SILVER versus other antimicrobial dressings: best practices!

All chronic wounds are colonized by bacteria. Increased bacterial burden or critical colonization can be deleterious to wound healing. In view of the ubiquitous presence of microbes, the clinician must discern whether bacterial balance (contamination or colonization) or bacterial damage has occurred. Silver is a common topical agent used to combat bacterial burden in chronic wounds. Given the wide array of silver-related wound care products, it is difficult to determine which product should be used. By reviewing relevant scientific evidence, we propose an acronym SILVER to address the key contentious issues. These issues are summarized as SILVER: Signs of bacterial damage, the need for Ionic silver, Log reduction of bacteria, Vehicle (importance of moisture balance), Effect on normal cells, and Bacterial Resistance.