Demystifying Prontosan Myths Continues

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Demystifying Prontosan Myths Continues

Prontosan® has been around for many years, yet there are some misconceptions around the use of Prontosan®.

Myth 1: Prontosan® soak time is too long

Not correct.

When Prontosan® was first developed, there was a recommended soak time for the products efficacy, however as further data and evidence has been made available, it has shown that the soaking time of Prontosan depends on the wound type and the goal of treatment. Ultimately it is important to look at both the patient and the wound to assess and then use the appropriate pathway to meet the treatment goal.

Evidence shows Prontosan® can be used for the appropriate time according to the type of wound.1

Alongside wound cleansing, debridement is often the first step in any protocol of wound care.  The aim of debridement is to obtain a clean, healthy wound bed to allow rapid and effective healing.  By removing devitalised tissue, excess exudate, senescent and abnormal cells, and microbial burden, healthy tissue is unimpeded, and granulation tissue encouraged to form in the wound bed (Halim et al, 2012).  These factors allow wounds to progress to and through the final phase of wound healing and towards complete closure.2

Debriding aids in the removal of biofilm, debris and slough from the wound bed.  Combined with the use of a surfactant based wound cleansing solution, it will cleanse the wound sufficiently to remove and disrupt the biofilm.  

Using the Prontosan® Debridement Pad decreases the time it takes to conduct the wound bed preparation process, and subsequently a reduction in the soak time as you are physically removing the biofilm from the wound bed.

It is also important to note that soaking alone is not sufficient. The action of cleansing and rinsing with a surfactant removes debris and biofilm.  What differentiates Prontosan® to other solutions is the inclusion of Betaine in the formulation.  The low surface tension induced in the surfactant supports physical removal of debris and bacteria. Betaine binds biofilm to the solution and prevents contamination.  Some other solutions on the market do not contain a surfactant therefore the biofilm is not removed from the wound bed, which can cause an inflammatory reaction and prolongs wound healing.

Myth 2: Prontosan® is not compatible with silver

Not correct.

Prontosan® Wound Irrigation can be used with Silver Dressings and it has been clearly demonstrated that the combination of a wet phase with Prontosan® and an application of a silver based product represents a highly effective option to treat chronic, critically colonised, or infected wounds.3

Experiences with the use of Polyhexanide- containing wound products in the management of chronic wounds demonstrate no degradation of functionality of either the irrigation solution, or the silver dressing. 4

An evaluation was conducted on the contact between Prontosan® Wound Irrigation Solution and the wound dressing Acticoat and whether it has an influence on the bacteriostatic efficacy of the wound irrigation solution.

The efficacy of both products will sustain; products do not inactivate each other, when they are used in combination.  

Therefore it can be expected, that Prontosan® Wound Irrigation Solution and Silver are compatible and can be used on combination for treatment of wounds.5

Table: Microbiostatic Efficacy (Aggar Diffusion Assay based on DIN 58940:2007)

Myth 3: Proteins might build up a resistance to Prontosan®

Not correct.

Prontosan®’s mode of action can be described as a non-specific electrostatic interaction with the bacterial cell wall. The attachment of polyhexanide to the bacterial cell wall results in a disorganisation of the biological structure of the bacteria.  The physicochemical action on the bacterial envelope prevents or impedes the development of resistant bacterial strains.  Thus, PHMB is particularly suitable and useful in the struggle against multi-drug resistant bacteria.6

Myth 4: Chlorhexidine and Povidone Iodine are more effective than Prontosan®

Not correct.

A comparative activity of a polyhexanide-betaine solution against biofilms produced by multidrug resistant bacteria belonging to high-risk clones concluded that PHMB was more active than 2% chlorhexidine against Gram-negative bacterial 24h and 48h biofilms and Gram-positive bacterial 7-day biofilms.  In summary, the activity of PHMB was superior to that of 2% of Chlorhexidine on biofilm.7  Polyhexanide is preferred over Chlorhexidine and PVP-Iodine for chronic wounds due to its higher tolerability. This is consistent with the recommendations for antisepsis of acute wounds.

Myth 5: The shelf life of Prontosan® is only 4 weeks and any unused solution must be discarded

Not correct.

Prontosan® Wound Irrigation Solution has a shelf life of 8 weeks once opened. Prontosan Wound Irrigation Solution and Prontosan Gel/Gel X is single patient use, and any unused solution can be used up to the recommended shelf life.9

Myth 6: Prontosan® cannot be used in mucosa, bone & tendons

Not correct.

Check the Prontosan® IFU to see that mucosa, bones, tendons and urinary system are not CONTRAINDICATIONS for Prontosan®.

While it is true that it can’t be used on hyaline cartilage in aseptic joint surgeries, it can still be used in joint surgery when applied AFTER FASCIAL CLOSURE and for septic cases.

Prontosan® Wound Irrigation Solution can still be used for orthopaedic surgeries. Several uses reported good clinical results in using Prontosan as rinsing solution for orthopaedic surgeries. Care has to be taken in case of partial joint replacement where intact hyaline cartilage is still present (contraindication). For total joint replacement (hip and knees) the cartilage is completely removed and therefore the use of Prontosan® is possible.

References:

1. Taking wound cleansing seriously to minimise risk. Wounds UK 13-1 Collier, 2017

2. Irving S. Ovens L, Collier M., Prontosan Debridement Pad Made Easy, Wounds International, May 2018.

3. Patrick Bindschedler, Wound care Solutions, Neue Aarauerstrasse, Switzerland, (Reference study: Moller et al (2004).

4. Results of a methodical and retrospective analysis of 953 patients, K2 Hygiene Services, Municiple Hospital Bilfeled, Aschaffenburg, Germany) and (Test report – Brill L13.0111.1).

5. Test Report no L13/0111.1 Method Microbiostatic Efficacy (Aggar Diffusion Assay based on DIN58940:1989*), Cr. Bill + Partner, Institure for hygiene Und Mikrobiologie, Version 2 2014.

6. Kaehn-PHMB-A-Safe-and-Highly-Effective-Biocide 2010.

7. 2019 Pasqual et al – PHMB vs CHG on Biofilms. 

8. Koburger T, Standardised comparison of antiseptic efficacy of triclosan, PVP-iodine, octenidine, dihydrochloride, PHMB, chlorhexidine digluconate).

9.  Prontosan® Instruction for Use.