Wound Dressings on the Drug Tariff

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

Submitted: 06 February 1998
Published: 16 February 1998

Edition 3.0
Edition 2.0 (19 September 1997) also available

Introduction
Cotton conforming bandage
High compression bandage
Zinc paste bandage
Absorbent, perforated film dressing
Absorbent, perforated film dressing with adhesive border
Knitted viscose primary dressing
Povidone iodine fabric dressing
Vapour-permeable adhesive film dressing BP
Alginate dressing
Dextranomer paste pad dressing
Hydrocolloid dressing
Hydrogel dressing
Polyurethane foam dressing
Polyurethane foam/film dressing
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 used 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.

Cotton conforming bandages

Used for the retention of light dressings; not designed for compression purposes.

Cotton conforming bandage	Type	Size	Price (each)
Crinx (Smith & Nephew)	A	5cm x 3.5m	59p
	A	7.5cm x 3.5m	73p
	A	10cm x 3.5m	90p
	A	15cm x 3.5m	123p
Kling (Johnson & Johnson)	B	5cm x 3.5m	59p
	B	7.5cm x 3.5m	76p
	B	10cm x 3.5m	92p
	B	15cm x 3.5m	121p

High compression bandages (Extensible)

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
Setopress (Seton)	10cm x 3.5m	£3.12
Tensopress (Smith & Nephew)	7.5cm x 3m	£2.39
Tensopress (Smith & Nephew)	10cm x 3m	£3.07
Surepress (Convatec)	10cm x 3m	£3.02

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 bandage	Size	Price (each)
Steripaste (15%) (Seton)	7.5cm x 6m	£3.01
Viscopaste PB7 (10%) (Smith & Nephew)	7.5cm x 6m	£3.03
Zincaband (15%) (Seton)	7.5cm x 6m	£2.96

Zinc paste & coal tar bandage	Size	Price (each)
Zinc paste & coal tar bandage BP	7.5cm x 6m	£2.96

Zinc paste and ichthammol bandage	Size	Price (each)
Icthopaste (6.5%) (Smith & Nephew)	7.5cm x 6m	£3.06
Icthaband (15.5%) (Seton)	7.5cm x 6m	£2.96

Zinc paste, calamine and clioquinol bandage	Size	Price (each)
Quinaband (Seton)	7.5cm x 6m	£3.05

Zinc paste and calamine bandage	Size	Price (each)
Calaband (Seton)	7.5cm x 6m	£3.05

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	41p
Release (Johnson & Johnson)	5cm x 5cm	12p
	10cm x 10cm	20p
	20cm x 10cm	37p
Skintact (Robinson)	5cm x 5cm	10p
	10cm x 10cm	17p
	20cm x 10cm	33p

Absorbent, perforated film dressing with adhesive border

Absorbent, perforated film with adhesive border	Size	Price (each)
Mepore (Molnlycke)	6cm x 7cm	8p
	9cm x 10cm	17p
	9cm x 15cm	28p

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	£0.30
N-A Ultra* (Johnson & Johnson)	9.5cm x 9.5cm	£0.28
Tricotex (Smith & Nephew)	9.5cm x 9.5cm	£0.26

* impregnated with silicone to further reduce adherence.

Povidone iodine fabric dressing

A knitted viscose primary dressing impregnated with povidone iodine

Povidone iodine fabric dressing	Size	Price (each)
Inadine (Johnson & Johnson)	5cm x 5cm	£0.27
Inadine (Johnson & Johnson)	9.5cm x 9.5cm	£0.40

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
Tegaderm (3M Health Care)	2	12cm x 12cm	£1.21
Bioclusive (Johnson & Johnson)	3	10.2cm x 12.7cm	£1.29
Cutifilm (Beiersdorf)	4	7.5cm x 10cm	£0.64
Cutifilm (Beiersdorf)	4	10cm x 14cm	£1.09
EpiView(Convatec)	5	6cm x 7cm	£0.40
EpiView(Convatec)	5	10cm x 12cm	£1.05

*To be deleted 01 April 1998

Alginate dressings

Possibly one of the most underrated of primary dressings, alginates have the supreme advantage over 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
Algosteril (BDF)	10cm x 10cm	£1.65
Comfeel Seasorb (Coloplast)	6cm x 4cm	£0.72
	10cm x 10cm	£1.50
	15cm x 15cm	£3.10
Kaltogel (Convatec)	5cm x 5cm	£0.71
Kaltogel (Convatec)	10cm x 10cm	£1.48
Kaltostat(Convatec)	5cm x 5cm	£0.73
Kaltostat(Convatec)	7.5cm x 12cm	£1.59
Sorbsan (Maersk)	5cm x 5cm	£0.91
Sorbsan (Maersk)	10cm x 10cm	£1.60
Tegagen (3M Health Care)	5cm x 5cm	£0.73
Tegagen (3M Health Care)	10cm x 10cm	£1.54

Alginate dressing with absorbent backing	Size	Price (each)
Sorbsan Plus (Maersk)	7.5cm x 10cm	£1.43
	10cm x 15cm	£2.53
	10cm x 20cm	£3.23

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	£1.70
Comfeel Plus Contour Dressing (Coloplast)	1	9cm x 11cm	£2.95
Granuflex (Bordered) (Convatec)	2	10cm x 10cm	£2.55
	3	10cm x 13cm	£3.01
	3	15cm x 18cm	£4.69
Tegasorb Advanced Formulation (3M Health Care)	4	10cm x 12cm	£2.05
Tegasorb Advanced Formulation (3M Health Care)	4	13cm x 15cm	£3.83

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)	1	10cm x 10cm	£2.13
	1	15cm x 15cm	£4.27
	1	20cm x 20cm	£6.53
Comfeel Plus Ulcer Dressing (Coloplast)	1	10cm x 10cm	£2.19
	1	15cm x 15cm	£4.36
	1	20cm x 20cm	£6.54
Granuflex (Improved Formulation) (Convatec)	1	10cm x 10cm	£2.14
	2	15cm x 20cm	£4.40
	1	15cm x 15cm	£4.06
	1	20cm x 20cm	£6.11
Tegasorb Advanced Formulation (3M Health Care)	1	10cm x 10cm	£2.09
Tegasorb Advanced Formulation (3M Health Care)	1	15cm x 15cm	£4.05

Notes:
1. Square
2. Rectangular

Hydrocolloid dressings 3. Thin Semipermeable Without Adhesive Border	Size	Price (each)
DuoDerm Extra Thin (Convatec)	7.5cm x 7.5cm	£0.61
	10cm x 10cm	£1.01
	15cm x 15cm	£2.18

Hydrocolloid dressings 4. 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

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	£1.78
Intrasite Gel (Smith & Nephew)	8g	£1.38
Intrasite Gel (Smith & Nephew)	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 1. with adhesive border	Note	Size	Price (each)
Allevyn Adhesive (Smith & Nephew)	1	7.5cm x 7.5cm	£1.15
	1	12.5cm x 12.5cm	£2.06
	1	17.5cm x 17.5cm	£4.06
	1	22.5cm x 22.5cm	£5.91
Lyofoam Extra Adhesive (Seton)	2	15cm x 15cm	£2.06
	3	22cm x 22cm	£4.06
	3	22cm x 26cm	£3.20
	4	30cm x 30cm	£5.91
Tielle (Adhesive Margin) (Johnson & Johnson)	5	7cm x 9cm	£1.07
	5	15cm x 20cm	£4.07
	5	11cm x 11cm	£1.99
	5	15cm x 15cm	£3.25
	5	18cm x 18cm	£4.14
Tielle Sacrum(Johnson & Johnson)	6	18cm x 18cm	£3.01

Notes:
1. Size includes 1cm border
2. Size includes 2.5cm border
3. Size includes 3.5cm border
4. Size includes 5cm border
5. Size includes 2cm border
6. Size includes 3-5cm border

Polyurethane foam/film dressing 2. Without adhesive border	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
Flexipore (Polymedica)	6cm x 7cm	£0.93
	10cm x 10cm	£1.73
	10cm x 30cm	£3.60
	15cm x 20cm	£3.70
	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)	10cm x 10cm	£1.98
Spyrosorb (Adhesive) (Perstorp)	20cm x 20cm	£5.65

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.

Previous editions

This version is updated from the previous edition. A new section includes conforming bandages; several sections have been slightly reorganised and many prices have been revised.

Edition 2.0 (19 Sept 1997)
Edition 1.1 (31 July 1997)
Edition 1.0 (14 July 1997)

References

1. Department of Health. Drug Tariff. London: HMSO, February 1998

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

http://www.worldwidewounds.com/1997/july/Heenan/Tariff-3.0.html
Last Modified: Thursday, 29-Mar-2001 14:21:57 BST