title: Evidence-based review of silver dressing use on chronic wounds.
abstract: OBJECTIVE
  Use of silver containing dressings has become prevalent in clinical practice to manage chronic wounds at risk for infections. This literature review examines the evidence for the efficacy of using silver dressings in the chronic wound management.
  
  
  METHODS
  Relevant in vitro articles on antimicrobial activity of silver dressings, relevant randomized controlled studies (RCTs), and one retrospective cohort study were selected to assess the effectiveness of silver dressings on human chronic wounds.
  
  
  CONCLUSIONS
  The emerging evidence base for this use of silver dressings in clinical practice on chronic wounds does not provide absolute evidence of antimicrobial efficacy because there are limited large, well-designed RCTs. To supplement this gap, more rigorously controlled long-term, randomized studies of human subjects with chronic wounds are needed.
  
  
  CONCLUSIONS
  It is essential that advanced practice nurses (APNs) be knowledgeable of the wound bacterial balance continuum. For deciding appropriate wound healing strategies, they also need to critically appraise the current literature as it changes for the latest information on antimicrobial efficacy of silver dressings. Until research clarifies the inconclusive evidence, APNs must provide holistic and accurate assessments of both the patient and the wound before selecting silver dressings.
authors.affiliation: Department of Physiological Nursing, School of Nursing, University of California-San Francisco, CA, USA. lilytoy@yahoo.com
authors.forename: Lily W
authors.initials: LW
authors.lastname: Toy
authors.forename: Liz
authors.initials: L
authors.lastname: Macera
mesh_terms: D000891:Anti-Infective Agents, Local / Q000009:adverse effects / Q000627:therapeutic use*; D001458:Bandages / Q000009:adverse effects; D018441:Biofilms; D002266:Carboxymethylcellulose Sodium / Q000009:adverse effects / Q000627:therapeutic use; D002908:Chronic Disease; D055318:Evidence-Based Nursing; D006801:Humans; D053758:Nanoparticles / Q000009:adverse effects / Q000627:therapeutic use; D011091:Polyesters / Q000009:adverse effects / Q000627:therapeutic use; D011095:Polyethylenes / Q000009:adverse effects / Q000627:therapeutic use; D012834:Silver / Q000009:adverse effects / Q000627:therapeutic use*; D014947:Wounds and Injuries / Q000188:drug therapy* / Q000382:microbiology
chemical_list: C117408:Acticoat; D000891:Anti-Infective Agents, Local; D011091:Polyesters; D011095:Polyethylenes; D012834:Silver; D002266:Carboxymethylcellulose Sodium