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Guidelines for use of Nanocrystalline Silver Dressing - Acticoat

Owner:

Department of Health WA

Contact:

Health Network Branch

Version:

Approved by:

Chief Medical Officer

Date:

November 2009

Review Date:

November 2011

Guideline reference number:

RSD-09740

Links to:

Burn Injury Model of Care

Royal Perth Hospital (RPH), Surgical Division.
Burns Service Policies

SUMMARY
The Injury & Trauma Health Networks Burn Injury Model of Care (BIMOC) under the Clinical
Lead of Professor Fiona Wood, was endorsed by the State Health Executive Forum (SHEF)
in May 2009.
In the Executive Summary it is noted that in Western Australia (WA), people who experience
a Burn Injury are well supported by a range of services that are delivered within a multidisciplinary team approach.
Although largely preventable, the Model of Care states that Severe Burn Injury is fortunately
far less frequent but the devastating outcome can be reduced dramatically when the right
care is provided at the right time, in the right place, by the right team.
Other important factors include an accurate definition of the Burn Injury and access to safe
and reliable services. It is imperative to have referral points that are well supported by
information and education from injury prevention, to first aid and multidisciplinary clinical
specialists care.
Epidemiological data indicate decreases in hospital admissions and readmissions in recent
times. This decrease can be attributed to primary and secondary prevention interventions as
well as advances in burns care processes and new technology that promotes consultant-led
support for collaboration and integration of services.
During mass casualty events Burn Injury is one of the most common injuries and therefore
planning and response to a disaster requires the involvement of trained burns injury
specialists.
A prospective review of burn injury in WA between January 2004 and November 2004 found
61% of cases recorded received inadequate or inappropriate first aid management. The
review also identified that indigenous children who reside predominantly in rural/remote
areas have a high incidence of burn injury and complications such as infection 1.

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This Guideline for use of Nanocrystalline Silver Impregnated Dressings on Burn Wounds
provides important information for health professionals and first responders seeking advice
on burn wound dressings for a burn injured patient as part of initial burn injury management
and early care.
The Department of Health, Health Networks Branch working group, in developing the Burn
Injury Model of Care identified the need to provide information and support, on burn injury
management at a state-wide policy level. This supporting operational guideline for the
recommended 'silver impregnated antimicrobial dressing' - Acticoat is endorsed and
operational within the major Burn Injury Units in WA. In order for all patients in WA with a
burn injury to benefit from ActicoatTM a review of the Royal Perth Hospital (RPH) Acticoat
guidelines was undertaken. The intent of this review was to consider suitability for state-wide
implementation and to provide an evidence-based framework to support use of Acticoat
over other silver impregnated dressings.
There was close liaison with the RPH Acticoat guideline development team, and the Injury
and Trauma Health Network during the review process and development of this policy.
Definition of Burn Injury
Burn injury was traditionally defined by percentage of total body surface areas (%TBSA)
affected. This definition excluded many other factors that impact on a persons well being.
The classification is dependant on a range of variables that describe the mechanism of
injury, how the patient is affected by the injury, %TBSA affected and depth of Burn Injury.
Other clinical variables include: age, site of burn, effect on airway, other injuries, co
morbidities, and psychiatric and psychosocial considerations. Assessment of these factors
allows the Burn Injury to be defined as minor, moderate and severe.
Different types of Burn Injury include flame burns, scalds from steam or hot liquids/food,
contact burns from hot surfaces such as stoves, heaters, and irons; electrical burns,
chemical burns, friction burns and radiation burns. The extent of the injury is dependant on
the degree of heat and length of time in contact with the heat. For example, flash burns are
generally less severe than scalds 1.
Burns are one of the most common and devastating forms of trauma. Patients with serious
thermal injury require immediate specialized care in order to minimize morbidity and
mortality. Significant thermal injuries induce a state of immunosuppression that predisposes
burn patients to infectious complications: 2
Definition of Burn Injury Dressings mentioned in this guideline
ActicoatTM (with Nanocrystalline Silver) dressing is an effective antimicrobial barrier
dressing. The nanocrystalline coating of silver rapidly kills a broad spectrum of bacteria in as
little as 30 minutes. ActicoatTM dressing consists of three layers: an absorbent inner core
sandwiched between outer layers of silver coated, low adherent polyethylene net.
Nanocrystalline silver protects the wound site from bacterial contamination while the inner
core helps maintain the moist environment optimal for wound healing.
JelonetTM is a soft paraffin, non-medicated dressing, making it ideal for use with topical
antibiotics or antiseptics. It is soothing and low-adherent, and allows the wound to drain
freely into an absorbent secondary dressing. Jelonet is available in a wide range of sizes,
the largest of which is suitable for use in burns units.

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DuoDERM CGF Dressing is a hydrocolloid, moisture-retentive wound dressing used for
partial and full-thickness wounds with minimal to moderate amounts of exudate. It
incorporates a unique ConvaTec hydrocolloid formulation that distinguishes it from other
hydrocolloid dressings. DuoDERM CGF Dressing is indicated for chronic wounds such as
pressure ulcers (Stage I-IV) and leg ulcers, as well as acute wounds such as traumatic
wounds (minor abrasions, lacerations) partial thickness burns and donor sites.
Scope
Patient group to whom this guideline applies: All burn injury patients adults and children,
throughout Western Australia.
Target area for guidelines:
Any location, place, community or health service where a patient with burn injuries may be
treated. The guideline will inform state-wide practice of doctors, nurses, allied health
professionals, first aid personnel such as St John Ambulance and OH& S, and personnel in
the mining industry.
Aims of this guideline:
1. To identify the importance of skilled, early intervention in burn injury management and
the optimal early use of Nanocrystalline Silver Dressings.
2. To describe the guidelines, protocols and evidence-based information for practice for
use of Acticoat as a wound dressing, for patients with burns in Western Australia.
3. To provide evidence-based practice guidelines for burn injury wound care.
4. To ensure the guideline is widely distributed to all health professionals such as
medical and nursing personnel, allied health organizations, paramedics and first aid
personnel, throughout the State of Western Australia.
Implementation of the guideline should be facilitated with a designated web page link to
ensure dissemination is as effective as possible, for the benefit of all burn injured patients in
Western Australia, and for professional guidance to all health professionals, emergency and
first aid personnel.
The body of this guideline comprises two documents from Royal Perth Hospital Surgical
Division, Burns Service.
Part 1. The use of a silver impregnated dressing Acticoat for early burn wound
management: an evidenced based practice. Fong, Joy, Burns Service, Royal Perth
Hospital, WA and Wood, Fiona, Burns Service, WA.
Part 2. Evidenced Based Practice Guideline. The use of Nanocrystalline silver
impregnated dressings on burn wounds. Joy Fong, CNC, Burns: Fiona Wood, Burns
Director, RPH. March 2009.
In both documents, levels of evidence (Level 1-4) are cited against relevant literature to
demonstrate an evidence-based context for the use of ActicoatTM. These levels of evidence
are based on the hierarchy of evidence framework endorsed by the Joanna Briggs Institute
(www.joannabriggs.edu.au) which were originally adopted from the NHMRC 3.

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The levels of evidence relate to the design of studies reported in the literature, and are
outlined below:
Levels of evidence
Level 1: Systematic review of Level 2 studies
Level 2: A randomised controlled trial
Level 3: Pseudo randomised control trial, comparative study with and without concurrent
controls
Level 4: Case series with either post test or pre-test/post test and expert opinion
The Department of Health (WA) endorses the RPH practice statement and guidelines in their
entirety. The RPH Burns Service Evidence Based Practice statement and guidelines have
been provided with the full permission of the authors.
References
1.
2.
3.

Department of Health Western Australia, Burn Injury Model of Care. 2009, Health
Networks Branch: Perth.
Church, D., et al., Burn wound infections. Clin Microbiol Rev, 2006. 19(2): p. 403-434.
NHMRC., A guide to the development, implementation and evaluation of clinical
practice guidelines. 1999, NHMRC: Canberra.

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PART 1:
Royal Perth Hospital Burns Service Evidence-Based
Practice Statement
The use of a silver impregnated dressing acticoat for early burn wound
management: an evidenced based practice.
Compiled by: Fong, Joy; Wood, Fiona. Burns Service, Royal Perth Hospital, W.A.
Equipment for Burn injuries over 5% TBSA:
Warm cubicle, appropriate personal protection equipment (PPE), Acticoat dressing,
(appropriate sizes and numbers of pieces), sterile water for irrigation, large burns gauze,
paraffin gauze (Jelonet), bandages or stretch netting (appropriate sizes).
Recommended Practice:
All burn injuries should have antimicrobial dressings applied if estimated time to arrive at
Burn Unit, Royal Perth Hospital will exceed 2 hours from time of burn injury.
Management to be performed prior to transfer:
Actions:
1. Perform timely and appropriate burn first aid (cool running tap water or wet/damp
towels for 20 minutes within the first 1 hour post burn) after the initial ABCs of first aid
are carried out.
2. Perform a burn injury assessment size of burn, depth of burn and severity of burn
injury.
3. Provide appropriate analgesia prior to commencement of dressings.
4. Consider risks for infection for the patient; use sterile technique where possible.
5. Moisten ActicoatTM dressings with sterile water for irrigation (not soaking wet), apply
over the burn area(s) with the dark blue side facing the wound bed. Apply two layers
of water moistened burns gauze, followed with dry gauze or padding. Secure with
loose bandages or loose stretch netting.
6. Bandaging or stretch netting must be checked frequently for tightness in view of
potential swelling as a result of burn oedema.
Evidence for clinical practice:
1. Why is there a need for topical antimicrobial dressings in the initial stages post burn
injury?
Burn wound cellulitis is commonly observed and is characterized by erythema
of the surrounding unburnt skin (1-2cm beyond the wound), pain and oedema
extending beyond the usual rim of inflammation are commonly seen within 72
hours of injury.1 [Level 4]

Burn wounds are susceptible to infection due to impairment of the skin barrier
and reduction in cell mediated immunity.2-5 [Level 4] 6 [Level 3].

Burns result in destruction of tissue which provide a wound environment at risk

of infection and can result in septicaemia 7-8 [Level 4].

The risk is further exacerbated by immuno-suppression associated with burn

injuries 9 [Level 4].
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2. What is the evidence for the use of Acticoat instead of silver sulphadiazine cream?

Acticoat is a silver impregnated dressing facilitating the delivery of silver to the burn
wound surface. It contains nanocrystalline silver which when moistened with sterile
water releases silver ions onto the wound surface. The invitro antimicrobial action of
silver has been demonstrated to destroy within 30 minutes, both Gram positive and
negative bacteria as well as Vancomycin resistant enteroccocci (VRE) and Methicillin
resistant S . aureus.6 [Level 3], 10, 12 [invitro studies],11 [Level 1].

The action is accomplished by the silver ions binding to tissue proteins causing a
structural change in the bacterial cell membranes.12 [invitro studies]. The silver then
binds and denatures the bacterial DNA and RNA, thus inhibiting replication.12-14
[invitro studies], 15 [Level 2].

The action of Acticoat is fast in destroying pathogens such as Escherica coli, S.

aureus and Methicillin resistant S. aureus and Pseudomonas aeruginosa 12 [invitro
study], 16 [Level 4], 17 [Level 3].

Acticoat dressings have been found to be less painful than Silver Sulphadiazine
cream dressings. 6 [Level 3], 18-19 [Level 1], 20 [Level 3]

The reduction of burn wound cellulitis by using ActicoatTM can be attributed to its
ability to reduce inflammation. Research revealed that ActicoatTM has an antiinflammatory effect through metalloproteinases, this has a role in the degradation of
extra-cellular proteins in wound sites, allowing optimal epithelialisation. 2,21 [Level 4],
11
[Level 2], 17 [Level 3], 22 [animal study].

Acticoat compared with silversulphadiazine cream reduces burn wound cellulitis,

antibiotic usage, improved patent outcomes and reduction in overall inpatient
costs.6,17 [Level 3], 18,19 [Level 1], 20,23,24 [Level 3], 25 [Level 1].

Silversulphadiazine cream has been found to have pro-inflammatory properties and

and shown to cause leucopenia. 26 [Level 4], 27 [Level 3], 28 [invitro study] 29 [Level 4].
ActicoatTM dressings have been found to be less painful than Silver Sulphadiazine
cream dressings. 6, 20 [Level 3], 18, 19 [Level 2].

The main contraindication of using Acticoat is agyria, where silver salts when
released in the presence of light precipitates into black silver sulphide. 30-31 [Level
4].This causes the wound and surrounding skin to become brownish black. However,
research states this staining is not permanent. 29, 31 [Level 4]. Silver toxicity in
Actiocoat not well documented and reports of toxicity are low to date. 28 [Level 4]

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References
1. Peck M, Weber J, McManus A, Sheridan R, Heimback D. Surveillance of burn wound
infection: a proposal for definitions. J Burn Care Rehabil 1998; 19:386-9.
2. Barlow Y. T lymphocytes, immunosuppression in the burned patient: a review.
Burns1994:20(6);470-87
3. Miller M, 1998. How do I diagnose and treat wound infection. Br J Nurs, 7 (6): 335-338
4. Heggers J, Hawkins H, Edgar P, et al. 2002. Treatment of infection in burns. In Herndon
DN (ed). Total Burn Care. 2nd ed . London: Saunders. p 120-169
5. Fong J. 2005. The use of silver products in the management of burn wounds: change in
practice for the burn unit at Royal Perth Hospital. Primary Intention, 13(4):S16-S22.
6. Fong J, Wood F, Fowler B. 2005. A silver coated dressing reduces the incidence of early
burn wound cellulitis and associated costs of inpatient treatment: Comparative patient care
audits. Burns, 31 :562-567.
7. Lansdown A. 2002. Silver 1:its antibacterial properties and mechanism of action. J Wound
Care, 11(4):125-13
8. Kumar G, Rameshwar L, Suhas C, et al. 1999. Pseudomonas aeruginosa septicaemia in
burns. Burns, 25: 611-616.
9. Cook N. 1998. Methicillin resistant staphylococcus aureus versus the burned patient.
Burns, 24: 91-98
10. Wright J, Lam K, Burrell R. 1998. Wound management in an era of increasing bacterial
antibiotic resistance: a role for topical silver treatment. Am J Infect Control, 26: 572-577
11. Tredget E, Shankovsky R, Groenveld A, et al. 1998. A matched-pair, randomised study
evaluating the efficacy and safety of Acticoat silver-coated dressing for the treatment of burn
wounds. J Burn Care Rehabil, 19(6):531-537
12. Yin H, Langford R, Burrell R. 1999. Comparative evaluation of the antimicrobial action of
Acticoat: antimicrobial barrier dressing. J Burn Care Rehabil, 20 (3):195-199
13. Thomas S. 2003b. An in vitro analysis of the antimicrobial properties of 10 silver
containing dressings. J Wound Care, 12 (8): 305-309
14. Thomas S. 2003a. A comparison of the antimicrobial effects of four silver-containing
dressings on three organisms. J Wound Care, 12 (3): 101-107
15 Demling R, DeSanti L 2001. The role of silver technology in wound healing: Part 1:
Effects of silver on wound management. Wounds. A Compendium Clinical Res and Pract.
Suppl A, 13(1):4- 15.
16. Leaper D 2006. Silver dressings: Their role in wound management. International Wound
Journal.3 (4):282-94.
17 Strohal R, Schelling M, Takacs M et al 2006. Nanocrystalline silver dressings as an
efficient anti-MRSA barrier: a new solution to an increasing problem. J of Hosp Infect.
63(2):231.
18. Varas R, OKeefe T, Namia N, et al. 2005. A prospective, randomized trial of
Acticoat versus silver sulfadiazine in the treatment of partial thickness burns: which method
is less painful? J Burn Care and Rehabil, 26(4):344-347
19 Huang Y, Li X, Liao Z et al. 2007. A randomized comparative trial between Acticoat and
SD-Ag in the treatment of residual burn wounds, including safety analysis. Burns. 33(2):1616.
20 Muangman P, Chuntrasakul C, Silthram S. et al. 2006. Comparison of efficacy of 1%
silver sulfadiazine and Acticoat for treatment of partial-thickness burn wounds. J Medical
Association of Thailand, 89(7):953-8.
21 Sibbald R, Raphael S, Rothman A, et al. 2005. The selective anti-inflammatory activity of
prolonged release nanocrystalline silver dressing (Acticoat7) in the treatment of chronic
venous leg ulcers. Wound Repair and Regeneration, 13(2): p40(abstract)

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22 Wright B, Lam K, Buret A et al. 2002. Early healing events in a porcine model of
contaminated wounds: effects of nanocrystalline silver on matrix metalloproteinase, cell
apoptosis, and healing. Wound Repair and Regeneration. 10(3):141-51.
23 Peters D, Verchere C. 2006. Healing at home: Comparing cohorts of children with
medium-sized burns treated as outpatients with in-hospital applied Acticoat to those children
treated as inpatients with silver sulfadiazine. Journal of Burn Care & Research. 27(2):198201.
24 Cuttle L, Naidu S, Mill J et al. 2007. A retrospective cohort study of Acticoat versus
Sivazine in a paediatric population. Burns. 33(6): 701-7.
25 Wasiak J, Cleland H, Campbell F. 2008. Dressings for superficial and partial thickness
burns. Cochrane Database of Systematic Reviews, 4:CD))2106.
26 Lansdown A. Silver 2: toxicity in mammals and how its products aid wound repair. J
Wound Care 2002, 11(5);173-177
27 Precht R, Burrell R. A comparative analysis of the anti-microbial efficacy of a novel silver
coated dressing, a silver sulfadiazine and a silver nitrate. J Burn Care and Rehabil
1997;18:178
28 Poon V, Burd A. 2004. In vitro cytotoxicity of silver: implication for clinical wound care.
Burns, 30 (2):140-7
29 Lansdown A. How safe is silver in wound care? J Wound Care 2004;13;131-5
30 Orvington L. 2004. The truth about silver. Ostomy Wound Management,
50; Suppl.9A:1S-10S
31 Walker M, Cochrane C, Bowler P. et al.2006. Silver deposition and tissue staining
associated with wound dressings containing silver. Ostomy Wound Management. 52(1):424, 46-50.

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PART 2:
Royal Perth Hospital, Surgical Division - EvidencedBased Practice Guideline
The use of nanocrystalline silver impregnanted dressings on
burn wounds.
Compiled by: Joy Fong, CNC, Burns; Fiona Wood, Burns Director, RPH. March 2009.
Introduction:
Acticoat is a 3 layered mesh dressing construct containing silver nanocrystals. When
moistened with sterile water and placed on the wound, Acticoat releases clusters of highly
reactive silver cations up to 100 parts per million, causing electron transport and inactivation
of bacterial cell DNA, cell membrane damage and binding of insoluble complexes in microorganisms 1-6 [Level 4].
Acticoat produces a controlled release of silver ions onto the wound and has been proven
to be effective in reducing exudate and odour, reducing the risk of colonisation, preventing
infection. It has an effective bactericidal effect. Several efficacy studies have demonstrated
that Acticoat is safe to use on wounds 3-7 [Level 4].
Acticoat absorbent is an alginate dressing impregnated with silver nanocrystals. It has an
absorbent property when in contact with wound exudate and forms a gel which releases
nanocrystalline silver cations onto the woundbed. Its antibacterial action is similar to that of
Acticoat . 8 [Level 4].
DRESSING APPLICATION INFORMATION

ActicoatTM should be applied on partial and full thickness depth burns in the first 3
days post burn injury. This is to prevent burn wound cellulitis which may occur within
this time period. 9 [Level 3].

ActicoatTM is applied moistened with sterile water with the dark blue side facing the
wound bed. This is followed by two layers of gauze moistened with sterile water,
JelonetTM, dry gauze and bandage.

After 24 hours, if the dressing is copper in colour, it means that all the silver ions have
been released onto the wound, the dressing needs to be replaced. Acticoat
dressings on burn wounds are replaced daily due to the high amount of exudate
which will activate the deposition of silver ions.

After 3 days of Acticoat dressings the burn wound should be assessed for dryness
and necessity for further topical antimicrobial treatment.

If after 3 days Acticoat is still required (based on clinical judgement) and

desloughing of the wound is needed, then:
1. Acticoat may be cut into 1-2cm strips and applied (not to cover the whole burn
wound, but a small portion) under a hydrocolloid dressing such as Duoderm This
dressing will promote desloughing of the wound by autolysis, whilst Acticoat
maintains an antimicrobial effect within the wound environment. This dressing needs
to be redressed every 2 or 3 days.
Or

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2. Acticoat absorbent may be used if the wound is highly exudative. Apply Acticoat
absorbent onto the wound and cover with a hydrocolloid dressing such as
DuodermCGF or a foam dressing, secure with retention tape. This dressing needs
to be redressed every 2 or 3 days.
Or
3. Continue Acticoat dressings with water compresses as described previously.
NOTE:

Acticoat has a drying effect and may be used for exudating burn wounds and as an
overlay dressing over a dermal regeneration template dressing such as Integra. 10
[Level 2], 11 [Level 4].

Acticoat has an anti-inflammatory effect which may reduce the amount of wound
exudate. 12 [Level 4].

Keep Acticoat to size as it stains good skin agyria is brownish black staining
caused by the silver ions (stains can be removed with saline) 13 [in vitro study].

Apply a layer of lanolin or emollient around the burn wound edges to prevent staining.

Acticoat is activated with sterile water or wound exudate. 2 [Level 4].

Acticoat is applied dark blue side facing the wound bed. 2 [Level 4].

If the woundbed is dry and Acticoat is still required, a layer of water based hydrogel
such as Intrasite gel may be applied under the Acticoat.

Acticoat absorbent may be used when the woundbed is highly exudative. 8 [Level
4].

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References
1. Fong J, Wood F. 2006. Nanocrystalline silver dressings in wound management: a review.
International Journal of Nanomedicine 1(4);1-9
2. Smith and Nephew. 2003. Dynamic silver release rapid destruction, sustained protection,
Acticoat with silvercryst, Smith and Nephew Pty. Ltd. Product Information
3. Orvington L. 2004. The truth about silver. Ostomy Wound Management, 50(suppl 9A); 1S10S.
4. Heggers J, Hawkins H, Edgar P, et al. 2002. Treatment of infection in burns. In Herndon
DN, ed. Total Burn Care. 2nd ed. London: Saunders. P 120-69.
5. Lansdown A. 2002. Silver 1: its antibacterial properties and mechanism of action. J
Wound Care, 11:125-13.
6. Dunn K, Edwards-Jones V.2004. The role of Acticoat TM with nanocrystalline silver in the
management of burns. Burns, 30(Supp 1):S1-9.
7. Vlachou E, Chipp E, Shale E et al. 2007. The safety of nanocrystalline silver dressings on
burns: A study of systemic silver absorption. Burns.33: 979-985.
8. Smith and Nephew. 2004. Together at last. Dynamic silver and super-powered
absorbency, Acticoat TM absorbent. Smith and Nephew Pty Ltd. Product
Information
9. Fong J, Wood F, Fowler B. 2005. A silver coated dressing reduces the incidence of early
burn wound cellulitis and associated costs of inpatient treatments: Comparative patient care
audits. Burns.31:562-567.
10. Tedget E, Shandkovsky R, Groenveld A, et.al. 1998. A matched pair randomised
controlled study evaluating the efficacy and safety of Acticoat silver-coated dressing for the
treatment of burn wounds. J Wound Care Rehabil, 19:531-7.
11. Voight D, Paul C. 2001. The use of Acticoat as silver impregnated Telfa dressings in a
regional burn and wound care centre: the clinicians view. Wounds: A Compendium of
Clinical Research and Practice, 13:11-23.
12. Kirshner R. 2002. Matrix metalloproteinases in normal and impaired wound healing: A
potential role of nanocrystalline silver. Wounds: A Compendium of Clinical Research and
Practice, 13:4-14.
13. Walker M, Cochrane C, Bowler P, et.al. 2006. Silver deposition and tissue staining
associated with wound dressings containing silver. Ostomy wound Management. 52(1):42-4,
46-50.

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Acknowledgements:
Health Networks:
Injury & Trauma Health Network Executive Advisory Group:
Karina Moore, Senior Development Officer
Jan Phillips, Development Officer
Dr Andrew Briggs, Senior Development Officer
Working Group for Acticoat Guidelines:
The generous assistance of the Burns Service, Royal Perth Hospital, WA and in particular:
Joy Fong, Clinical Nurse Consultant, State adult Acute Burns Service, Ambulatory and
Telehealth Burn Services.
Professor Fiona Wood, Burns Director, of the above unit, gratefully acknowledged for
supplying policy information.
Alwena Willis, Clinical Nurse Educator, State adult Acute Burns Service, Ambulatory and
Telehealth Burn Services
Companion Documents
Department of Health, Western Australia. Burn Injury Model of Care. Perth: Health
Networks Branch, Department of Health, Western Australia; 2009.
http://www.healthnetworks.health.wa.gov.au/modelsofcare/docs/Burn_Injury_Model_of_Care
.pdf

Links
Smith& Nephew:
Acticoat, http://wound.smith-nephew.com/uk/node.asp?NodeId=2793
Jelonet http://wound.smith-nephew.com/au/node.asp?NodeId=3521
Convatec DuoDERM CGF http://www.convatec.com.au/enau/cvtoc-products/cvt-

products/0/proddett/2034/2034/4429/duoderm-cgf-sterile-dressing-.aspx?franchise=364&typesearch=429&proddett=4429&prodfamily=369

Department of Health (WA) Disaster Preparedness: http://www.health.wa.gov.au/disaster/

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