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Wound Dressings on the Drug Tariff

Andrew Heenan RMN RGN BA(Hons)
Editor,
World Wide Wounds
a.heenan@smtl.co.uk

Submitted: 16 September 1997
Published: 19 September 1997

Edition 2.0
Edition 1.1 (31 July 1997) also available

Introduction
High compression bandages
Zinc paste bandages
Absorbent, perforated film dressings
Knitted viscose primary dressings
Povidone iodine fabric dressings
Vapour-permeable adhesive film dressing BP
Alginate dressings
Dextranomer paste pad dressings
Hydrocolloid dressings
Hydrogel dressings
Polyurethane foam dressings
Polyurethane foam film dressings
References

Introduction

In the UK, the availability of dressings for use in patients' homes is dictated by the Drug Tariff[1]. This monthly publication defines what may be prescribed in the community (and paid for by the National Health Service).

The Drug Tariff is not an arbitrary list; it contains only those products that are tried and tested; so it tends to exclude the latest products. The exact criteria for selection are not published, but it may not be a coincidence that products with a lower unit cost have, in the past, had a greater chance of quick inclusion than more expensive products. This, it might be suggested, shows a lack of understanding of the principles of wound management: a higher unit cost might apply to a product which needs applying less frequently and/or requires less time and skill to apply. Such a product might be more cost effective over a period of time.

The Drug Tariff has also shown obscure prejudice against certain areas; cavity wound dressings, and dressings for malodorous wounds have fared badly.

Recently, however, the Drug Tariff seems to have become more closely related to the market place and to patients' needs. New products, particularly those with a CE mark, and new sizes/formulations of existing products, appear to reach the Tariff more easily.

The Drug Tariff matters, because without an FP10 prescription (England and Wales; GP10 in Scotland) a dressing is officially unobtainable for NHS patients outside of hospital. (Hospitals are not bound by the Drug Tariff; they are free to draw up their own lists of acceptable purchases - but that is another story!). In practice, non-Tariff dressings are obtained by the time honoured techniques of begging, stealing and borrowing. Hospital staff need to be aware of the Drug Tariff and its limitations, in order to plan for continuity of wound management as patients go home.

This article reflects on information already available in the Drug Tariff [1], arranged in tables for convenience. It specifically excludes obsolete dressing, gauze swabs which are sued for cleansing purposes and items like paraffin gauze which are still available on community prescription, but are rarely the dressing of choice[2], particularly those impregnated with antibiotics which are an anachronism to be avoided. Colonization and contamination are not an indication for topical antibiotics, rather an imperative to effective wound healing as quickly as possible, and any sign of significant wound infection is an indication for appropriate systemic antibiotics.0

High compression bandages

Used for the application of sustained compression in the treatment of venous insufficiency. Length given is the unstretched length.
High compression bandages (extensible) Size Price (each)
Setopress  (Seton) 7.5cm x 3.5m
£2.41
10cm x 3.5m
£3.12
Tensopress (Smith & Nephew) 7.5cm x 3m
£2.34
10cm x 3m
£3.02
Surepress (Convatec) 10cm x 3m
£2.96

Setopress is a P.E.C. high compression bandage; Polyamide, Elastane and Cotton Compression (high) Extensible Bandage (PECCHE). Tensopress is a V.E.C. High Compression bandage; Viscose, Elastane and Cotton Compression (high) Extensible Bandage (VECCHE).

Zinc paste bandages

Zinc paste bandages Note Size Price (each)
Steripaste (15%) (Seton)
1
7.5cm x 6m
£3.01
Viscopaste PB7 (10%) (Smith & Nephew)
1
7.5cm x 6m
£3.03
Zincaband (15%) (Seton)
1
7.5cm x 6m
£2.96
Icthopaste (6.5%) (Smith & Nephew)
2
7.5cm x 6m
£3.06
Icthaband (15.5%) (Seton)
2
7.5cm x 6m
£2.96
Quinaband (Seton)
3
7.5cm x 6m
£3.05
Calaband (Seton)
4
7.5cm x 6m
£3.05

notes
1. zinc paste bandage
2. zinc paste and ichthammol bandage
3. zinc paste, calamine and clioquinol bandage
4. zinc paste and calamine bandage

Absorbent, perforated plastic film faced dressings

These dressing were probably the first serious attempt to improve on the cotton gauze 'dry dressing', and combine absorbency with reduced risk of adherence. They were also the first to be described as 'non-stick' or non adherent, a claim that brings them close to falling foul of the Trades Descriptions Act (1963). Compared with the fabric dressings used before, however, they were certainly low adherent.
Perforated film absorbent dressings Size Price (each)
Melolin(Smith & Nephew) 5cm x 5cm 13p
10cm x 10cm
21p
20cm x 10cm
40p
Mepore(Molnlycke) 6cm x 7cm 8p
9cm x 10cm
17p
9cm x 15cm
28p
Release (Johnson & Johnson) 5cm x 5cm
12p
10cm x 10cm
19p
20cm x 10cm
37p
Skintact (Robinson) 5cm x 5cm
10p
10cm x 10cm
17p
20cm x 10cm
33p

Knitted viscose primary dressing BP

These dressings are designed to be used with a secondary dressing, depending on the level of absorbency required; they rely on the low adherent property of knitted viscose.
Knitted viscose primary dressings Size Price (each)
N-A Dressing (Johnson & Johnson) 9.5cm x 9.5cm
29p
N-A Ultra* (Johnson & Johnson) 9.5cm x 9.5cm
28p
Tricotex (Smith & Nephew) 9.5cm x 9.5cm
25p
* impregnated with silicone to further reduce adherence.

Povidone iodine fabric dressings

Povidone iodine fabric dressing Size Price (each)
Inadine (Johnson & Johnson) 5cm x 5cm
£0.26
9.5cm x 9.5cm
£0.39

Vapour-permeable adhesive film dressing BP

Though they have found a variety of uses in securing primary dressings intravenous cannulae and other medical devices, their main indication is lightly exuding, clean, superficial wounds.
Vapour-permeable adhesive film dressings Type Size Price (each)
Opsite Flexigrid (Smith & Nephew) 1 6cm x 7cm
£0.43
1 10cm x 12cm
£1.20
1 15cm x 20cm
£2.90
Tegaderm (3M Health Care) 2 10cm x 12cm
£1.21
Bioclusive (Johnson & Johnson) 3 10.2cm x 12.7cm
£1.28
Cutifilm (Beiersdorf) 4 7.5cm x 10cm
£0.64
4 10cm x 14cm
£1.09
EpiView(Convatec) 5 6cm x 7cm
£0.40
5 10cm x 12cm
£1.05

Alginate dressings

Possibly one of the most underrated of primary dressings, alginates have the supreme advantage of their competitors that the dressing can simply be soaked off with saline or a low-force shower; even after several days. Useful for medium to heavily exuding wounds (or parts of wounds), alginates are not the dressing of choice for infected wounds; there is little point in using alginates for dry wounds.
Alginate dressings Size Price (each)
Algosteril (BDF) 5cm x 5cm
£0.72
10cm x 10cm
£1.65
Comfeel Seasorb (Coloplast) 6cm x 4cm
£0.71
10cm x 10cm
£1.47
Kaltogel (Convatec) 5cm x 5cm
£0.70
10cm x 10cm
£1.45
Kaltostat  (Convatec) 5cm x 5cm
£0.72
7.5cm x 12cm
£1.57
Sorbsan (Maersk) 5cm x 5cm
£0.89
10cm x 10cm
£1.57
Tegagen (3M Health Care) 5cm x 5cm
£0.72
10cm x 10cm
£1.51

Alginate dressing with absorbent backing Size Price (each)
Sorbsan Plus (Maersk) 7.5cm x 10cm
£1.43
10cm x 15cm
£2.53

Dextranomer paste pad dressings

Dextranomer dressings are indicated for sloughy, infected, medium to heavily exuding wounds. Transient pain may occur in the wound area: this can be avoided by wetting the wound prior to application.
Dextranomer paste pad dressing Size Price (each)
Debrisan Absorbent Pad (Pharmacia) 3g
£2.30

Hydrocolloid dressings

Probably the first dressings to fully exploit the concept of moist wound healing, there is still a major role for hydrocolloid dressings in light to medium exuding wounds. Hydrocolloids are not ideal for infected wounds. The dressing requires a margin of smooth skin around the wound to ensure adhesion. Dressings need frequent change with heavily exuding wounds.
Hydrocolloid dressings
1. Semipermeable With Adhesive Border
Note Size Price (each)
Comfeel Plus Contour Dressing (Coloplast)
1
6cm x 8cm
£1.67
1
9cm x 11cm
£2.89
Granuflex (Bordered) (Convatec)
2
10cm x 10cm
£2.50
3
10cm x 13cm
£2.95
3
15cm x 18cm
£4.60
Tegasorb Advanced Formulation
(3M Health Care)
4
10cm x 12cm
£2.01
4
13cm x 15cm
£3.79

notes
1. list size plus border
2. square; list size, plus adhesive border
3. triangular; list size plus adhesive border
4. oval; size includes1.5cm border

Hydrocolloid dressings
2. Semipermeable Without Adhesive Border
Note Size Price (each)
Comfeel (bevelled edge) (Coloplast)   10cm x 10cm
£2.11
  15cm x 15cm
£4.19
  20cm x 20cm
£6.40
Comfeel Plus Ulcer Dressing (Coloplast)   10cm x 10cm
£2.15
  15cm x 15cm
£4.27
  20cm x 20cm
£6.41
Granuflex (Improved Formulation) (Convatec)   10cm x 10cm
£2.12
  15cm x 15cm
£3.99
  15cm x 20cm
£4.35
  20cm x 20cm
£5.99
Tegasorb Advanced Formulation
(3M Health Care)
  10cm x 10cm
£2.05
  15cm x 15cm
£3.97
Hydrocolloid dressings
3. Thin Semipermeable With Adhesive Border
Note Size Price (each)
Combiderm (Convatec)
1
10cm x 10cm
£1.25
1
14cm x 14cm
£1.74
2
15cm x 18cm
£3.00

notes
1. size includes 2.5cm border
2. size includes 3cm border

Hydrocolloid dressings
4. Thin Semipermeable Without Adhesive Border
Note Size Price (each)
DuoDerm Extra Thin (Convatec)   7.5cm x 7.5cm
£0.60
  10cm x 10cm
£1.00
  15cm x 15cm
£2.17

Hydrogel dressings

Particularly useful for dry, sloughy or necrotic wounds, hydrogels have a role in lightly exuding wounds and granulating wounds. Hydrogels are not suitable for infected or heavily exuding wounds; an appropriate secondary dressing is required.
Hydrogel dressings Size Price (each)
Granugel Hydrocolloid Gel (Convatec) 15g
£1.75
Intrasite Gel (Smith & Nephew) 8g
£1.38
15g
£1.85
Nu-Gel (Johnson and Johnson) 15g
£1.75
Purilon Gel (Coloplast) 15g
£1.75
Sterigel (Seton) 15g
£1.75

Polyurethane foam dressing BP

Indicated for light to medium exuding wounds; not recommended for dry superficial wounds.
Polyurethane foam dressing Note Size Price (each)
Lyofoam (Seton) 1 7.5cm x 7.5cm
£0.87
1 10cm x 10cm
£1.03
1 17.5cm x 10cm
£1.60
1 20cm x 15cm
£2.16

Notes
1. Dressings should be secured with adhesive tape, rather than occlusive tape or film.

Polyurethane foam film dressings

Indicated for light to medium exuding wounds; not recommended for dry superficial wounds.

Polyurethane foam film dressing Note Size Price (each)
Allevyn (Non-adhesive)
(Smith & Nephew)
  5cm x 5cm
£0.97
  10cm x 10cm
£1.92
  10cm x 20cm
£3.09
  20cm x 20cm
£5.16
Allevyn Adhesive
(Smith & Nephew)
1,2 7.5cm x 7.5cm
£1.15
1,2 12.5cm x 12.5cm
£2.06
1,2 17.5cm x 17.5cm
£4.06
1,2 22.5cm x 22.5cm
£5.91
Flexipore
(Polymedica)
1 6cm x 7cm
£0.93
1 10cm x 10cm
£1.73
1 10cm x 30cm
£3.60
1 15cm x 20cm
£3.70
1 20cm x 20cm
£5.06
Lyofoam Extra (Non-adhesive)
(Seton)
  10cm x 10cm
£1.72
  10cm x 17.5cm
£2.91
  10cm x 25cm
£3.52
  15cm x 20cm
£3.77
Spyrosorb (Adhesive) (Perstorp) 1 10cm x 10cm
£1.98
1 20cm x 20cm
£5.65
Tielle (Adhesive Margin)
(Johnson & Johnson)
1,3 7cm x 9cm
£1.05
1,3 15cm x 20cm
£3.99
1,3 11cm x 11cm
£1.95
1,3 15cm x 15cm
£3.25
1,3 18cm x 18cm
£4.06
Tielle Sacrum  (Johnson & Johnson) 1,4 18cm x 18cm
£2.95
Notes
1. Adhesive dressing.
2. Size includes 1cm border
3. Size includes 2cm border
4. Size includes 3-5cm border

Final Note

This article is not intended to provide advice on the suitability of a particular dressing for a particular wound; it is intended to be no more than a guide to dressings availability in Great Britain. The warnings and uses given are indicative only, and are largely taken from the Drug Tariff [1] and the British National Formulary [2], but any opinions expressed are those of the author. The Drug Tariff is updated on a monthly basis.

Edition 2.0 is an updated form of the original (14 July 1997) article, with reference to a later issue of the Drug Tariff. Changes include latest prices and classification; Edition 1.0 (14 July 1997) is still available

References

1. Department of Health. Drug Tariff. London: HMSO, September 1997

2. Anna Prasad (Editor) British National Formulary. London BMA/RPSGB, March 1997


All materials copyright © 1992-Feb 2001 by SMTL, March 2001 et seq by SMTL unless otherwise stated.

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