraid I will have to disprove your theories that surgeons or medical staff forgo the use of antibiotic ointment, if indicated, AND, that dressings are reapplied more frequently due to non-adhering dressings. After an exhaustive search and my healthcare experience, I conclude that your two strategies are a non-problem for medical staff. I found no articles describing problems with ointments and dressings falling off. Non-adherence of a dressing due to greasy ointments may happen to us at home, when applying excess ointment, to be covered with a band-aid, but it is not a problem for post-operative wounds today. There are numerous medical products that can be utilized to keep post-op dressings in place, designed to stay in place either by adhering to dry skin further than the perimeter of the wound?s edge, or a wrap around type of bandage. Wound dressing retention apparatus? may be used as well. In addition, if the wound is in a part of the body that makes wrapping a bandage difficult, then health care personnel may decide to use a water-soluble ointment to eliminate adherence problems. The decision may be made to leave the wound undressed, with only an ointment if deemed necessary. The use of water-soluble ointments, gels or sprays may be utilized, or dressings with built in antibiotics. It all depends on the type of patient, the type of wound, and the location of the wound ? not due to the risk of the dressing falling off. Applying topical agents ?In many chronic wounds, topical agents are used to change the environment of the wound bed. Many times, topical antibiotics or antiseptic agents are applied. This will decrease bacteria while allowing the natural healing processes to continue. If the wound is too dry, moisturizing agents such as saline gels may be added. If there is still necrotic tissue in the base of the wound, then mild enzymes can be added to assist the body in removing this dead tissue in allowing it to come out of the wound. The topicals are most often applied with a cotton tip applicator or a wooden applicator stick directly to the base of the wound. The base of the wound should be coated with about as much topical as icing on a cake.? http://www.maexamhelp.com/wound_dressg.htm ?Unlike ordinary gauze dressings or bandages, wound dressings are special because they help keep an ideal level of moisture in the wound. Decades of research have shown that the closer the wound?s moisture level is to that of healthy skin, the better the wound?s chance that it will heal. This concept is called moist wound healing. Keeping wounds covered. Although you may think otherwise, keeping a dressing in place for several days aids in the early healing process because the wound is left undisturbed. This is important because it provides a moist environment as well as keeps the wound at body temperature--conditions necessary to promote healing. To explain further, frequent dressing changes cool the temperature of a wound by exposing it to the air. This slows the healing process until the body can rewarm the area. So changing wound dressings less frequently actually assists the healing process.? ?Note: Your doctor is the final judge in deciding which wound dressing is best for your wound.? http://www.clevelandclinic.org/health/health-info/docs/3800/3820.asp?index=12223&src=news ?Irrespective of the nature of the wound contact layer, most dressings also require the use of a bandage or some form of adhesive layer to keep them in position. This adhesive layer may be separate, or be an integral part of the product itself, forming an island dressing in which the low-adherent pad is located centrally on a sheet of plastic, foam, or fabric, coated with adhesive. Whilst this adhesive area does not come into contact with the wound and therefore cannot cause damage to the newly formed tissue, repeatedly removing and replacing such dressings can damage the surrounding skin, especially if the patient is elderly or the skin is particularly fragile.? ?In a second paper involving the management of hand wounds, Mepitel was compared with paraffin gauze and Adaptic, an apertured cellulose acetate non-adherent dressing coated with a petrolatum emulsion [16]. A total of 108 patients undergoing hand surgery were recruited to the study and randomly assigned to treatment with one of the three products under examination. The selected primary dressing was covered with gauze and a crepe bandage together with a plaster of Paris splint as appropriate. The dressing was left intact until the first follow-up appointment. The performance of each dressing was judged in terms of ease of application and removal, amount of blood on secondary dressing, appearance and condition of the wound and pain experienced during dressing removal. Removal of Adaptic and Mepitel was reported to be 'very easy' for 88% and 84% of wounds respectively, compared to 57% of wounds dressed with paraffin gauze. This difference achieved significance for Adaptic but not Mepitel. Pain scores were also lower for Adaptic-treated patients, 75% of whom experienced no pain compared to 56% for Mepitel and 51% for paraffin gauze. All dressings were more difficult to remove from raw tissue and although Mepitel appeared to perform better than the other products in this situation, insufficient numbers of subjects with this type of wound prevented further analysis. The reason for the relatively poor pain scores achieved with Mepitel was discussed by the authors who suggested that this was probably due to the dressing adhering to the intact but bruised or injured skin around the wound. The authors concluded that of the three dressings, Adaptic had significant advantages over the other products examined in terms of performance and cost, and recommended it as the dressing of choice for this particular application. Mepitel, they suggested, could be used with advantage on wounds such as raw nail beds, as reported some years earlier by Williams [17] who also described its use following traumatic amputation of the fingers, and in the treatment of a dehisced abdominal wound.? ?One Allevyn Adhesive dressing was sufficient for the treatment period of one donor site in 18 out of the 44 patients. In six patients, half the donor site dressed with paraffin gauze became infected and took up to 14 days to heal, compared with the other half dressed with Allevyn Adhesive which healed within 4 days. No infection occurred in the trial site, suggesting that the risk of infection was reduced when using Allevyn Adhesive for this treatment. The Allevyn Adhesive dressing was shown to be cost-effective.? http://www.worldwidewounds.com/2003/january/Thomas/Atraumatic-Dressings.html ?The necessary dressing changes several times a day and the maintenance of an even moisture level in the dressings, in addition, make considerable demands on nursing time, naturally associated with great costs, and can only be offered to a satisfactory degree in clinical care units disposing of a sufficiently equipped medical staff. In ambulatory wound treatment, the use of this sort of moist dressings is limited from the outset, because only one nursing visit is usually scheduled per day, per patient or person in need of care.? ?Upon absorption of wound secretions, the hydrocolloid components of the dressing start to swell and transform into a gel that expands into the wound and maintains a moist environment. The gel remains absorbent until the hydrocolloids are saturated. Sucking activity and absorption capacity of the dressing thus depend on the properties and amounts of incorporated hydrocolloid particles. Due to the self-adhesive properties of the elastomer, Hydrocoll can be applied to the wound like an adhesive bandage, which considerably simplifies its handling. Upon gel formation, adhesion over the wounded area declines, so that Hydrocoll remains attached only to the intact surrounding skin, and is thus extremely gentle to the injured tissue. Moreover, a protective gel-layer remains on the wound at dressing removal, ensuring an absolute atraumatic dressing change. Hydrocoll is self-adhesive. Because self-adhesion over the wounded areas tends to decline, as has been mentioned before, the size of Hydrocoll should be chosen so that the dressing exceeds the wound edges by at least 2 cm. For larger wounds, several Hydrocoll dressings can be applied in an overlapping manner, also exceeding the edges of the wound by 2 cm each.? http://www.hartmann-online.de/english/produkte/wundbehandlung/wundforum/sond1_1.htm ?A dressing is a clean cover over an incision. A gauze dressing is secured to the skin with surgical tape. Some dressings are clear and adhere to the skin without tape. The purpose of a dressing is to keep the incision (or wound) clean, dry, and protected during the healing process. A dressing also absorbs any drainage that may come from the incision or wound. Sometimes dressings are used after a medication is applied to the incision or wound; the dressing keeps the medication in contact with the incision or wound. http://patienteducation.upmc.com/Pdf/IncisionCare.pdf You?ll find lots of information on wound care in this article, by Hartmut Gross, M.D., FACEP, Medical College of Georgia: ?The basic principles of wound care are simple, as long as one keeps in mind what the intent of the care being rendered is. First of all, one must remember that the wound heals itself. If the patient is not mortally wounded, then the wound will heal all by itself. The physician who believes that he made the wound heal is deluding himself and does not understand wound healing. So, what is the big deal and what are the doctors good for if the wound is going to heal no matter what? In essence, the objective is to restore tissue integrity, and function, while avoiding infection and morbidity, and minimizing scarring. To achieve this outcome, a thorough understanding of wounds is necessary.? http://www.mcg.edu/som/clerkships/EM/woundmgtManual.PDF ?Some wound coverings provide poor protection for the wound and must be kept dry to ensure they continue to adhere to skin. This has led to the development of occlusive dressings that greatly reduce the potential for bacterial contamination and speed healing by creating a bacteria-free moist environment, preventing the formation of scabs. Band-Aid Liquid Bandage is a novel occlusive dressing that uses a liquid adhesive formulation. This approach has been used successfully in reconstructive surgery to provide suture-free superficial skin closure, and it works rapidly to control bleeding and pain? ?Finally, patients should not self-treat any wound that requires more antibiotic ointment than can cover the surface area of the tip of a finger. Many patients misunderstand and apply medication to a wound that is too large for self-treatment.? http://scholar.google.com/scholar?hl=en&lr=&q=cache:6DLqpybQD-UJ:www.aphanet.org/JAPHA/marapr03pdfs/13-popovich-otcs_249-260.pdf+wound+dressing+%2B+adhering+%2B+neosporin ?Topical antimicrobial, antifungal, and antibiotic products are available as ointments, impregnated into gauzes or other types of dressings, and as sprays or powders. Some antibacterial dressings may help decrease wound odor, although they also may emit a chemical odor of their own.? http://www.findarticles.com/p/articles/mi_qa3964/is_199905/ai_n8845496/pg_2 ?Higher-tech dressings that can increase the time between dressing changes are another component of the wound care program. Lower-end dressings, like gauze, are not necessarily the best. "Many times we'll find that gauze is the least cost-effective dressing because it has to be changed too often," says Gill. "So we're looking at composite dressings that can absorb drainage and provide odor control and keep an ideal wound environment with less frequent dressing changes."? ?Even if topical antibiotics are included in the therapy, they will be Bacitracin or Neosporin, which are both offered over the counter. "Review of the literature feels that all it does is set the patient up for MRSA because you're treating a broad spectrum of bugs that are sitting on the wound," Gill says. "But unless they're there in sufficient quantities to actually cause infection, you're just giving antibiotics for no good reason. The other thing is, patients oftentimes develop an allergy to long-term use with Neosporin or Bacitracin because of the vehicle they're mixed in--(like) petroleum jelly."? http://www.infectioncontroltoday.com/articles/331topics.html ?May apply an antibiotic ointment, such as Bacitracin or Neosporin to area, if not allergic. 10. Do not cover wounds on face. Leave open to air. 11. Apply a loose, sterile, non-adhering dressing, such as telfa, or a band-aid until a firm scab forms. Then leave open to air. 12. Bathe (do not soak) or shower as usual and gently cleanse the wound daily. 13. Change dressing at least daily and it it gets wet. May need to soak it off to avoid pulling off scab.? http://72.14.207.104/search?q=cache:dTbrCNu7JvgJ:www.mckennan.org/hubs/ask-a-nurse/health_lib/lacerations.htm+wound+dressing+%2B+adhering+%2B+neosporin&hl=en&gl=us&ct=clnk&cd=8 ?Dressings should be changed from 1 to 3 times daily, depending on the amount of drainage. Hydrocolloids (DuoDERM; ConvaTec, a Bristol-Myers Squibb Company, Princeton, NJ; Restore; Hollister Inc, Libertyville, IL; RepliCare; Smith & Nephew, Largo, FL) may be left in place for 5 to 7 days. Although transparent films (Tegaderm; 3M Health Care, St Paul, MN; OpSite; Smith & Nephew, Largo, FL; POLYSKIN II; Kendall, Mansfield, MA) do not adhere well to areas with skin folds, they may have advantages when compared with hydrocolloids and hydrogels.? http://www.findarticles.com/p/articles/mi_qa3977/is_200209/ai_n9125760/pg_2 ?CHANGE DRESSING: ? Wear time varies from 1 to 3 days according to amount of exudate. ? Easily removed with normal saline (or in the shower at home) http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/SupportiveCare/ChronicUlceratingMalignantSkinLesions/RecommendedProducts.htm ?The vehicle in which the topical antibiotic is formulated also provides some occlusive effect when liberally applied to a wound, but this effect is not comparable to that provided by an occlusive dressing. Some vehicles, such as petrolatum, may prevent the dressing from adhering to the wound, thus lessening pain and soreness during and after dressing changes.? ?Prophylactic topical antibiotic use makes particular sense for wounds in which the risk of infection is high, such as those that are likely to be contaminated (accidental wounds, lacerations, abrasions, and burns). Because all traumatic wounds should be considered contaminated, topical antibiotics are a logical measure to prevent wound infection.? When applied to skin that is free of chronic skin disorders, the intermittent use of topical antibiotic for prophylaxis and treatment of infection in minor skin wounds is not a clinically important issue. There is a great need for controlled studies in individuals with normal skin to provide the evidence needed to change the continuing misperception that contact dermatitis is a risk with neomycin-containing topical antibiotics. Data to date support that this perceived risk, perpetuated by medical schools and held by a large portion of the medical community, is grossly overstated.? http://www.medceu.com/course-no-test.cfm?CID=997 ?After application of the antiseptic, dry the wound and the surrounding tissues, and apply an antibiotic ointment, such as Neosporin Ointment, directly to the wound with a cotton swab to avoid any contamination. Select an appropriate bandage to cover the scrape with. Keep in mind cost, location of the wound (i.e., knee) and amount of exudates. Any hydrocolloid dressing would be appropriate for this patient since there is little to no exudates. A product such as a flexible adhesive bandage would allow flexibility at the knee.? Page 4 of this document by Pharmacist Continuing Education and Johnson and Johnson illustrates some of the newer bandages: https://www.cedrugstorenews.com/userapp/lessons/page_view_ui.cfm?lessonuid=&pageid=981A479F3535604148321774019B8DF9 ?Post-operatively, the patient had an infectious disease consult, and, based on the culture results, had the intravenous antibiotics changed. We provided local wound care by advancing the packing and applying saline wet-to-dry dressings. After one week of this course of treatment, the patient was discharged. We followed up with the patient until achieving wound closure via secondary intention. Within 10 weeks, the patient was fully healed.? http://scholar.google.com/scholar?hl=en&lr=&q=cache:wardvr5EBOcJ:www.mmhc.com/podtd/displayArticle.cfm%3FarticleID%3Dpod_200107f3%26type%3DA+wound+care+%2B+neosporin Keep in mind that petrolatum based ointments are not always used. ?Proper wound care is essential to the prevention of surgical site infections, such as those caused by MRSA and VRE. Wound dressings must maintain a moist environment for optimal healing while creating a barrier against harmful bacteria. Microban® antimicrobial product protection is now built-in during the manufacturing process to FDA approved wound dressings. Microban technology is effective against a broad range of gram positive and gram negative bacteria, providing continuous antimicrobial protection that prevents proliferatioin of bacteria on and in the dressing.? http://www.microban.com/americas/products/category.html?lang=en&CategoryID=5&SubcategoryID=174 ?Silverlon® Wound Contact Dressings can be applied as a wound contact layer between the wound surface and V.A.C.® (Vacuum Assisted Closure?) porous polyurathane foam sponge. The V.A.C.® assists in wound closure by applying localized negative pressure to the edges of the wound. The Silverlon® Wound Contact Dressing is porous enough so as not to interfere with the negative pressure generated by the V.A.C. device. The Silverlon® Wound Contact Dressing should be changed when the VAC sponge is changed.. ? Silverlon® Wound Dressings Applied with Apligraf® The Silverlon® Wound Pad may be applied on top of the Apligraf® dressing. The Silverlon® Wound Dressings should be moistened with water and changed every second to every day. The effectiveness of the dressing is increased by keeping the Silverlon® pad moist.? http://www.keomed.com/silverlon/silverlon_wound_protocol.asp ?Silver dressings are another option; because silver controls a broad spectrum of pathogens, it helps prevent infection in the wound and reduces time and costs associated with wound care. More homeopathic remedies are sometimes incorporated to promote wound healing. "Alginate, like Kaltostat, (is) a moisture absorber; it's a dressing for the highly exudating," says Gill. "(In addition, you're using) any kind of secondary -- it depends on what the goal of the dressing is and what type of wound it is. We are more and more looking to do less frequent wound care with higher tech products. A lot of times we'll often put alginate on highly exuding wounds but put them into a dressing we won't change for a week." ?This demonstrates the bulk dressing on the wound. The dressing should be changed twice daily, and the wound irrigated with sterile saline in an attempt to further remove any debris, including necrotic tissue.? http://medstat.med.utah.edu/kw/derm/pages/wopu_7.htm ?This shows a bulky dressing applied on top of the non-adherent dressing to absorb the bleeding that will occur over the next hour or two after debridement. The wound should be gently cleansed once or twice daily with dilute Hibiclens (one part Hibiclens and three parts water), and then the Silvadene or Polysporin ointment can be applied followed by the non-adherent dressing and a bulk dressing if necessary.? http://medstat.med.utah.edu/kw/derm/pages/woge_10.htm ?Dry the surgery site with a Q-tip or gauze pad ? Apply a thin layer of antibiotic ointment directly over the surgery site. NEVER reapply ointment from the tube to a used Q-tip. Please contact our office if you develop increased redness or itching from use of your antibiotic ointment. ? Cut the Telfa (non-stick) pad to fit the size of the surgery site and secure with paper tape. ? When you are inside, a bandage is not necessary as long as you have adequate coverage with your antibiotic ointment.? ?After initial removal of your bandage, you may bathe normally (keep any skin graft dry. After showering, please dry the surgical area and proceed with your wound care.? http://www.goslencenter.com/imagesGoslen/POSTOPINSTRUCTIONS.pdf ?The use of an occlusive dressing and an antibiotic solution to maintain surface moisture is now a common approach to management of the meshed skin graft (or excised wound) The most common current approach is to use the moist wound healing techniques using a topical antibiotic solution beneath an occlusive dressing.? http://www.journalofburnsandwounds.com/education/module01/module01_01.pdf ?The goal of wound dressings is to protect the wound from infection and promote a moist environment. There are hundreds of dressing products available. The dressing of choice depends on the wound. Skin tears (partial-thickness wounds) are acute wounds secondary to tape or transparent occlusive dressings and should be cared for using an Adaptic-type dressing (without iodine/Betadine additives) that is then covered with a Kling- or Kerlix-type dressing to avoid further tearing of the skin. It is important to minimize the use of adhesives in all forms for patients prone to skin tears.? http://connections.lww.com/Products/morton/documents/pdfs/morton_ch52.pdf ?An ointment gauze, generally applied on top of a coat of Polysporin ointment or Silvadene cream, helps to also keep the wound moist.? http://medstat.med.utah.edu/kw/derm/pages/woge_14.htm ?Tegaderm or other similar transparent dressings that allow for transfer of gases, such as air and water vapor, but are impermeable to liquids, are an excellent dressing for wounds that are not draining much.? http://medstat.med.utah.edu/kw/derm/pages/woge_18.htm ?Non-adherant Pads Non-adherant pads are useful to cover open wounds such as burns and abrasions. The brand known best is Telfa. The pad keeps the dressing from sticking to the wound. After cleaning the wound, antibiotic ointment is applied. Be sure the patient isn't allergic to the antibiotic. The non-stick pad is placed next, then a gauze pad to cushion and protect. A kling wrap keeps the gauze in place.? ?Padding Roll Gauze Padding roll gauze is very useful to cushion large wounds. It's often called "Kerlix," which is a specific brand. It can be used in place of a kling wrap in the dressing, and for many wounds provides enough padding that gauze pads are not required. It absorbs ooze or blood, and prevents dryness in an open wound. The padding roll gauze can also be used for compression dressings, for example to compress a sprained ankle. Apply it under the elastic wrap.? http://www.utahmountainbiking.com/firstaid/bandage.htm Disregard the non-sterile technique of applying Neosporin in the illustration. The photos are from a mountain biker?s site, and we?ll grant them a bit of leeway for not having proper medical supplies for applying an ointment! But notice how a gauze kling type of bandage is used to hold the dressing in place. ?Place a non-stick pad over the wound. It should be large enough that it can slide or shift a bit without uncovering the wound. Telfa and Adaptic are sample brands. If additional padding is needed, put gauze pads over the non-stick pad to provide thickness, or use a padded roll gauze (sample brand Kerlix) to cushion the area.? http://www.utahmountainbiking.com/firstaid/dressing.htm ?After cleansing the wound, Treat the wound with a more long lasting ointment or cream designed to provide long lasting protection against skin irritation or infection. Swift Triple Antibiotic Ointment is a combination of bacitracin, neomycin and polymyxin B, three common antibiotics which are capable of killing various ranges of infection including the most common strain: ?staph?. Embedded in a petrolatum base (similar to petroleum jelly, ie; Vaseline) the triple antibiotic ointment keeps the wound moist and provides long term infection protection. Keeping the wound moist minimizes scabbing and as a result minimizes scarring as well and shortens the time necessary for complete wound healing. Additional ointment should be applied each time a new bandage dressing is applied. Every workplace first aid first aid kit should include triple antibiotic ointment. First aid cream should be included in workplace first aid kits where there is a possibility of scratches and large abrasions. The first aid cream provides necessary moisture in a cream base that penetrates the skin and aids in the healing process. Subsequent bandaging is not required when utilizing first aid cream.? http://www.firstaidsuppliesonline.com/news/?p=8 ?Hydrogel dressings contain a large portion of water, often more than 70-90%. They have some important characteristics of an ideal dressing. Hydrogels can cool the surface of the wound, resulting in marked pain reduction. Moreover, hydrogels maintain the moist wound environment and are mostly suitable for use on dry or necrotic wounds or on lightly exuding wounds. They are suitable for use at all stages of wound healing except for infected or heavily exuding wounds. Hydrogels are a good alternative for classic wet dressings. In some cases, however, hydrogels may macerate the healthy skin (mostly wound border areas), decreasing the keratinocyte reepithelialization ratio or leading to overwetting of split-skin donor sites. Hydrogels are available as sheet dressings or gels.? http://www.emedicine.com/derm/topic826.htm ?The skin is covered with an occlusive dressing consisting either of multiple layers of waterproof tape or petroleum jelly to prevent evaporation of the phenol, allowing for increased penetration and burn depth. The peeled skin is maintained by daily cleansing and consequent reapplication of ointment, which keeps the surface moist and prevents desiccation. If this protocol is followed, healing is completed within 5-7 days.? http://www.emedicine.com/plastic/topic492.htm You?ll have to obtain a free registration to read this entire article: ?The performance of dressings significantly affects wound healing and quality of life for patients. Despite extensive collective nursing care experience, uncertainty remains about the optimum choice of many parameters that affect dressing performance, such as shape, extensibility, and fixing position. A technique was developed to investigate some of the parameters involved in the fixing of dressings for acute and chronic wounds. Representative mobile areas in the upper torso, neck, and leg were chosen for surface modeling. Digital surface photogrammetry was used to obtain surface data for various sites in young, middle-aged, and elderly subjects. In each case, landmarks were used to identify a grid of points in a region of skin, and the relative movements of the points were found following typical movements of the appropriate body part. The amounts and orientation of deformation of the skin were computed and displayed in such a way that some preliminary hypotheses could be made concerning why dressings may fail in practice.? http://www.medscape.com/viewarticle/521450 All kinds of dressing supplies =============================== http://www.sharedomaha.com/Catalog/08_Woundcare.pdf http://www.medifair.com/woundcare.html A small cut can use adhesive bandages with antibiotic ointment embedded in the bandage: http://www.drugstore.com/qxp12928_333181_sespider/band_aid_antibiotic/adhesive_bandages_with_antibiotic_ointment_assorted_sizes.htm I hope this has helped! If this is not the information you are seeking, please request an Answer Clarification, and allow me to respond. I will pleased to assist you further, before you rate this answer. Sincerely, Crabcakes Search Terms ============= wound dressings + techniques post-operative wound dressings + TAO wound dressing + adhering + Neosporin non-adhering wound dressings dressing retention devices