To analyze the effectiveness of interventions and to offer patient-centered care. They include: It is important to note that not all cases of cellulitis are medical emergencies. Hypertension (HTN) is a chronic disease that requires long-term, Making the correct diagnosis is key to management. WebAntihistamine drugs should be administered 1.Patient who have cellulitis develop a cycle of itch- scratch and the scratching worsens the itching (Nazik et al., 2020). Three studies with a total of 88 people comparing a penicillin with a cephalosporin showed no difference in treatment effect (RR 0.99, 95% CI 0.68 to 1.43). I will assess and monitor closely for signs of deteriorating infection. Nursing interventions are centered on an antibiotic regimen while practicing proper wound care to prevent complications. Select personal protective equipment (PPE) where appropriate. Cellulitis is simply defined as an acute infection of the skin involving the dermis and subcutaneous tissues. I have listed the following factors that predispose individuals to cellulitis, A weak immune system allows bacteria to easily lodge in a person who is unable to fight off the infection, People with breaks in the skin, such as athlete's foot and eczema, provide points of entry for cellulitis-causing bacteria, Intravenous drug use also provides a break in the skin that could be an entry point for pathogens, Patients living with diabetes have sluggish wound healing, and extended exposure to wounds predisposes them to bacterial infections, History of cellulitis in the family or the patient, Lymphedema, a chronic localized swelling of the upper and lower extremities, Widespread tissue damage and tissue death( gangrene), Infection can spread to other body parts such as blood, bones, lymph system, heart, and nervous system, leading to shock and sometimes death ( sepsis), Septic shock-untreated cellulitis can cause unwarranted stress to body organs, causing numerous organ failure, Meningitis is an infection of the exterior cover of the brain. Technique. WebPathophysiology Cellulitis is a common deep bacterial skin infection that causes redness, swelling, and pain in the affected area of the skin (usually the arms and legs). The company was founded in 1985 by Are you Seeking online help with a Physics project? If the WBC and CRP continue increasing, it indicates a worsening infection. cavities. Cellulitis is an infection that occurs when bacteria enter the skin, causing a dented appearance attributed to fatty Infections of the Skin, Muscles, and Soft Tissues. We identified 25 randomised controlled trials. Treatment includes antibiotics. I have listed the following factors that predispose individuals to cellulitis. The inflammatory response then occurs, exhibiting the hallmark characteristics of cellulitis (i.e., redness, pain, hot skin, and swelling). No two trials investigated the same antibiotics, and there was no standard treatment regime used as a comparison. If you are not familiar with wound assessment/debridement confer with a senior/expert nurse. WebAnyone can get cellulitis, but the risk is higher if you have a skin wound that allows bacteria to enter your body easily or a weakened immune system. Patients with severe or necrotising infections should have initial broad spectrum antimicrobial cover to include staphylococci, streptococci, Gram-negative organisms and also an agent with activity against toxin production in group A streptococci, such as clindamycin or linezolid.12,15 Treatment with an agent active against methicillin-resistant S aureus (MRSA) should be considered in patients with a known history of, or risk factors for, MRSA colonisation as well as in those with suspected necrotising fasciitis.12 Recent prospective trials in the USA have suggested that empiric use of agents active against MRSA may not be warranted in the treatment of non-purulent cellulitis.20, There is little evidence to support the historical practice of adding benzylpenicillin to flucloxacillin in the treatment of cellulitis.21 In a randomised double-blinded trial comparing flucloxacillin and clindamycin with flucloxacillin alone, there was no difference in clinical improvement or the resumption of normal daily activities, but there was increased diarrhoea in the clindamycin group.22 Brunn et al found that early antimicrobial escalation (during the first 3days of therapy) did not result in improved outcomes and addressing non-antibiotic factors such as limb elevation and treatment of comorbidities should be considered as an integrated part of the clinical management of cellulitis.23, Outpatient parenteral antimicrobial therapy has become an increasingly important means of delivering ambulatory care. Ignatavicius, D., Workman, M., Blair, M., Rebar, C., & Winkleman, C. (2016). Debridement is the removal of dressing residue, visible contaminants, non-viable tissue, slough or debris. In some cases of cellulitis, the entry point may not be evident as the entry may involve minute skin changes or intrusive qualities of some infectious bacteria. The Infectious Disease Society of America recommends hospitalization for patients with cellulitis under certain circumstances but there is little actual clinical evidence to guide the decision to admit. For more information follow the Nursing interventions are aimed at prevention. I must conduct nursing assessments with the knowledge that, cellulitis infections sometimes look like common skin infections, I will assess the patient's medical history to identify the presence of comorbid illnesses that may increase the risk of cellulitis. Unlike many contagious bacterial infections, we must note thatcellulitis is not infectious and cannot be spread from person to person. Hospital Episode Statistics for England 201415, Mandell, Douglas, and Bennett's principles and practice of infectious diseases, Use of cultures in cellulitis: when, how, and why, Erysipelas, a large retrospective study of aetiology and clinical presentation, Erysipelas: clinical and bacteriologic spectrum and serological aspects, Improvement of a clinical score for necrotizing fasciitis: Pain out of proportion and high CRP levels aid the diagnosis, Distinguishing cellulitis from its mimics, Risk factors for erysipelas of the leg (cellulitis): case-control study, Risk factors for acute cellulitis of the lower limb: a prospective case-control study, Association of athlete's foot with cellulitis of the lower extremities: diagnostic value of bacterial cultures of ipsilateral interdigital space samples, Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America, Costs and consequences associated with misdiagnosed lower extremity cellulitis, Severe lower limb cellulitis is best diagnosed by dermatologists and managed with shared care between primary and secondary care, Managing skin and soft tissue infections: expert panel recommendations on key decision points, Guidelines on the management of cellulitis in adults, Severity assessment of skin and soft tissue infections: cohort study of management and outcomes for hospitalized patients, A predictive model for diagnosis of lower extremity cellulitis: A cross-sectional study, National Institute for Health and Care Excellence, Sepsis: recognition, diagnosis and early management, Clinical trial: comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial, Flucloxacillin alone or combined with benzylpenicillin to treat lower limb cellulitis: a randomised controlled trial, Adjunctive clindamycin for cellulitis: a clinical trial comparing flucloxacillin with or without clindamycin for the treatment of limb cellulitis, Early response in cellulitis: A prospective study of dynamics and predictors, Gilchrist DM. Moisture/ exudate is an essential part of the healing process. These two terms are now considered different presentations of the same condition by most It also commonly appears on your face, arms, hands and fingers. By using any content on this website, you agree never to hold us legally liable for damages, harm, loss, or misinformation. Assess the skin. Outlined in the Procedures: Even if healing is apparent. I present the following clinical manifestations that are apparent in most cellulitis infections. Your health care provider will likely be able to diagnose cellulitis by looking at your skin. Cleaning and trimming your fingernails and toenails. cavities, -Ideal for bleeding wounds due to haemostatic properties, Change every 1-7 days depending on exudate. Stevens, DL, Bryant AE. In: Loscalzo J, Fauci A, Kasper D, et al., eds. These include actual and risk nursing diagnoses. Surprisingly, oral antibiotics appeared to be more effective than antibiotics given into a vein for moderate and severe cellulitis. Assess for pain, noting quality, characteristics, location, swelling, redness, increased body temperature. Exposure of a skin break to salt or fresh water is associated with Vibrio vulnificus and Aeromonas spp respectively.2, Group A streptococci can be associated with the development of necrotising fasciitis, although this can also be due to mixed infection including Gram-negative and anaerobic organisms, particularly in the elderly and immunosuppressed.2. ODOUR can be a sign of infection. Advertisementsif(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[250,250],'nurseship_com-leader-2','ezslot_8',662,'0','0'])};__ez_fad_position('div-gpt-ad-nurseship_com-leader-2-0');Cellulitis is most commonly caused by group A streptococci (Streptococcus pyogenes). Dispose of single-use equipment into waste bag and clean work surface, a. Single-use equipment: dispose after contact with the wound, body or bodily fluids (not into aseptic field), b. Multiple-use equipment: requires cleaning, disinfection and or sterilisation after contact with the wound, body or bodily fluids. Careful clinical examination may reveal a portal of entry such as ulcers, trauma, eczema or cutaneous mycosis.5 The finding of bilateral lower limb erythema in an afebrile patient with normal inflammatory markers should prompt the clinician to reconsider the diagnosis of cellulitis.8 Systemic features and groin pain are common and may predate the onset of skin changes.5 Skin breaks, bullae or areas of necrotic tissue may be present in severe cellulitis. I will also evaluate blood cultures to identify the specific pathogen that will guide antibiotic treatment, I will closely assess patients with chronic conditions such as diabetes and other risk factors such as suppressed immune system, as these factors predispose patients to worsen infections. Nursing Interventions for Cellulitis: Rationale: Assess the patients skin on his/her whole body. However, if cellulitis is left untreated it can cause life-threatening complications such as sepsis. Cellulitis is a bacterial infection that causes inflammation of the dermal and subcutaneous layers of the skin. The program will also give information on managing any complications that may arise. Skin breaks, lymphedema, venous insufficiency, tinea pedis and obesity have been associated with an increased risk of lower limb cellulitis in case control studies.911, Assessment of baseline liver and renal function may be useful for assessing end-organ dysfunction in patients with sepsis and for dosing of antimicrobials. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Clean and assess the wound (wound and peri wound should be cleaned separately if washing the patient), 9. Royal College of Physicians 2018. Method for Mastering Nursing Pharmacology, 39 Things Every Nursing Student Needs Before Starting School. Oral antibiotics may include dicloxacillin or cephalexin. As a nurse, I will assess subjective and objective data when assessing the patient for cellulitis. Nursing Interventions for the Risk of Impaired skin integrity linked to cellulitis. Elsevier. This will ensure the healthcare teams have the information to deliver safe and effective patient care for cellulitis infections. Hinkle, J., & Cheever, K. (2018). Art. WebWound care: This is an important part of treating cellulitis. To diagnose cellulitis, your healthcare provider will ask about your symptoms and perform a physical examination of the affected area. NURSING DIAGNOSES: Definitions and Classifications 2021-2023 (12th ed.). Blog Institute for Quality and Efficiency in Health Care. Skin surface looks lumpy or pitted, like an orange skin. Nursing Diagnoses Handbook: An Evidence-based Guide to Planning Care (12th ed.). The expected nursing goals and outcomes for the individual are: Nursing assessment and diagnosis for risk for infection. following is an illustration of cellulitis infection on the legs. Assist patient to ambulate to obtain some pain relief. Procedure Management Guideline. Cellulitis usually appears around damaged skin, but it also occurs in areas of your skin with poor hygiene. You can reduce your risk of developing cellulitis by: With early diagnosis and treatment, the outlook for people with cellulitis is good. Cultures of blood, aspirates or biopsies are not recommended but should be considered in patients who have systemic features of sepsis, who are immunosuppressed or for cases associated with immersion injuries or animal bites.12. Use warm water and mild soap, The infected areas must remain clean at all times to promote healing, Encourage patient to stop itching affected skin areas, To avoid worsening the skin inflammation even further, Educate the patient on appropriate hand hygiene and cut their fingernails if they are long, Long fingernails harbor bacteria which are a risk for infections, Use skin indicators to mark the affected skin areas and check for reduction or spread of infection, To determine the effectiveness of interventions particularly the antibiotic energy and if there is need to change, Educate the patient on signs of a deteriorating infection. Place Your Order to Get Custom-Written Paper. A wound is a disruption to the integrity of the skin that leaves the body vulnerable to pain and infection. Risk for infection related to a decrease in immune function, non-adherence to antibiotic treatment, broken skin barriers, chronic illnesses, malnutrition, and poor hygiene practices. National OPAT Conference, 2015 Apr 13; Business Design Centre, London, Factors associated with outcome and duration of therapy in outpatient parenteral antibiotic therapy (OPAT) patients with skin and soft-tissue infections, Comparison of short-course (5days) and standard (10days) treatment for uncomplicated cellulitis, Penicillin to prevent recurrent leg cellulitis, CME Infectious diseases (113044) self-assessment questionnaire. treatment and management plans are documented clearly and comprehensively. Bacterial Diseases. Cellulitis isnt usually contagious. Nursing care plans: Diagnoses, interventions, and outcomes. If you do this yourself, you will: Remove the old bandage and packing. This review looks at interventions for the skin infections 'cellulitis' and 'erysipelas'. Cellulitis is a bacterial subcutaneous skin infection. Our primary outcome 'symptoms rated by participant or medical practitioner or proportion symptom-free' was commonly reported. The infection most commonly affects the skin of the lower leg but can infect the skin in any part of the body, usually following an injury to the skin. While the British Society for Antimicrobial Chemotherapy (BSAC) expert panel recommendations and UK Clinical Resource Efficiency Support Team (CREST) guidelines recommend use of the Eron classification of cellulitis in order to grade severity,15,16 the lack of a clear definition of systemic sepsis and ambiguous and potentially overlapping categories have hampered its use in clinical practice. WebNarrow spectrum penicillins targeting streptococci and staphylococci (in the case of purulent infection) should be the mainstay of antimicrobial therapy The natural history of cellulitis 50 Flemington Road Parkville Victoria 3052 Australia, Site Map | Copyright | Terms and Conditions, A great children's hospital, leading the way, standard aseptic technique or surgical aseptic technique, RCH Procedure Skin and surgical antisepsis, Parkville EMR | Nursing Documenting Wound Assessments (phs.org.au), Clinical Images- Photography Videography Audio Recordings policy, Pain Assessment and Management Nursing Guideline, Procedural Pain Management Nursing Guideline, Infection Control RCH Policies and Procedures, Pressure injury prevention and management, evidence table for this guideline can be viewed here, The goal of wound management: to stop bleeding, The goal of wound management: to clean debris and prevent infection, The goal of wound management: to promote tissue growth and protect the wound, The goal of wound management: to protect new epithelial tissue, Cellulitis: redness, swelling, pain or infection, Macerated: soft, broken skin caused by increased moisture, Wound management practices and moisture balance (e.g. Nausea is associated with increased salivation and vomiting. Treatment includes antibiotics. Our expert physicians and surgeons provide a full range of dermatologic, reconstructive and aesthetic treatments options at Cleveland Clinic. ALL-IN-ONE Nursing Care Planning Resource (4th ed.). Assess the surrounding skin (peri wound) for the following: Pain is an essential indicator of poor wound healing and should not be underestimated. Let it sit for about 30 minutes, and then rinse it off with clean water. The read-only self-assessment questionnaire (SAQ) can be found after the CME section in each edition of Clinical Medicine. Nursing Diagnosis: Risk for infection related to a decrease in immune function, non-adherence to antibiotic treatment, broken skin barriers, chronic illnesses, malnutrition, and poor hygiene practices. Transmission based precautions. Contact us Sample nursing care plan for hyperthermia. Debridement can be enzymatic (using cleansing solutions), autolytic (using dressings) or surgical. Patients with a history of cellulitis, particularly of the lower limbs, have an estimated recurrence rate of 820%.12 Patients with recurrent cellulitis should be carefully evaluated for any predisposing factors such as lower limb oedema, lymphoedema, dermatitis, tinea pedis, and measures taken to address them. Educate the patient on proper skin hygiene and proper hand hygiene using water and mild soap, This helps maintain the cleanliness of the affected area and this promotes healing, Encourage the patient not to scratch affected areas and trim their fingernails if they are long, Long fingernails harbor bacteria and scratching can worsen skin inflammations, Use skin markers to mark the boundaries of the cellulitis area and observe for decrease or spread, To check the effectiveness of antibiotics and need to change if no changes are observed prevent prevent, Prevent shearing or further irritation especially if the patient is immobile and unable to guard against more skin breakdown, Be careful when repositioning the patient if they are immobile, To ensure they are not putting pressure on affected area worsening health outcomes. In most cases, you should feel better within seven to 10 days after you start taking antibiotics. Washing under a shower may be appropriate after carefully considering the risks associated with contamination from pathogenic microorganisms, Surfactants or antiseptics for biofilm or infected wounds e.g. Pain assessment and measurement guideline. Referrals to the Stomal Therapy, Plastic Surgery, Specialist Clinics or Allied Health teams (via an EMR referral order) may also be necessary for appropriate management and dressing selection, to optimise wound I will assess all lab work. If you have cellulitis on your hands or feet, it may be challenging to close your hands or walk. Cellulitis most frequently affects the periorbital area and limbs where the skin is damaged by blisters, surgical incisions, cuts, insect bites, or burns. (https://www.ncbi.nlm.nih.gov/books/NBK303987/), Visitation, mask requirements and COVID-19 information, You have a long-lasting (chronic) skin condition such as. Advancing of edges can be assessed by measuring the depth (cavity/sinus), length and width of the wound using a paper tape measure. No two trials examined the same drugs, therefore we grouped similar types of drugs together. Pain can occur from the disease process, surgery, trauma, infection or as a result of dressing changes and poor wound management practices. Oral care may make the patient feel more comfortable. Our goal is to ensure that you get nothing but the In May 2010 we searched for randomised controlled trials in the Cochrane Skin Group Specialised Register, the Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and the ongoing trials databases. WebThe goal of wound management: to stop bleeding. Signs and symptoms include redness and swelling. If you need special wound coverings or dressings, youll be shown how to apply and I will assess the patient for high fever and chills. WebCellulitis is an acute, painful, and potentially serious infection of the skin and underlying tissue affecting approximately 1 in 40 people per year. Your symptoms dont go away a few days after starting antibiotics. It may feel slightly warm to the touch. Its very important to take cellulitis seriously and get treatment right away. Chills and fever as the body fights off the infection, A feeling of warmness around the affected area, pain is felt at the site of developing cellulitis, A red, painful rash with coatings and sores that spread rapidly due to the invasion of pathogens, Swollen glands and lymph nodes from the infection, Swelling of the skin in the tender area as infections spread to the inner layer of the skin, Tender skin accompanied by an aching, dull pain, Red lines from the original location of the cellulitis, Tight, polished appearance of the skin. Standard or surgical aseptic technique is used as per the RCH Procedure Aseptic Cellulitis. These two terms are now considered different presentations of the same condition by most experts, so they are considered together for this review. stores or Many more cases are treated in primary care.1, Gram-positive cocci such as Streptococcus spp and Staphylococcus aureus are thought to be the predominant cause of cellulitis.2, Positive blood cultures are found in less than 10% of cases. The goal of wound management: to clean debris and prevent infection. No single treatment was clearly superior. A cellulitis infection may cause flu-like symptoms, including a fever higher than 100 degrees Fahrenheit (38 degrees Celsius), chills, sweats, body aches and fatigue. Obtain specimens for culture and sensitivity testing, Administration of prescribed antibiotics and pain medications, Patient family education on condition and management at home, Danger signs and symptoms of infection (such as, very high grade fever, confusion or disorientation, severe pain, dyspnea), Immunocompromised health status due to comorbidities such as HIV/AIDS, diabetes, and cancer. Human or animal bites and wounds on underwater surfaces can also cause cellulitis. We now know that when cellulitis is left untreated, it can spread to life-threatening systemic infections. Associated risk factorsAdvertisementsif(typeof ez_ad_units != 'undefined'){ez_ad_units.push([[300,250],'nurseship_com-large-mobile-banner-2','ezslot_5',644,'0','0'])};__ez_fad_position('div-gpt-ad-nurseship_com-large-mobile-banner-2-0'); Cellulitis is a condition affecting skin caused by exogenous bacteria whereby localized inflammation of the connective tissue occurs causing subsequent inflammation of the skin above (dermal and subcutaneous layers). We found only small single studies for duration of antibiotic treatment, intramuscular versus intravenous route, the addition of corticosteroid to antibiotic treatment compared with antibiotic alone, and vibration therapy, so there was insufficient evidence to form conclusions. Fever and inflammation often persist during the first 72hours of treatment. The opportunistic infections from cellulitis can affect the brain as its contaminants circulate the body through infected blood, Endocarditis or the infection of the heart and adjacent tissues, Lymphangitis, an infection of lymph nodes and vessels. Clinical images are a valuable assessment tool that should be utilised to track the progress of wound management. * Dressings not available on ward imprest/more extensive dressing supplies can be sourced in hours from Some of the online platforms that offer MHF4U Canadore College in Canada offers a program in Supply Chain Management. Cellulitis | Nursing Times. WebPack the wound with saline-soaked dressings and a bandage WOUND CARE Your surgical wound may need to be cleaned and the dressing changed on a regular basis. BRUNNER & SUDDARTHS TEXTBOOK OF Medical-Surgical Nursing(14th ed.). Please go to the home page and simply click on the edition that you wish to read. Dressings that cover/ compliment primary dressings and support the surrounding skin. 1. Cellulitis was the most common primary infective diagnosis in UK OPAT Outcomes registry in 2015.24 Outpatient parenteral antimicrobial therapy may be considered as initial management in suitable patients with moderate (Dundee grade II) cellulitis without evidence of necrotising infection or sepsis;12,15 alternatively, it may be used to facilitate early discharge in patients with improving parameters. Read More Discoloration (red, purple or slightly darker than your usual skin color) that may look like a rash. However, it can occur in any part of your body. Cleveland Clinic Children's is dedicated to the medical, surgical and rehabilitative care of infants, children and adolescents. To use turmeric for leg cellulitis treatment, thoroughly mix a teaspoon of turmeric powder with 1 tablespoon of raw organic honey to make a paste. Thieme. We will also document an accurate record of all aspects of patient monitoring. Normal skin can be affected by cellulitis after an injury that causes the skin to break, such as shock and surgical procedures. There is variation in the types of treatments prescribed, so this review aims to collate evidence on the best treatments available. It is essential for optimal healing to address these factors. At NURSING.com, we believe Black Lives Matter , No Human Is Illegal , Love Is Love , Women`s Rights Are Human Rights , Science Is Real , Water Is Life , Injustice Anywhere Is A Threat To Justice Everywhere . Wound healing occurs in four stages, haemostasis, inflammation, proliferation and remodelling, and the appearance of the wound will change as the wound heals. There are more than 14 million cases of cellulitis in the United States per year. Wound or tissue cultures are negative in up to 70% cases,3 with S aureus, group A streptococci and group G streptococci being the most common isolates from wound cultures.4 Serological studies suggest group A streptococcal infection is an important cause of culture negative cellulitis.5 Skin infection with pus is strongly associated with S aureus.6, Animal bites can be associated with cellulitis due to Gram-negatives such as Pasteurella and Capnocytophaga. I present the illustration to differentiate between normal skin and skin affected by cellulitis. See also Jones & Bartlett Learning. Major nursing care plan objectives for the child with hypospadias or epispadias include improving the childs physical appearance, ensuring a positive body image , providing relief of pain and discomfort, decreasing parental anxiety, and absence of complications ( bleeding, infection, catheter obstruction and sexual dysfunction ). The following are the patient goals and anticipated outcomes for patients with Cellulitis. Applying an antibiotic ointment on your wounds or sores. In patients with a history of penetrating trauma or with a purulent infection, the addition of anti-staphylococcal cover is strongly advised.12 Guidance from UK CREST recommends an agent with both anti-streptococcal and anti-staphylococcal activity, such as flucloxacillin.16 Due to the increased risk of venous thromboembolism due to the acute inflammatory state and immobility, thromboprophylaxis with low-molecular-weight heparin should be considered in line with local and national guidelines. Class 1: no fever and healthy; no systemic toxicity, no comorbiditiesClass 2: fever and appears ill; systemic symptoms, stable comorbiditiesClass 3: significant toxicity; at least one unstable comorbidityClass 4: Sepsis; life-threatening condition The SEWS is a standardised form of early warning score, calculated from the patient's routine clinical observations, with a threshold score of 4 selected to indicate the most severely unwell patients (class IV) in whom a clinical review was mandated at the site where the study was undertaken. As a nurse, I will assess subjective and objective data when assessing the patient for disease risk. It can be described as: If any of the above clinical indicators are present (including fever, pain, discharge or cellulitis) a medical review should be initiated and consider a Microscopy & Culture Wound Swab (MCS). People with diabetes should always check their feet for signs of skin breaks and infection. RCH Procedure Skin and surgical antisepsis. Cellulitis is a common painful skin infection, usually bacterial, that may require hospitalisation in severe cases. moisture donation/ retention, debridement and decreasing bacterial load), -Broad spectrum antimicrobial agent to reduce/ treat infected wounds, -If the silver needs to be activated, it should be done with water (normal saline will deactivate the silver), Can be left on for 7 days (Acticoat3 is changed every 3 days).
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