IODOSORB^◊

Cadexomer Matrix with Iodine

About IODOSORB

IODOSORB and IODOFLEX are a range of Cadexomer dressings with Iodine products, available in three presentations.

IODOSORB removes barriers to healing by its dual action antimicrobial and desloughing properties. The broad spectrum antimicrobial action is provided by the sustained release of iodine and the desloughing action is provided by the unique cadexomer matrix.

By effectively removing the barriers of bacteria, slough and debris and excess exudate, IODOSORB is effective for the treatment of infection in chronic exuding wounds.

IODOSORB Claims

Provides sustained antimicrobial activity
Effectively reduces the bacterial load
Manages excess exudate in highly exuding wounds
Creates a moist wound environment

IODOSORB Benefits

Clinically proven to treat infection
Effective antimicrobial and deslougher
High absorbency
Wide range of high level clinical support
Versatile range
Changes colour as iodine is released
Encourages wound healing
Helps to eliminate odour

Features of IODOSORB

Features 2

Changes colour: to indicate when dressing change is needed
Non-adherent: can be removed with saline to help reduce trauma to the patient, and increase patient quality of life
Biodegradable
Range of sizes: Aids dressing selection
Helps reduce wastage

IODOSORB Properties

IODOSORB is a dual action wound management product. It offers the benefits of a broad-spectrum, slow-release antimicrobial agent in combination with desloughing and fluid handling properties. IODOSORB is effective at treating infection and preparing the wound bed to heal, in highly exuding chronic wounds.

Odour Control Properties

Odour is generated by wounds which are infected and heavily colonised by both anaerobic and aerobic bacteria. Odour is attributed to the volatiles produced by the bacteria within a wound^4,5. Therefore, control of such bacteria should also control the associated odour.

Desloughing Properties

"Ulcers treated with Cadexomer Iodine showed significantly more rapid desloughing and healing than those treated with a standard dressing"¹⁶

Wound fluid, containing bacteria and cellular debris, is readily drawn up into the Cadexomer matrix cleansing the wound bed of extra debris and bacteria, thereby helping to promote wound healing. This desloughing and removal of bacteria is believed to be responsible for the increase in wound healing and the rate of epithelialisation observed in clinical studies of chronic leg ulcers after treatment with Cadexomer Iodine^7,8,13,16

Exudate Control Properties

Cadexomer Iodine is able to manage excess exudate by its ability to absorb up to six times its own weight¹⁰. This reduces the risk of maceration and leakage and can result in less dressing changes and reduced nursing supervision for patients compared to standard treatments.

IODOSORB Presentations

IODOSORB Ointment

Cadexomer Iodine Ointment

IODOSORB Cadexomer Iodine Ointment IODOSORB Ointment is a sterile formulation of cadexomer iodine. When applied to the wound, it cleans it by absorbing fluids, removing pus and debris and forming a moist gel over the wound surface.

As IODOSORB swells in situ the active iodine is released, killing resident micro-organisms in the wound site and changing colour.

IODOSORB Dressing

Cadexomer Iodine Medicated Sheet Dressing

IODOSORB Cadexomer Iodine Medicated Sheet Dressing IODOSORB dressings are sterile formulation of cadexomer iodine. When applied to the wound, it cleans it by absorbing fluids, removing pus and debris and forming a moist gel over the wound surface.

As IODOSORB swells in situ the active iodine is released, killing resident micro-organisms in the wound site and changing colour.

IODOSORB Powder

Cadexomer Iodine Powder

IODOSORB Cadexomer Iodine Powder IODOSORB powder is a sterile formulation of cadexomer iodine. When applied to the wound, it cleans it by absorbing fluids, removing pus and debris and forming a moist gel over the wound surface.

As IODOSORB swells in situ the active iodine is released, killing resident micro-organisms in the wound site and changing colour.

References

¹ Gustavson B. Cadexomer Iodine: Introduction. In: Cadexomer Iodine. Fox JA, Fisher H, editors. Stuttgart: Schattauer Verlag 1983. p. 35-41

² Drosou A, Falabella A, Kirsner RS. Antiseptics on Wounds: An Area of Controversy. Wounds 2003 15(5): 149-66.

³ LeVeen HH, LeVeen RF, LeVeen EG. The mythology of povidone-iodine and the development of self-sterilizing plastics. SURGERY 1993 Feb; 176(2):183-190

⁴ Haughton W, Young T. Common problems in wound care: malodorous wounds. BJN 1995 4, (16):959-963

⁵ Thomas S. Treating malodorous wounds. Community Outlook, 1989 Oct :27-28,30

⁶ Falanga V. Iodine containing pharmaceuticals: a reappraisal. Proceedings of the 6th European Conference on Advances in Wound Healing. London: Macmillan Magazines Ltd 1997

⁷ Tröeng T, Skog E, Arnesjö B, Gjöres JE, Bergljung L, Gundersen J et al. A randomised multicentre trial to compare the efficacy of cadexomer iodine and standard treatment in the management of chronic venous ulcers in out patients. In: Cadexomer Iodine, Fox JA, Fisher H editors. Stuttgart:Schattauer Verlag 1983. p. 43-50

⁸ Hillstrom L. Iodosorb compared to standard treatment in chronic venous leg ulcers - a multi center study. Acta Chir Scand Suppl. 1988; 544: 53-56

⁹ Holloway GA. Johansen KH, Barnes RW, Pierce GE. Multicenter trial of cadexomer iodine to treat venous stasis ulcers. West J Med 1989;151: 35-38

¹⁰ Sundberg J. Poster presentation. The European Wound Management Association Conference, Milan, Italy 1997

¹¹ Mertz PM, Oliveira Gandia MF, Davis SC. The evaluation of cadexomer iodine wound dressing on methicillin resistant staphylococcus aureus (MRSA) in acute wounds. Dermatol Surg 1999; 25(2): 89-93.

¹² Sundberg J, Meller R. A retrospective review of the use of cadexomer iodine in the treatment of chronic wounds. Wounds 1997; 9(3):68-86.

¹³ Gilchrist B, Should iodine be considered in wound management? J Wound Care 1997; 6(3): 148-50.

¹⁴ Jones V, Milton T. When and how to use iodine dressings. Nursing Times 2000; 96 (45 suppl):2-3

¹⁵ Collier, M. Recognition and management of wound infections. Worldwidewounds, January 2005.

¹⁶ Ormiston MC, Seymour MT, Venn GE,Cohen RI, Fox JA Controlled trial of Iodosorb in chronic venous ulcers. BMJ 1985; 291:308-310.

¹⁷ Skog E. et al A randomised trial comparing cadexomer iodine and standard treatment in the out-patient management of chronic venous ulcers Br J Dermatol 1983; 109(1): 77-83.

¹⁸ Zhou L.H. Nahm W.K. Badiavas E, Yufit T and Falanga V. Slow release iodine preparation and wound healing: in-vitro effects consistent with lack of in-vivo toxicity in human chronic wounds. British Journal of Dermatology 2002; 146(3): 365-374

¹⁹ Mertz PM, Davis S, Brewer L, Franzen L. Can antimicrobials be effective without impairing wound healing? The evaluation of a cadexomer iodine ointment. Wounds 1994; 6(6): 184-93

IODOSORB in Use

"The effect of Cadexomer Iodine on pain and its ease of application and removal gave high acceptance by patients and nurses" ¹⁷

Considering an Appropriate Topical Antimicrobial Treatment

IODOSORB Product Range

The importance of wound infections, in both economic and human terms, should not be underestimated. Practitioners need to know how to recognise and manage the signs and consequences of clinically infected wounds. The key principles for the management of a patient with a wound infection can be summarised as follows¹⁵:

Treat the patient holistically
Recognise the signs of inflammation/increased bacterial burden/clinical infection
Be able to take 'reliable' wound swabs
Be able to interpret culture reports
Treat the infection - causative organism(s)
Consider antibiotic sensitivities
Consider which wound management products are suitable and appropriate*
Minimise the risk of cross-infection
Reduce the risk of any complications
Educate the patient and his/her family and carers

*Topical antimicrobials are used to reduce bio-burden; therefore, the choice has to be related to the identity of the causative organisms, assessed either through bacterial culture or clinical judgement. The choice of topical agent should also include an awareness of their potential to induce sensitisation.

IODOSORB Applications

IODOSORB Dressing Application

Step 1:
Choose a suitable size of dressing for the wound.

Step 2:

Clean the wound and surrounding area with a gentle
stream of sterile water or saline.
DO NOT DRY.

Step 3:

Remove carrier gauze on both sides of the dressing.

Step 4:

Apply IODOFLEX to wound surface.
IODOFLEX dressing can be moulded or cut to fit wound.

Step 5:

Cover with an appropriate secondary dressing e.g. ALLEVYN^◊

Step 6:

IODOFLEX dressing can be used for up to 3 months in a single course of treatment.

IODOSORB Ointment Application

Step 1:
Thoroughly clean the wound and surrounding area with a gentle stream of sterile water or saline. Remove excess fluid, leaving wound surface slightly moist.

Step 2:

Apply IODOSORB ointment directly to a dry, sterile non-adherent gauze, ensuring sufficient ointment to cover all parts of the wound.

Step 3:

Position prepared dressing onto the wound.

Step 4:

Lightly smooth a gloved finger over the dressing to spread the ointment underneath to the shape of the wound and to a depth of 3mm.

Step 5:

Cover with an appropriate secondary dressing e.g. ALLEVYN^◊ Apply compression bandaging where appropriate.

Step 6:

Discard remaining contents of tube after application.

IODOSORB Powder Application

Step 1:
Thoroughly clean the wound and surrounding area with a gentle stream of sterile water or saline. Remove excess fluid, leaving wound surface slightly moist.

Step 2:

Apply powder to the wound surface to form a layer 3mm deep and cover with a dry dressing or gauze.

Step 3:

Cover with an appropriate secondary dressing e.g. ALLEVYN^◊

Step 4:

To avoid the risk of cross-contamination, it is recommended that the use of a single sachet of IODOSORB powder be confined to one patient.

Warnings

There is a potential risk of interaction with lithium, resulting in an increased possibility of hypothyroidism
Do not use IODOSORB or IODOFLEX concomitantly with mercurial antiseptics and taurolidine

Precautions

The contents of the sachet/tube should be used on one patient only
Do not use IODOSORB or IODOFLEX in the vicinity of the eyes, ears, nose or mouth
The product is for external use only
IODOSORB or IODOFLEX may cause transient smarting especially in the first hour after treatment. This is a sign that the product is beginning to clean the wound. Occasionally, IODOSORB or IODOFLEX may cause the skin around the wound edges to swell or redden. This will usually pass.
Contact with the skin around the wound edges/intact skin should be minimised
It is possible for an adherent crust to form if the IODOSORB or IODOFLEX is allowed to dry out
A single application of IODOSORB or IODOFLEX should not exceed 50g and not more than 150g in one week
The duration of treatment should not exceed 3 months and allow a one week break before re-starting treatment to enable excretion of iodine

Contraindications

Do not use on dry necrotic tissue or on patients with a know sensitivity to any of its ingredients
Do not use on children, pregnant or lactating women or people with thyroid disorders or renal impairment

References

Technology

Cadexomer with Iodine: Intelligent Interactive Iodine

Cadexomer with Iodine is a uniquely formulated starch matrix formed into spherical, highly absorbent microbeads containing 0.9% elemental iodine.

The Cadexomer is a 3D cross-linked polysaccharide starch matrix. The 0.9% iodine is physically bound to the cadexomer matrix and is only released when it is required.

Cadexomer with Iodine: Mode of Action

Wound fluid and exudate are absorbed into the cadexomer beads of the product, allowing the iodine to be released slowly.

When Cadexomer with Iodine is applied to the wound surface, exudate, pus and debris are absorbed into the cadexomer beads. The beads will swell resulting in the formation of a demonstrable gel.

The presence of exudate and the consequent swelling of the beads results in the cross-linked bonds of the cadexomer matrix breaking and the iodine being released into the surrounding wound environment.

When the iodine is released, the amount of iodine released will be to a level such that the concentration of iodine in the dressing and the wound environment reach an equilibrium. The equilibrium will remain and no further iodine will be released until the balance is disturbed.

Once the iodine in the surrounding wound environment has been depleted, more will be released from the product until the equilibrium is reached again and will remain until disturbed. This process will continue until all the 0.9% iodine within the product has been exhausted.

The conversion of iodine is also associated with a colour change from orangey brown to white. Therefore once all the iodine has been converted and utilised, the IODOSORB will appear white in colour. At this point it is time to make a dressing change.

References

Clinical Background

Expert Summary

"The development of slow-release antiseptic agents, such as those based on iodine, has rendered antiseptics safe, effective, and reliable in the management of difficult wounds. In my own practice, I have found these therapeutic agents particularly useful in the bacterial 'de-colonization' of chronic wounds, an important step in the overall approach to wound bed preparation. As a result, patient management is greatly facilitated, whether one is simply applying standard treatments or using more advanced therapies.

The bacterial burden decreases, as does wound exudate. Quite frankly, I don't know what I would do without the use of slow-release antiseptics, particularly in the outpatient setting. I do know that some of my clinician colleagues are still fearful of the word 'antiseptics'. This fear is rooted in old literature on the use of 'straight' antiseptics, with no mechanisms for slow and smart delivery.

However, in the field of medicine and in caring for patients, one needs to adapt while remaining critical, and most of all be vigilant about new opportunities that can help our patients."

Vincent Falanga, MD
Professor of Dermatology and Biochemistry

Clinical Studies

Dr Marazzi patients with Diabetic Foot Ulcers:

IODOSORB Case Study Case Study 1
Female, 39 years old, with diabetic ulcer in her right foot for 2 years.

Case Study 2
Male, 66 years old, with diabetic ulcer (right foot) for 2 months.

Further Recommended Reading

Antibiotics and Antiseptics for Venous Leg Ulcers - Cochrane Review 2010 (PDF - 226kb)

Antimicrobial dressing efﬁcacy against mature Pseudomonas aeruginosa bioﬁlm on porcine skin explants Priscilla L Phillips1,2, Qingping Yang1, Stephen Davis3, Edith M Sampson2, John I Azeke1,∗, Aﬁfa Hamad1& Gregory S Schultz1

Burks R I, 'Povidone iodine solution in wound treatment' Phys Ther 1998;78:212-18

Clancy J. McVicar A, 'Homeostasis - The key concept to physiological control' Brit-J-Theatre-Nurse, vol 7, No 4, July 1997:25-34

Danielsen L, Cherry G W, Harding K, Rolloman O, 'Cadexomer Iodine in ulcers colonized by Pseudomonas aeruginosa' Journal of Wound Care, April, Vol 6, No. 4 1997:169-172

Falanga V. 'Classifications for wound bed preparation and stimulation of chronic wounds' Wound Repair and Regeneration Vol.. 8, No. 5, 347-352

Hansson C. 'The effects of cadexomer iodine paste in the treatment of venous leg ulcers compared with hydrocolloid dressing and paraffin gauze dressing. Int. J. Dermatology 1998;37 pp390-396

Hansson C, Persson L-M, Stenquist et al. 'The effects of Cadexomer Iodine dressing treatment on exudating, sloughy venous leg ulcers in comparison with hydrocolloid dressing and paraffin gauze dressing' Int.J Dermatology 1998 May;37(5):390-6.

Hunt T K. 'Disinfectectants, antiseptics and antibiotics' Iodine & Wound Physiology, Information Transfer Ltd, UK 1995; 2.1-2.6

Ishibashi Y, Ohkawara A, Kukita A et al. Clinical evaluation of NI-009 on various cutaneous ulcers. Comparative study with Debrisan. J Clin Therap Med 1990; 6(4): 785-816

Inflammation, Healing and Repair. In: MacSween RNM, Whaley K, Arnold E, editors. Muir's Textbook of Pathology, 13th Edition. Little Brown and Company 1993. p. 112-129

Martensson LI. Iodine and wound physiology. Proceedings of the 5th Annual Meeting of the European Tissue Repair Society, Padua, Italy. 1995

Martin P. Wound Healing - aiming for perfect skin regeneration. Science 1997; 276(4): 75-81

Mertz PM, Davis SC, Oliveira-Gandia M, Eaglestein WH. The wound environment: Implications from research studies for healing and infection. Wounds 1996; 8(1): 1-8

Mertz PM. Cadexomer Iodine ointment decreases Staph. aureus in partial thickness wounds and stimulates epidermal wound healing. Soc for Invest Derm. 1993

Moore K. Thomas A, Harding KG. The effect of Iodosorb on cytokine production by human macrophages. In: Iodine and Wound Physiology. UK: Information Transfer Ltd 1995: 5.1-5.14

Salman H, Leakey A. GR Micro Ltd. Data on File 2001

Schmidt RJ, Kirby AJ, Chung LY. Cadexomer iodine formulations may modulate the redox environment of wounds. In: Iodine & Wound Physiology. UK: Information Transfer Ltd 1995; 6.1- 6.26

Sibbald RG, Orsted H, Schultz GS, Coutts P, Keast D. Preparing the wound bed 2003 - Focus on Infection and inflammation. Ostomy Wound Management 2003; 49(11): 24-51

Westrin B, Larsson M. Lund University. Data on File 1997

References

FAQ

Frequently Asked Questions about IODOSORB

How do I remove IODOSORB from the wound?

Remove the secondary dressing. If it is sticking to the IODOSORB, soak with sterile saline or water. To remove IODOSORB from the wound, simply flush it away with sterile saline or water. If there are any small remnants of IODOSORB left in the wound, they will be naturally degraded without causing any delay to healing or systemic reaction.

How can I tell when the IODOSORB needs changing?

IODOSORB will change from a dark brown to off white which indicates that all the iodine has been released. This indicates that it is time to change the IODOSORB. The number of dressing changes therefore depend on the levels of infection and exudate present in the wound.

Is there any risk of iodine absorption causing any problems for the patient?

Generally if you use IODOSORB within the guidelines of the prescribing information (up to a maximum of 150g a week) it is unlikely that there will be any significant iodine absorption and therefore any systemic side effects. However, IODOSORB should not be used in patients with severely impaired renal function or a past history of any thyroid disorder as they are more susceptible to alterations in thyroid metabolism with chronic IODOSORB therapy. It has been observed occasionally that an adherent crust can form when IODOSORB is not changed with sufficient frequency.

Can I use a secondary dressing to secure IODOSORB to the wound?

Yes, you can use any semi-permeable secondary dressing, or secure IODOSORB with bandages over a non-adherent piece of padding or gauze.

Does IODOSORB cause patient pain in what often is already a painful ulcer?

IODOSORB desloughs by absorbing and drawing away slough and exudate from the wound surface. This is not harmful but indicates that the product is working. Sometimes patients feel a warm or smarting sensation and this may be due to the drawing effect of the slough and exudate.

Will IODOSORB relieve ulcer pain?

Yes, it has been shown to. Often IODOSORB will relieve pain whilst in the process of desloughing the wound and killing bacteria. In clinical trials, pain reduction has been a well observed benefit for patients.

What organisms is IODOSORB effective against?

Because IODOSORB contains elemental iodine, it is effective against a wide range of pathogenic bacteria, fungi, yeasts which can delay wound healing. Iodine is also highly effective against Methicillin Resistant Staphylococcus Aureus (MRSA). There have been no reports of acquired resistance with iodine.

For how long can I use IODOSORB on a slow healing ulcer?

IODOSORB can be used for up to 3 months. At this stage if the ulcer still needs treatment a non-iodine containing product must be used for a minimum of one week before resuming treatment with IODOSORB.

What is the largest amount of IODOSORB I can use in a week?

150g of IODOSORB can be applied per patient per week. A single application should not exceed 50g. If more is needed, refer to the warnings on the relevant data sheet and prescribing information.

Can IODOSORB be used in patients who are sensitive to iodine?

No, this is not recommended.

Will IODOSORB delay wound healing as it contains an antiseptic?

No. In fact IODOSORB has been reported to accelerate healing in randomised controlled trials.¹⁴

IODOSORB Matrix Dressing

References

IODOSORB^◊

About IODOSORB

IODOSORB Claims

IODOSORB Benefits

Features of IODOSORB

IODOSORB Properties