Table 1.

Key requirements of effective antiseptic dressings and the evidence for NCS

Key requirements	Features of NCS	NCS evidence and outcomes
Broad‐spectrum activity including activity against antibiotic‐resistant bacteria14	Silver is effective against Gram‐positive and Gram‐negative bacteria, yeast, and fungi in vitro18	NCS is effective in vitro against Gram‐positive, Gram‐negative bacteria, yeast, and fungi31, 36, 37, 38, including antibiotic‐resistant organisms such as MRSA, VRE, enterobacteriaceae strains containing NDM‐1 carbapenemases37, 39, 40
Rapid bactericidal activity25	Large surface area of nanocrystalline structure allows fast release of Ag+ with other oxidation states also proposed (Ag0, Ag2+, and Ag3+) at a level high enough to kill bacteria rapidly in vitro32, 35	Rapid speed of kill in vitro31, 36, 37, 38. Clinically proven to resolve the signs and symptoms of infectiona faster than other silver dressings41
Acts on multiple targets on bacterial cell14, 17, 18, 19, 25. Low potential for resistance17, 18, 25, 26	Silver ions (Ag+) bind to multiple targets on bacterial and fungal cells18. Ag+ interacts with thiol groups in enzymes and proteins, inhibits cell division, and damages the cell envelope and DNA18	Laboratory data highlights potential to develop silver resistance if sub‐lethal levels used;42 however, further in vitro research suggests NCS still effective against these resistant strains43. Clinically, no failure of silver dressings because of silver resistance27
Bacterial barrier property14, 21	NCS layer provides antimicrobial barrier39 to microorganisms, which are killed rapidly on contact	In vitro evidence against MRSA44 and EMRA 15 and 1639 and clinical evidence showing reduced transfer of MRSA from wounds44
No evidence of delayed wound healing in clinical use14	Sustained release over wear time of the dressing31 provides sufficient level to kill microorganisms whilst demonstrating minimal toxicity in patients45, 46, 47	Peer‐reviewed literature suggests that modern silver products do not delay wound healing29. Excellent antimicrobial barrier performance as graft/dermal replacement resulting in outstanding reepithelialisation48

Abbreviations: EMRSA, Epidemic methicillin‐resistant Staphylococcus aureus; MRSA, methicillin‐resistant Staphylococcus aureus; NCS, nanocrystalline silver; VRE, vancomycin‐resistant enterococci.

^aACTICOAT is cleared as a bacterial barrier only in the United States.