U.S. patent application number 16/512157 was filed with the patent office on 2020-03-05 for dressing device for use with a cannula or a catheter.
The applicant listed for this patent is Bard Access Systems, Inc.. Invention is credited to Peter Donnellan, Marie Ni Beiliu, Keith Real.
Application Number | 20200069475 16/512157 |
Document ID | / |
Family ID | 44532985 |
Filed Date | 2020-03-05 |
![](/patent/app/20200069475/US20200069475A1-20200305-D00000.png)
![](/patent/app/20200069475/US20200069475A1-20200305-D00001.png)
![](/patent/app/20200069475/US20200069475A1-20200305-D00002.png)
![](/patent/app/20200069475/US20200069475A1-20200305-D00003.png)
![](/patent/app/20200069475/US20200069475A1-20200305-D00004.png)
![](/patent/app/20200069475/US20200069475A1-20200305-D00005.png)
![](/patent/app/20200069475/US20200069475A1-20200305-D00006.png)
![](/patent/app/20200069475/US20200069475A1-20200305-D00007.png)
United States Patent
Application |
20200069475 |
Kind Code |
A1 |
Donnellan; Peter ; et
al. |
March 5, 2020 |
Dressing Device for use with a Cannula or a Catheter
Abstract
A method of protecting an insertion site permitting passage of a
transcutaneous medical device into a patient. The method includes
grasping a dressing device, positioning the dressing device over
the insertion site, and adhering the dressing device to the patient
over the insertion site. The dressing device may include a moisture
vapor permeable backing, a polyurethane foam matrix, and an
adhesive. The polyurethane foam matrix may be adhered to a first
side of the moisture vapor permeable backing, and the adhesive may
cover a second side of the moisture vapor permeable backing
opposite of the first side. The polyurethane foam matrix can
include a polyanhydroglucuronic acid or salt thereof in an amount
to achieve a haemostatic effect, and chlorhexidine di-gluconate in
an amount of 9% to 16% (w/w) to achieve an antimicrobial effect
without adversely affecting wound healing.
Inventors: |
Donnellan; Peter; (County
Limerick, IE) ; Ni Beiliu; Marie; (County Louth,
IE) ; Real; Keith; (County Wicklow, IE) |
|
Applicant: |
Name |
City |
State |
Country |
Type |
Bard Access Systems, Inc. |
Salt Lake City |
UT |
US |
|
|
Family ID: |
44532985 |
Appl. No.: |
16/512157 |
Filed: |
July 15, 2019 |
Related U.S. Patent Documents
|
|
|
|
|
|
Application
Number |
Filing Date |
Patent Number |
|
|
13808183 |
Jan 3, 2013 |
|
|
|
PCT/IE11/00034 |
Jul 4, 2011 |
|
|
|
16512157 |
|
|
|
|
61344403 |
Jul 14, 2010 |
|
|
|
Current U.S.
Class: |
1/1 |
Current CPC
Class: |
A61L 15/26 20130101;
A61L 2300/45 20130101; A61L 2300/404 20130101; A61L 15/46 20130101;
A61L 2400/04 20130101; A61L 2300/418 20130101; A61L 2300/206
20130101; C08L 75/04 20130101; A61L 2300/232 20130101; A61F
13/00063 20130101; A61L 15/26 20130101 |
International
Class: |
A61F 13/00 20060101
A61F013/00; A61L 15/46 20060101 A61L015/46; A61L 15/26 20060101
A61L015/26 |
Claims
1. A method of protecting an insertion site permitting passage of a
transcutaneous medical device into a patient, the method
comprising: grasping a dressing device, the dressing device
comprising: a moisture vapor permeable backing; a polyurethane foam
matrix adhered to a first side of the moisture vapor permeable
backing, the polyurethane foam matrix comprising: a
polyanhydroglucuronic acid or salt thereof in an amount to achieve
a haemostatic effect; and chlorhexidine di-gluconate in an amount
of 9% to 16% (w/w) to achieve an antimicrobial effect without
adversely affecting wound healing; and an adhesive covering a
second side of the moisture vapor permeable backing opposite of the
first side; positioning the dressing device over the insertion site
with the second side facing toward the patient; and adhering the
dressing device to the patient over the insertion site.
2. The method according to claim 1, wherein the dressing device
includes a central aperture and a slit extending from the central
aperture through an outer edge, the method further comprising
positioning the central aperature around the transcutaneous medical
device.
3. The method according to claim 2, wherein the central aperture is
a circular hole ranging in diameter from 0.1 mm to 10 mm.
4. The method according to claim 2, wherein the central aperture is
"x" shaped or "T" shaped.
5. The method according to claim 1, wherein the
polyanhydroglucuronic acid or salt is a salt in an amount from 3%
to 20% (w/w).
6. The method according to claim 1, wherein the
polyanhydroglucuronic acid or salt is a salt in an amount of
approximately 8% (w/w).
7. The method according to claim 6, wherein the chlorhexidine
di-gluconate is in an amount of approximately 11% (w/w).
8. The method according to claim 6, wherein the remaining 81% (w/w)
comprises the polyurethane foam matrix, wherein the polyurethane
foam matrix exhibits flexibility and hydrophilicity.
9. The method according to claim 1, wherein the
polyanhydroglucuronic acid or salt thereof and the chlorhexidine
di-gluconate are homogenously dispersed through the polyurethane
foam matrix.
Description
PRIORITY
[0001] This is a division of U.S. patent application Ser. No.
13/808,183, filed Jan. 3, 2013, which is a U.S. national stage
application of International Application No. PCT/IE11/00034, filed
Jul. 4, 2011, claiming the benefit of priority to U.S. Provisional
Application No. 61/344,403, filed Jul. 14, 2010, each of which is
hereby incorporated by reference in its entirety into this
application.
INTRODUCTION
[0002] The present invention relates to a wound device,
particularly for use with IV catheters and other percutaneous
devices.
[0003] Vascular and nonvascular percutaneous medical devices such
as: IV catheters, central venous lines, arterial catheters,
dialysis catheters, peripherally inserted coronary catheters,
mid-line catheters, drains, chest tubes, externally placed
orthopedic pins, and epidural catheter tubes are widely used in
modern day medical practice. Annually more than 20 million
inpatients in hospitals in the United States receive intravenous
therapy and almost 5 million require central venous catheterization
(Bouza et al., 2002)
[0004] Mechanical complications such as hemorrhage and thrombosis
are associated with catheterization. The risk of bleeding
associated with catheterization is reported to range between 1% and
8% (Mital et al., 2004) and although minor bleeding may be quite
common serious bleeding is rare (Doerfler et al. 1996). Though
dressings for antimicrobial effectiveness have long been available
no product deals sufficiently with the bleeding from these wound
types and this leads to dressing changes being a regular
occurrence. There remains a need for an effective dressing for use
with IV catheters that stops bleeding and is an effective
antimicrobial solution.
[0005] Catheter use causes a semi-permanent breach of the skin that
provides an access point for pathogens to enter the body, placing
the patient at risk for local and systemic infectious
complications. The potential for infection may be increased by
proliferation of bacteria within or underneath the dressing.
Studies have shown that between 5% and 25% of IV devices are
colonized at the time of removal (Maki et al., 1998). Skin flora is
the main source of microbial contamination and is responsible for
approximately 65% of catheter related infections. Bacteria from the
skin migrate along the external surface of the catheter and
colonize the intravascular catheter tip leading to catheter related
blood stream infections (Raad et al., 2001; Sheretz et al., 1997).
Catheter-related bloodstream infection (CR-BSI) is the third most
common health care-acquired infection in the United States and is
considered one of the most dangerous complications for patients. In
Europe the incidence and density of central venous catheter (CVC)
related bloodstream infections ranges from 1-3.1 per 1000 patient
days (Suetens et al., 2007). Most organisms responsible for CR-BSIs
originate from the insertion site of the catheter (Timsit, 2007),
therefore, decreasing bacterial colonization at the site of
insertion may help reduce the incidence of CR-BSIs.
[0006] It is an object of the current invention to provide an
improved wound dressing device that will provide protection at an
insertion site.
SUMMARY OF THE INVENTION
[0007] According to the invention there is provided a dressing
device for use with a transcutaneous medical device such as a
cannula or a catheter, the dressing device comprising a flexible
hydrophillic polyurethane matrix, an antimicrobial agent contained
within the matrix, and a hemostatic agent contained within the
matrix, the hemostatic agent comprising polyanhydroglucuronic acid
or salt thereof in an amount to achieve a hemostatic effect, and
the antimicrobial agent comprising chlorhexidine di-gluconate in an
amount to achieve an antimicrobial effect without adversely
affecting wound healing.
[0008] The invention provides a wound dressing device that prevents
microbial colonization of the dressing and stops bleeding from the
insertion site. The device provides combined hemostatic and
antimicrobial effects at the insertion site but without adversely
affecting wound healing.
[0009] This is a particularly surprising aspect of the invention
because a dressing composition that contains only
polyanhydroglucuronic acid or salt thereof to promote wound healing
and hemostasis is not conducive to contamination and infection
control. The addition of chlorhexidine di-gluconate as an
antimicrobial agent effective at preventing contamination and
infection would be expected to adversely affect wound healing. We
have surprisingly found that this is not the case.
[0010] The polyanhydroglucuronic salt may be present in an amount
of from 3% to 20% (w/w). The polyanhydroglucuronic salt may for
example be present in an amount of approximately 8% w/w.
[0011] The chlorhexidine di-gluconate may be present in an amount
of from 9% to 16% (w/w). The chlorhexidine di-gluconate may for
example be present in an amount of approximately 11% w/w.
[0012] In one embodiment the dressing device comprises
approximately 8% (w/w) polyanhydroglucuronic acid, approximately
11% (w/w) chlorhexidine di-gluconate, and approximately 81%
hydrophillic flexible polyurethane foam.
[0013] In one embodiment the dressing device comprises an aperture
for reception of a medical device such as a cannula or a
catheter.
[0014] In one embodiment the dressing device comprises a breathable
backing material to allow vapor transmission from the device.
[0015] A skin contacting side of the device may contain an adhesive
compound to keep the device affixed to a site.
[0016] In one case the central access aperture is a circular hole
ranging in size from 0.1 mm to 10 mm in diameter.
[0017] Alternatively the central access aperture is "x" shaped.
[0018] The central access aperture may be "T" shaped.
[0019] In one embodiment the device contains a quantity of the
antimicrobial agent to maintain antimicrobial efficiency for up to
7 days.
[0020] The invention in one aspect is an absorbent polymeric wound
dressing containing a broad spectrum antimicrobial agent and a
hemostatic agent with a moisture vapor permeable backing and radial
slit and central access hole to allow insertion of an IV catheter
line or other similar percutaneous device. The device contains
sufficient quantities of the broad spectrum antimicrobial agent to
ensure that a clear antimicrobial zone of inhibition can be
maintained around the insertion site and to prevent microbial
contamination of the dressing. The device also contains sufficient
quantities of hemostatic agent in order to successfully control
minor bleeding at the insertion site.
[0021] The absorbent polymer foam matrix dressing of the invention
rapidly addresses bleeding, prevents dermal wound site
contamination and infection while at the same time promoting wound
healing. Rapid wound healing and closure in a controlled aseptic
(near microbe free) environment provides the optimal conditions for
reduced wound site morbidity.
[0022] The absorbent polymer foam matrix dressing composition of
the invention addresses the paradoxical requirement of good
antimicrobial efficacy, good hemostatic efficacy and good wound
healing properties in the same absorbent, conformable polymer foam
composition containing specific narrow range non-antagonistic
concentrations of antimicrobial, hemostatic and wound healing
agents that allow for combined effective interactions that are
antimicrobial, hemostatic and wound healing.
[0023] A specific application of the present invention relates to a
wound device, particularly for use with IV catheters and other
percutaneous devices.
[0024] The invention disclosure described herein identifies a novel
device composition which allows for the singular important
advantage in being able to attain antimicrobial, hemostatic and
wound-healing promoting characteristics in a single absorbent and
compliant device system. Normally achieving such functional
heterogeneity in one device is not possible due to antagonistic
effects of the separate functions on one another. The unique
feature of this invention is that it is able to identify and
integrate effective ranges for each active component without
adversely affecting the functions of the other components.
BRIEF DESCRIPTION OF THE DRAWINGS
[0025] The invention will be more clearly understood from the
following description of an embodiment thereof, given by way of
example only, with reference to the accompanying drawings, in
which:
[0026] FIG. 1 shows the results of the antimicrobial testing
against methicillin-resistant Staphylococcus aureus (MRSA) using
AATCC Test Method 100-2004 after 24 hours incubation of sterilized
polyurethane foam matrix dressings containing polyanhydroglucuronic
acid calcium sodium salt (8% w/w) dressing with increasing weight
percent of chlorhexidine di-gluconate (CHG) in a 217 mg, 25 mm
diameter dressing;
[0027] FIG. 2 shows results of Kirby Bauer antimicrobial zone of
inhibition testing after 24 hours incubation for the polyurethane
foam matrix described in example 3 and a commercially available
chlorhexidine di-gluconate containing matrix control material
(intended to reduce catheter related blood stream infection)
against methicillin resistant Staphylococcus aureus (MRSA),
methicillin resistant Staphylococcus epidermidis (MRSE),
Pseudomonas aeruginosa, vancomycin resistant Enterococcus faecium
(VRE), Acinetobacter baumannii, Klebsiella pneumoniae and Candida
albicans;
[0028] FIGS. 3A-3B show results of Kirby Bauer antimicrobial zone
of inhibition testing after 1, 2, 3, 4, 5, 6 & 7 days for the
polyurethane foam matrix described in example 3 against the gram
positive organisms (FIG. 3A) methicillin resistant Staphylococcus
aureus (MRSA), methicillin resistant Staphylococcus epidermidis
(MRSE), vancomycin resistant Enterococcus faecium (VRE) and the
fungus and Candida albicans, and against gram negative organisms
(FIG. 3B) Escherichia coli, Pseudomonas aeruginosa, Acinetobacter
baumannii and Klebsiella pneumoniae;
[0029] FIG. 4 shows the results of testing of suppression of
re-growth of human skin microflora on prepped subclavian sites for
the polyurethane foam matrix described in example 3 in healthy
volunteers (N=12). The method of testing was based on that
described by Maki et al 2008. The control dressing is polyurethane
foam matrix with no chlorhexidine di-gluconate and no
polyanhydroglucuronic acid. Bacterial counts are expressed as log
10 CFU/cm.sup.2. There is a statistically significant difference
(P<0.001) between test and control dressings at both day 7 and
day 10. Skin prepping was carried out for 1 minute with 70%
isopropyl alcohol;
[0030] FIG. 5 compares mean wound surface area in a study 1 of an
untreated control (dashed line (- - -) un-treated wounds), a test
item (solid line--wounds treated with the test dressing device of
Example 3), and a control dressing (dotted line ( . . . ));
[0031] FIG. 6 demonstrates the change in wound surface area of an
untreated control (dashed line (- - -) un-treated wounds), a test
item (solid line--wounds treated with the test dressing device of
Example 3), and a control dressing (dotted line ( . . . ));
[0032] FIG. 7 demonstrates oedema development of an untreated
control (dashed line (- - -) un-treated wounds), a test item (solid
line--wounds treated with the test dressing device of Example 3),
and a control dressing (dotted line ( . . . ));
[0033] FIGS. 8(a) to 8(h) illustrates some different physical
embodiments of a wound dressing device of the invention; and
[0034] FIGS. 9(a) to 9(b) shows representative micrographs of
polyurethane foam A) without the impregnation of haemostatic
calcium sodium polyanhydroglucuronic acid and B) with the
impregnation of calcium sodium polyanhydroglucuronic acid. The
apparatus in FIG. 9(b) indicate particles of calcium-sodium
polyanhydroglucuronic acid.
DETAILED DESCRIPTION OF THE INVENTION
[0035] The invention provides wound dressings for controlling minor
bleeding at the access sites of IV catheters and similar
percutaneous devices. Moreover the invention provides protection at
the access site and contains a broad spectrum antimicrobial agent
to help resist microbial colonization of the dressing. The device
also successfully reduces bleeding time. The dressing device
provides advantages over other IV site dressings as it contains a
hemostatic agent.
[0036] In one embodiment of the invention polyanhydroglucuronic
acid is incorporated into the polymeric base material as the
hemostatic agent and chlorhexidine di-gluconate is incorporated as
the broad spectrum antimicrobial agent.
[0037] The device may have a moisture vapor permeable backing to
allow for moisture transmission. The backing may, for example,
comprise a thin polyurethane film.
[0038] The system of the present invention has been shown to
effectively maintain antimicrobial efficacy over a period of up to
7 days.
[0039] On complete saturation with an aqueous medium the absorption
capacity of the foam of the present invention is typically greater
than 8 times (wt/wt relative to the dry weight of the dressing).
Preferred absorption capacity of the dressing is 10 to 15 times
(wt/wt).
[0040] In one embodiment of the system the polymeric base material
is polyurethane foam. The components that make up the system may be
present in the system with final concentrations of, for example, 8%
(w/w) polyanhydroglucuronic acid 11% (w/w) chlorhexidine
di-gluconate and 81% hydrophillic flexible polyurethane foam.
[0041] The dressings of the invention will generally be sterile.
Sterilization may be carried out using gamma irradiation but other
sterilization methods such as ethylene oxide sterilization may also
be used.
[0042] In one embodiment, the dressing device has an adhesive
technology on the skin contacting surface to aid in site securement
and also for removal and re-securement.
[0043] In one embodiment the wound dressing is circular with an
outer diameter of 0.6 to 2 inches (1.52 to 5.08 cm). The outer
diameter may be about one inch (2.54 cm). The dressing of the
invention will typically have a central access aperture to
facilitate passage of an IV catheter line or other similar
percutaneous device.
[0044] In other embodiments the central access aperture may be "x"
or "T" shaped. One embodiment of the device has a circular cut
central access site. The size of the central access site may vary
from typically 1 mm to 10 mm.
[0045] In further embodiments of the invention the device may be
non-circular.
[0046] Having described the invention in general terms, reference
is now made to specific non-limiting examples.
[0047] The invention provides a hemostatic and wound healing
promoting antimicrobial dressing for general wound use, but also
particularly for controlling minor bleeding at the access sites of
IV catheters and similar percutaneous devices. Moreover the
invention promotes wound healing while providing protection at the
access site by slow release of a broad-spectrum antimicrobial agent
to help resist microbial colonization of the dressing. The device
also successfully reduces bleeding time. The antimicrobial
hemostatic dressing device described herein provides significant
advantages over prior art dressing forms as it provides for wound
healing in combination with hemostasis and contamination and
infection control while avoiding antagonism between pro-healing,
hemostatic and antimicrobial elements.
Example 1
Hemostatic and Antimicrobial Polyurethane Foam Preparations
[0048] To prepare hemostatic and antimicrobial foam the hemostat
polyanhydroglucuronic acid (PAGA) (HemCon Medical Technologies
Europe Ltd, Dublin) and the antimi-crobial compound chlorhexidine
di-gluconate (CHG) (Kapp Technologies LLC, New Jersey) were used.
Polyurethane foam dressings were prepared with varying
concentrations of PAGA and CHG relative to the final dry weight of
polyurethane foam. The polyurethane foam used is type MS50P(w)
Lendell medical foam available from Filtrona Porous Technologies
(www.filtronaporoustechnologies.com)
TABLE-US-00001 Usable Width: 15 inches (381 mm) Thickness: 0.22
inches (5.6 mm) % Moisture: 2% Density: 6.0 pcf (96 Kg/m.sup.3)
Tensile Strength: 51.0 psi (352 kPa) Target Elongation: 194% Tear
Strength: 5.6 pli (0.98 kN/m) CDF@50%: 0.74 psi (5.14 kPa)
Durometer: 47 shore Cell Size: 131 ppi Absorption: 15 g/g Expansion
75% Wrung Retention: 1.2 g/g
[0049] The polyurethane foam was produced by firstly producing a
prepolymer comprising a poly-isocyanate [OCN--R--NCO].sub.n and
dial [OH--R--OH] which were mixed in a pre-polymer reaction vessel.
The components of the prepolymer were mixed together using
agitation in a mechanical mixer for over ten minutes ensuring that
all components were thoroughly mixed. The polyurethane
polymerisation reaction occurred in the pre-polymer mixing vessel.
In a separate vessel the PAGA and CHG were blended together in a
vessel containing only water and surfactant with continual mixing
until a homogenous suspension had been achieved. Unlike other
hemostats the PAGA hemostat had the solubility and viscosity
characteristics that allow for aqueous mixing and it additionally
demonstrates chemical inertness towards the CHG and silver entities
to allow such aqueous phase preparation. The water content of the
aqueous phase ranged up to 300% stoichiometric equivalents to the
pre-polymer. Surfactants chosen from the group silicone oils,
polydimethylsiloxane-polyoxyalkylene block copolymers, nonylphenol
ethoxylates, or other similar acting organic compounds used for the
dual purpose of acting as anti-foaming compounds in the aqueous
phase while regulating the correct cell size and structure and
overall physical appearance of the foam. The aqueous phase
containing the actives and the reacted prepolymer mix were then
both independently pumped to a third vessel where they were
physically mixed by mechanical means ensuring a homogenous mixture.
The pre-polymer and aqueous phase mixture was then dispensed from
the mixing vessel onto a conveyer belt coated with a carrier liner
to prevent adherence to the belt. The water of the aqueous phase
reacted with the isocyanate groups of the pre-polymer and CO.sub.2
gas was expelled which caused the foam to rise to desired height
0.375 inches. The polyurethane foam was then covered with a
nitrogen blanket to prevent further reaction and allowed to cure
and dry for 24-72 hrs. A number of different formulations were
prepared for manufacturing suitability. The formulations with the
impregnated components are outlined in Table 1.
TABLE-US-00002 TABLE 1 Prepared foam formulations PAGA CHG
Polyurethane (w/w %) (w/w %) (w/w %) 15 30 55 15 22.5 62.5 15 15 70
15 7.5 68.5 15 5 80 11.25 22.5 66.25 7.5 15 68.5 3.75 7.5 88.25
Example 2
Antibacterial Efficacy of Prepared Formulations Calcium Sodium Salt
Polyanhydroglucuronic Acid and Chlorhexidine Di-Gluconate in a
Polyurethane Foam
[0050] Polyurethane foam matrix dressings were prepared with the
calcium sodium salt of polyanhydroglucuronic acid (15% w/w) and w/w
percentages of CHG at 0%, 5%, 11%, 15%, 23% and 30% as presented in
Example 1. These formulations were investigated for their
antibacterial efficacy against methicillin-resistant Staphylococcus
aureus (MRSA) using AATCC Test Method 100 "Assessment of
Antibacterial Finishes on Textiles".
[0051] Analysis of FIG. 1 indicates that the acceptable minimum low
range of chlorhexidine di-gluconate percentage weight fraction in
the polyurethane foam matrix is 9% (20 mg) to 16% (35 mg) w/w since
this range achieves the acceptable>Log 4 reduction.
[0052] The results for gamma-irradiated sterilized testing and
non-gamma-irradiated testing are presented in Table 2.
TABLE-US-00003 TABLE 2 Formulations of PAGA impregnated PU foam
with increasing CHG concentrations 5% 11% 15% 23% 30% CHG (w/w)
(w/w) (w/w) (w/w) (w/w) Log Reduction 2.3 >4.7 5.3 >5.4
>5.0 (Sterile) Log Reduction 2.7 >5.2 >5.3 >5.4 5.3
(Non-sterile)
Example 3
Device Assembly
[0053] A catheter access site dressing device to control bleeding
was prepared by impregnating calcium sodium salt of
polyanhydroglucuronic acid into polyurethane foam. CHG was
incorporated to achieve an antimicrobial efficacy of greater than 4
log in 24 hours. A formulation as described in Table 3 was prepared
and a moisture vapor permeable backing that comprised of
polyurethane film with a MVTR of 1000 gm/m.sup.2/24 hour (3M) was
adhered.
TABLE-US-00004 TABLE 3 IV site device composition Formulation (%
w/w) Ingredients final formulation Chlorhexidine gluconate 11
Calcium-sodium polyanhydroglucuronic acid 8 Hydrophillic flexible
polyurethane foam 81
[0054] The polyurethane foam matrix was die cut into 25. mm
diameter disks with a central 4 mm diameter section removed from
each disk. A radial slit was also punched from the center of the
disk to the outside of the disk. The slit and 4 mm punch are
designed to allow catheter access. The dressing is sterilized by
gamma irradiation between 25 and 45 kGy, sufficient to produce a
sterility assurance limit (SAL) of 10.sup.-6.
[0055] The device described was tested for antimicrobial efficacy
against a number of micro-organisms including gram positive and
gram negative bacteria, fungi and yeast. The antimicrobial efficacy
was tested using the AATCC Test Method 100 "Assessment of
Antibacterial Finishes on Textiles". In summary 1.0 ml of test
organism suspension at a minimum of 1.times.10.sup.6 CFU/ml was
inoculated to the test sample. At selected time points (time zero
and 24 hours) organisms were extracted in a neutralizer media (D/E
broth) which was diluted and plated. Log reduction and percent
reduction were determined. The results obtained are shown in Table
4.
TABLE-US-00005 TABLE 4 Antimicrobial results of the IV site device
Decrease of CFU number/ Micro-organism 24 hours Staphylococcus
aureus >4 log Staphylococcus epidermidis >4 log Enterococcus
faecium >4 log Escherichia coli >4 log Pseudomonas aeruginosa
>4 log Acinetobacter baumanii >4 log Klebsiella pneumoniae
>4 log Candida albicans >4 log Aspergillus niger >4
log
Example 4
In Vitro Hemostatic Efficacy
[0056] The device described in Example 3 was tested for its ability
to activate the intrinsic blood coagulation cascade, specifically
coagulation factor XIIa and kallikrein. In summary, 0.5 cm.sup.2 of
the device and also a control device which was another polyurethane
IV site device but without polyanhydroglucuronic acid (1'' DISK,
4.0 mm centre hole with radial slit and containing 92 mg CHG
(Biopatch; Ethicon)), were placed in Eppendorfs. 0.25 ml of
deionized H.sub.2O was added to the dressings and incubated at room
temperature for 10 min. After 10 min incubation, the dressings were
compressed and the fluid supernatant removed. Subsequently, 45 ul
of the fluid supernatant was added to fresh Eppendorfs. Then 90 ul
of deionized H.sub.2O was added along with 45 ul of normal
coagulation control plasma. The samples were mixed and incubated at
room temperature for 10 min. After the incubation stage 40 ul of
each sample were added to microtiter plate wells and 40 ul of 0.8
mM S-2302 (specific Factor XIIa and kallikrein chromogenic
substrate) was then added to initiate the reaction. The reaction
was allowed to proceed for 3 minutes and then the optical density
at 405 nm was read. The results for this study are presented in
Table 5.
TABLE-US-00006 TABLE 5 Activation of Factor XIIa and kallikrein
Mean Optical Density @ 405 nm Activity Sample (3 min read) Rate/min
PAGA containing 53.40 17.80 PU Foam IV device Other non PAGA 0 0
containing PU Foam IV device
[0057] The control IV site dressing not containing PAGA did not
activate the coagulation factor XIIa and kallikrein of the
intrinsic coagulation system. The device described by Example 3 did
activate the intrinsic coagulation enzymes. Such activation is
consistent with oxidized cellulose mechanism of action and this
demonstrated the potential of the device to be a hemostat.
Example 5
Hemostatic Efficacy--In Vivo Measurements
[0058] Having established the potential for hemostatic activity in
Example 4 the device was tested for hemostatic activity in a
suitable in vivo bleeding model. Devices of the formulation as
described in Example 3 were tested for their hemostatic efficacy in
vivo in a rabbit ear model.
[0059] The study was divided in two periods. Within the first test
period (D+1) the Test Item was tested on the left ear of the
rabbit, the right ear was used as control. Within the second period
(D+3) the Test Item was tested on the right ear of the rabbit, the
left ear was used as a control. Bleeding was caused by puncture of
a lateral ear vein with an injection needle (external diameter
always 0.9 mm). On D+1 the puncture was performed at an acral part
of the ear, on D+3 the puncture was performed cranially. Distance
between both punctures was 2-3 cm. The test and control were
applied immediately after the puncture wounds were made. Test items
and controls were weighed before their use and immediately after
cessation of bleeding. Also the time from start to the end of
bleeding was measured.
[0060] In this study wounds treated with the Test Item bled for a
shorter period of time and had a smaller blood loss compared to the
control (Pur-Zellin.RTM. cellulose swab, HARTMANN-RICO a.s.)
thereby demonstrating the hemostatic efficacy of the device. Data
demonstrating the in vivo hemostatic efficacy of the device is
outlined in Table 7.
TABLE-US-00007 TABLE 11 Results for the device in time to stop
bleeding and blood loss mass Test Item (n = 16) Control (n = 16)
Average quantity of 0.167 .+-. 0.18 1.311 .+-. 1.08 Absorbed Blood
(g) Average Time of Bleeding 48.8 .+-. 20.1 89.4 .+-. 77.4
(seconds)
Example 6
Wound Healing
[0061] The effect on wound healing of the device prepared with the
composition of Example 3 was assessed on dermal wound healing in
two separate in vivo studies on rats.
[0062] Dressings prepared with the composition of Example 3 were
assessed in vivo for their effect on dermal wound healing in rats.
Each of twelve animals received three dorsal full thickness wounds
created with an 8 mm dermal punch. Following wound creation the
wound was covered with a test sample, a control dressing (non PAGA
containing IV site dressing as in Example 4) or left untreated. The
wound sites on each animal were covered with a secondary dressing.
Animals were observed daily to ensure integrity of the wound, to
observe signs of general clinical health and to record wound
measurements. The same dressing that was removed was replaced on
the wound after each measurement had been taken. Dressings were
changed as necessary depending on the degree of saturation with
exudate and wear time was limited to a maximum of 7 days exposure
of a single treatment on the wound.
[0063] All wounds healed comparably by day 14 with the test article
of the composition of Example 3 performing between the untreated
wound (see FIG. 5) and the control dressing. However, it could be
seen that during the mid-stage of the study the animals from the
control dressing group showed slower dermal healing compared to the
described device and the negative control. This can be attributed
to the significantly higher CHG content (92 mg/dressing or 30%
(w/w)) of the control dressing.
Example 7
Further Wound Healing and Oedema Formation
[0064] Dressings prepared with the composition of Example 3 were
assessed in vivo for their effect on dermal wound healing in rats
in an experiment similar to that described in Example 6. Each of
ten animals received three dorsal full thickness wounds to the
depth of the subcutis created with a 10 mm dermal punch. Following
wound creation each of the three wound on each animal was covered
with either a test sample, a control dressing (non PAGA containing
IV site dressing as in Example 4 and 6) or left untreated. The
wound sites on each animal were covered with a secondary dressing.
Animals were observed daily to ensure integrity of the wound, to
observe signs of general clinical health and to record wound
measurements. The same dressing that was removed was replaced on
the wound after each measurement had been taken. Dressings were
changed as necessary depending on the degree of saturation with
exudate and wear time was limited to a maximum of 7 days exposure
of a single treatment on the wound. The wounds were also evaluated
for signs of erythema and oedema.
[0065] As with the study described in FIGS. 9(a) and 9(b) all
wounds healed comparably by day 10 with the test article of the
composition of Example 3 performing between the untreated wound and
control dressing (See FIG. 6). There were no visible signs of
erythema development at any of the wound sites (Table 12). Slight
oedema formation was reported for untreated wounds and those
treated with the test item (FIG. 7 and Table 13). In general a
similar response was observed for un-treated wounds and wounds
treated with the test item. Oedema formation was more pronounced in
wounds treated with the control dressing which contained a
significantly higher fraction of CHG (30% w/w).
[0066] Generally, untreated wounds and wounds treated with the test
item healed in similar manners. Both healed at a faster rate than
wounds treated with control dressing and the higher CHG
concentration. Also Oedema formation was less pronounced in these
wounds compared to wounds treated with control dressing. The less
favorable wound healing results seen for the control dressing can
be attributed to the higher CHG content (30% w/w).
TABLE-US-00008 TABLE 12 Erythema Formation Erythema Average Score
Day 0 1 2 3 4 5 6 7 8 9 10 Un-treated 1 0 0 0 0 0 0 0 0 0 0 Test
Item 1 0 0 0 0 0 0 0 0 0 0 Control Dressing 1 0 0 0 0 0 0 0 0 0 0
Key: (0 = Normal (no erythema), 1 = Slight erythema, 2 = Mild
erythema, 3 = Severe erythema)
TABLE-US-00009 TABLE 13 Oedema Development Oedema Average Score Day
0 1 2 3 4 5 6 7 8 9 10 Un-treated 1 1 1.3 1.2 1.1 1.1 1.1 1.1 1.1
1.1 1 Test Item 1 1 1.1 1.7 1.3 1.3 1.3 1.1 1.1 1.1 1.1 Control
Dressing 1.1 1 1.3 2 1.8 2 2 1.8 1.9 1.8 1.9 Key: (0 = Normal (No
oedema), 1 = Slight oedema, 2 = Mild oedema, 3 = Severe oedema)
Example 8
Sustained Antimicrobial Efficacy-Log Reduction
[0067] To demonstrate the sustained antimicrobial efficacy of was
dressing formulation in example 3 over 24 hours and 7 days, AATCC
Test Method 100-2004 "Assessment of Antimicrobial Finishes on
Textiles" was used. The results of this testing (Table 14)
demonstrate that the formulation in example 3 is highly effective
in controlling a broad range of gram negative and gram positive
bacteria as well as the fungi C. albicans and A. niger. Also a
modified version of the AATCC Test Method 100 was investigated. In
the modified AATCC 100 test method, in addition to testing dressing
samples following 24 hour exposure to the test organisms, reference
and test dressings are also exposed for 6 days to a mock wound
environment that potentially could lead to loss or degradation of
the antimicrobial activity. Following the 6-day exposure, the
dressings are inoculated and the test conducted according to the
standard AATCC Test Method 100. Dressing were tested against a
number of micro-organisms including gram positive and gram negative
bacteria and dimorphic fungi/yeast. The log reduction data observed
following 24 hours and 7 days is outlined in Table 15 below. A log
reduction of greater than 4 log was recorded for each of the test
organisms demonstrating the sustained antimicrobial activity of the
antimicrobial agent in the dressing.
TABLE-US-00010 TABLE 14 Standard AATCC antimicrobial finish testing
24 hrs Log 7 days Log Micro-organism Reduction Reduction
Staphylococcus aureus CCM 7110 5.50 6.31 Staphylococcus epidermidis
CCM 7221 5.53 6.18 Enterococcus faecium CNCTC 5773 5.52 5.51
Escherichia coli CCM 4517 5.58 6.38 Pseudomonas aeruginosa CCM 1961
5.76 6.70 Acinetobacter baumanii CNCTC 6168 5.55 6.16 Klebsiella
pneumoniae CCM 4415 4.83 6.62 Candida albicans CCM 8215 4.72 4.71
Aspergillus niger 4.20 4.19
TABLE-US-00011 TABLE 15 Modified AATCC antimicrobial finish testing
7 days Log Micro-organism Reduction Staphylococcus aureus CCM 7110
>4 Staphylococcus epidermidis CCM 7221 >4 Enterococcus
faecium CNCTC 5773 >4 Escherichia coli CCM 4517 >4
Pseudomonas aeruginosa CCM 1961 >4 Acinetobacter baumanii CNCTC
6168 >4 Klebsiella pneumoniae CCM 4415 >4 Candida albicans
CCM 8215 >4 Aspergillus niger >4
Example 9
Sustained Antimicrobial Efficacy--Zone of Inhibition
[0068] A Kirby-Bauer Zone of Inhibition method was used to
investigate the sustained antimicrobial efficacy of the dressing in
Example 3 over 24 hours and 7 days. Overnight cultures were
prepared to a minimum inoculum count of 1.times.107 CFU/ml and
spread on freshly prepared agar plates. An individual test article
was placed onto the agar plate and incubated for 24 hrs at
35-37.degree. C. The area under the test article was swabbed and
the swab was transferred onto sterile agar plates. The test article
was then placed on a freshly inoculated agar plate and the
procedure repeated. The test articles were transferred each day for
up to seven days. Growth from the swabs taken from the test
articles indicated bacteriostatic action of the antimicrobial agent
while no growth indicated bactericidal action. Samples were tested
in triplicate. The bactericidal or bacteriostatic action of the
dressing at 7 days is shown in Table 16. FIG. 2 shows zone of
inhibition results at 24 hours while FIGS. 3A & 3B show the
zone of inhibition % changes at 1, 2, 3, 4, 5, 6 & 7 days.
TABLE-US-00012 TABLE 16 Bacteriocidal or Bacteriostatic action of
the device Bacteriocidal or Micro-organism Bacteriostatic
Staphylococcus aureus CCM 7110 Bacteriocidal Staphylococcus
epidermidis CCM 7221 Bacteriocidal Enterococcus faecium CNCTC 5773
Bacteriocidal Escherichia coli CCM 4517 Bacteriocidal Pseudomonas
aeruginosa CCM 1961 Bacteriostatic Acinetobacter baumanii CNCTC
6168 Bacteriostatic Klebsiella pneumoniae CCM 4415 Bacteriocidal
Candida albicans CCM 8215 Bacteriostatic
Example 10
A Prospective Human Clinical Study of Suppression of Skin
Microflora
[0069] The primary objective of this study was to investigate the
ability of the polyurethane foam matrix dressing formulation of
example 3 to suppress the regrowth of skin microflora following
skin preparations on healthy human volunteers. This study was
performed on healthy human volunteers following the method of Maki
et al. 2008. The study was independently conducted by the Center
for Laboratory Activities in Public Health Protection and
Promotion, National Reference Laboratory for Disinfection and
Sterilization, National Institute of Health, Prague, Czech
Republic.
[0070] Subjects--A group of 12 study subjects was selected and
enrolled for testing through informed consent. All were Caucasian
with an average age of 52.5 years and an age range between 25 years
and 69 years. This study was conducted to assess the capacity of
the test dressings (example 3 formulation) to suppress skin flora
re-growth following skin prepping for 1 minute with 70% isopropyl
alcohol when compared to an inactive control dressing. Each subject
served as his or her own control by using 8 randomized sites in the
subclavian area of each volunteer. On study day 0, baseline skin
flora counts were established from randomized sites. Skin flora
count from these randomized sites was also measured following air
drying immediately post-prep with 70% isopropyl alcohol. Once the
remaining sites had air-dried immediately post-prep, the test
dressings (example 3 formulation) and the control dressings
(polyurethane foam with no CHG or oxidized cellulose) were applied
to the remaining prepped sites of the subjects. Dressings were
applied to the subclavian sites using sterile tweezers and attached
by latex-free, hypoallergenic and transparent polyurethane
securement dressings. The dressings were left up to 10 days, and
skin flora counts were taken at 7 and 10 day time points. Skin
flora was measured using standard scrubbing techniques and the skin
flora beneath the dressing quantitated through use of a recovery
solution that was then cultured on agar plates. Wilcoxon paired
tests were used for statistical testing of the level of
significance (P-values<0.05 were considered significant).
[0071] Disinfection of the skin prior to catheter insertion
provides substantial protection to a site, but viable bacteria may
still remain on the skin and re-grow over time, thus leading to a
greater possibility of infection. Any catheter related bloodstream
infection preventive strategy should be able to reduce skin
microbial colonization for the duration of the catheter insertion.
The results seen in FIG. 4 show the effect of the 70% isopropyl
alcohol skin prep. The raw skin flora counts were dramatically
reduced, as would be expected. It can also be observed that after
both the 7 day and 10 day time points, the test dressings
maintained the skin flora at levels equivalent to those of the
post-prep level, whereas with the control dressings significant
skin flora re-growth was evident. Bacterial counts were converted
to log 10 CFU/cm2 prior to statistical analysis. At day 7, the test
dressings showed significantly lower skin flora counts post-prep
compared to the control dressings which had substantial re-growth
(P<0.001). At day 10, test dressings also showed significantly
lower re-growth (P<0.001). As can be seen (FIG. 4), the test
dressing maintained the skin flora count at less than the post-prep
count for the complete duration of the study out to 10 days.
[0072] No adverse events, such as skin irritation, edema or
erythema formation were reported for the study with the test
dressing. The test dressing successfully and significantly
prevented the re-growth of microorganisms for up to 10 days as
demonstrated by this study. After both 7 and 10 days, the microbial
count was seen to be less than that of the post-prep microbial
count. As such, it would be expected that the test dressing
formulation (example 3) would be an effective component of a
strategy to reduce skin microbial colonization. From literature,
such a reduction in skin colonization markedly reduces the risk of
catheter related bloodstream infection [Bjornson et al. 1982,
Safdar et al. 2004, Maki et al. 1997].
Example 11
Different Physical Embodiments
[0073] The produced PAGA and CHG impregnated foam described in
Example 3 was also die cut into different sized and shaped devices.
Radial slits were always punched from the centre of the disk to the
outside of the device but different catheter access site holes and
shapes were produced. Some of these different physical embodiments
of the device can be seen in FIGS. 8(a) to 8(h).
[0074] In FIG. 8(a) the device has a diameter of 1 inch (2.54 cm)
with a 1.5 mm central access site hole and a radial slit extending
outwardly from the central hole.
[0075] The device of FIG. 8(b) is similar to 8(a) but in this case
there is a 4 mm central hole.
[0076] The device of FIG. 8(c) is also similar to 8(a) but in this
case there is a 7 mm central hole.
[0077] The device of FIG. 8(d) is similar to 8(a) but in this case
there is a T-shaped central access site.
[0078] The device of FIG. 8(e) has a +shaped access site whilst the
device of FIG. 8(f) has an X shaped access site.
[0079] The device of FIG. 8(g) is an orthogonal shaped device with
a central access site hole which may be about 4 mm and there is a
radial slit.
[0080] FIG. 8(h) shows a rectangular shaped device with a central
access site hole which may be about 4 mm and again in this case
there is a radial slit.
Example 12
Microscopy Analysis of Foam Constructs
[0081] The PAGA and CHG impregnated foam dressings were also
studied using microscopy to so demonstrate the impregnation of the
dressing with PAGA. Thin sections of the dressing were cut with a
scalpel and placed into wells of 6-well plates. 1 ml aliquots of a
solution of 0.001% aqueous bromophenol blue were added to the well
and allowed to stain at room temperature (RT) for 30 min. As a
Negative Control, a thin section of non-impregnated foam dressing
which did not contain PAGA, were similarly treated, Bromophenol
blue is an acid phthalein dye, commonly used as a pH indicator and
was used here for better visualization contrast of the polyurethane
and PAGA due to their different pHs.
[0082] After staining for 30 min, the bromophenol blue was removed
and the sections of the dressings were washed with 3 ml deionized
H.sub.2O. The washing was repeated three times. Images of the
dressings were taken using an Olympus CKX41 microscope with an
Olympus E-600 digital camera attached at a magnification of
10.times.. Representative images are presented in FIGS. 9(a) and
9(b). FIG. 9(a) shows the standard foam without active
impregnation. The stained micrograph shows the cell structure of
the individual cell units. FIG. 9(b) shows the PAGA impregnated
foam. The stained PAGA particles can be seen in the micrograph
along with the polyurethane foam stained cells.
[0083] Although the disclosure hereof is detailed and exact to
enable those skilled in the art to practice the invention, the
physical embodiments herein disclosed merely exemplify the
invention that may be embodied in other ways. While the preferred
embodiment has been described the details may be changed without
departing from the invention.
[0084] Modifications and additions can be made to the embodiments
of the invention described herein without departing from the scope
of the invention. For example, while the embodiments described
herein refer to particular features, the invention includes
embodiments having different combinations of features. The
invention also includes embodiments that do not include all of the
specific features described.
REFERENCES
[0085] Mital A, Fried L F and Piraino B, 2004 "Bleeding
complications associated with peritoneal dialysis catheter
insertion" Peritoneal Dialysis Int. 24 pp. 478-480 [0086] Doerfler
M E, Kaufman B and Goldenberg A S, 1996 "Central venous catheter
placement in patients with disorders of hemostasis" Chest 110 (1)
pp. 185-188 [0087] Bouza E, Burillo A and Munoz, 2002
"Catheter-related infections: diagnosis and intravascular
treatment" Clin. Microbial. Infect. 8: 265-274 [0088] Maki D G,
Mermel L A 1998 "Infections due to infusion therapy" Taken from:
Bennett J V, Brachman P S, eds. Hospital Infections. Philadelphia,
Pa.: Lippincott-Raven; pp. 689-724 [0089] Raad I I, Hanna H A and
Darouiche R O 2001 "Diagnosis of Catheter--Related Bloodstream
Infections: Is it necessary to culture the subcutaneous catheter
segment?" Eur. J. Clin. Microbial. Infect. Dis. 20 pp. 566-568
[0090] Sherertz R J, Heard S O and Raad I I, 1997 "Diagnosis of
triple-lumen catheter infection: Comparison of roll plate,
sonication and flushing methodologies" J. Clin. Microbial. 35 pp.
641-646 [0091] Timsit J F, 2007 "Diagnosis and prevention of
catheter-related infections" Curr. Opin. Crit. Care 13 (5) pp.
563-571 [0092] Lee R I and White P D "A Clinical Study of the
Coagulation Time of Blood" J. Am. Med. Sci., April 1913 Vol. 245
(4), 495-503 [0093] Maki et al. "Novel Integrated
Chlorhexidine-impregnated Transparent Dressing for Prevention of
Vascular Catheter-related Bloodstream Infection: A Prospective
Comparative Study in Healthy Volunteers", Poster Presentation at
the Society for HealthCare Epidemiology of America Conference 2008,
Orlando, Fla. [0094] Bjornson, H. S., et al. 1982 "Association
between microorganism growth at the catheter insertion site and
colonization of the catheter in patients receiving total parenteral
nutrition" Surgery, 92(4): pp. 720-727 [0095] Safdar, N. and D. G.
Maki 2004 "The pathogenesis of catheter-related bloodstream
infection with noncuffed short-term central venous catheters"
Intensive Care Med, 30(1): pp. 62-67 [0096] Maki, D. G., et al.
1997 "Prevention of central venous catheter-related bloodstream
infection by use of an antiseptic-impregnated catheter. A
randomized, controlled trial" Ann Intern Med, 127(4): pp.
257-266
* * * * *