nhs fife woundcare guidelines · anne wilson vascular nurse and senior prescribing support nurse...

Approved: December 2016 For review: February 2020 Approved by NHS Fife ADTC 2016

Wound Formularyand Wound Management Guidelines

2017

Developed by the NHS Fife Wound and Skin Care Forum (WSCF) Group

48451 Woundcare Formulary Jan 2017 FINAL DRAFT 260117.pdf 1 27/01/2017 10:09

Area Drug and Therapeutics Committee

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Contents Introduc on 2 Wound Defini on 4 Cavity Wounds, Packing and Probing 4 Necro c Wounds & Comprehensive wound assessment 5 Factors to consider when planning holi wound care 7 Characteris of ideal dressings & Ordering products 8 Guide to selec on of wound dressings 9 Overgranula on 10 STAR – Skin Tear Classifica on System 11 Bacterial burden and management of infec on 12 Wound cleansing guidelines 14

MONOGRAPHS FOR DRESSINGS o Barrier film 17 o Non adherent dressings 17 o Hydrocolloid dressings 18 o Foam dressings 19 o Hydrofibre dressings 20 o Hydrogel dressings 21 o Alginate dressings 22 o Deodorising dressings 23 o Silicone dressings 24 o Silicone Foam 25 o Super Absorbent Dressings 26

SPECIALISED DRESSINGS Guidance for use of Specialised dressings and therapies 27 Ropper Ladder 28

o Silver containing Dressings 29 o Prontosan Preparation 29 o Cutimed Range 30 o Honey Preparations 30 o Iodine containing Dressings 32 o Antimicrobial Alginate Gel 32 o Pain Management Dressings 33 o Foam/Fibre Dressings - Heavily Exuding Wounds 33 o Debridement product 33 o Tulle Dressings 34 o Technology Lipidocolloid (TLC) 34 o Specialist Plastic Surgery 35 o Larvae Therapy 37 o Negative Pressure Wound Therapy 37 o Wound Drainage Bags 38

Glossary of Wound Terms 39 Reading list / Resources 40 Related Policies 42 Appendix 1 – Wound Assessment Charts 43 Appendix 2 – Wound Conversion Charts 46



2

Introduction

Wound care consumes a significant amount of resources in terms of wound management products and professional time. The range of wound care products currently available can be bewildering and choosing the most appropriate dressing difficult. There is no such thing as the perfect dressing, so the choice is usually a compromise, trying to achieve the optimum environment to encourage the best outcomes in the shortest time. The dressing selected will invariably change as the wound healing proceeds, adding to the number of decisions necessary. The introduction of non-medical prescribing has increased both responsibility and accountability in wound management. Prescribers must therefore ensure that the choice of dressing is based on a full and accurate assessment of all the factors which may influence healing, and not just the wound itself. These guidelines aim to assist practitioners in the assessment and management of wounds. They encourage rational, Price-effective prescribing of dressings and other materials used in wound care. Demonstrating the use of evidence based treatments, and allowing practitioners to disseminate and share best practice, will promote seamless care across all sectors. On most of the pages containing information on dressings, a 1st and 2nd choice is given. Where possible, the 1st choice dressing should be used, however there may be reasons that this is not appropriate, therefore the 2nd choice dressing may be used. Staff must be able to give a rationale for choosing a dressing out with the main pages of the guidelines and this should be documented in the patients’ notes. Other dressings, treatment choices are within the specialised dressing pages. Dressing prices (Scottish Drug Tariff, SDT January 2017) have been added to make practitioners aware of Price. More expensive dressings may still be Price effective if used in the correct manner. Practitioners are advised to contact their local Tissue Viability nurse or Podiatrist for further advice, if they have a good rationale for not using the choice of dressing given. These guidelines are based on a selection of up to date research and clinical expertise of group members. We do accept that opinions vary and point out that these guidelines are not intended to be a definitive textbook, therefore a further reading list is included.

Disclaimer

Guideline users should be mindful that, as with any clinical guideline, recommendations may not be appropriate for use in all circumstances. Clearly, a limitation of any guideline is that it simplifies clinical decision making processes and recommendations. Decisions to adopt any particular recommendations must be made by the practitioner in the light of available resources, local services, policies and protocols. The particular patient’s circumstances and wishes including consent for treatment and medical photography, available personnel and equipment, clinical experience of the practitioner and knowledge of most recent research findings must all be considered and decisions clearly documented in the patient’s notes.



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Acknowledgements

The NHS Fife Wound and Skin Care Forum would like to thank the Glasgow Wound Guidelines Group, for allowing us to use some of their work, particularly in the teaching area of the Fife Guidelines. We would also like to thank Ruth Ropper, Tissue Viability Nurse in Lothian for her permission to use the Ropper Lothian Ladder for wound infection.

We would also acknowledge the contribution of both NHS Fife Community Services and NHS Fife Acute Services Division staff in the development of these Guidelines.

NHS Fife Wound and Skin Care Forum (WSCF) Guideline Group

NAME POSITION

Jane Nicoll Lead Tissue Viability Nurse, ASD (Chairperson)

Anne Barns District Charge Nurse, Path House, Kirkcaldy

Andy Cameron Senior Procurement Officer

Julia Chalmers District Charge Nurse, Balmullo Health Centre

Lynn Coyne Plastic Surgery Specialist Nurse, ASD

Antonia De Angelis Tissue Viability Nurse, ASD and Community

Katrina Deas Clinical Practice Development Officer

Fiona Dick Charge Nurse, Ward 13 VHK

Kevin Finnegan Assistant Procurement Administrator

Fiona Graham Highly Specialist Podiatrist

Tanya Hardy Senior Staff Nurse, Plastic Surgery, ASD

Joanne Koczubik Plastic Surgery Nurse, ASD

Deborah McCallum Clinical Nurse Practitioner, Plastic Surgery, ASD

Heather McKellar Senior Charge Nurse in OPD, Adamson Hospital

Gillian Meldrum Highly Specialist Podiatrist

Gillian Preston Tissue Viability Nurse, ASD

Leesa Radcliffe Community Tissue Viability Nurse, West Fife

Yvonne Robson Senior Charge Nurse, OPD, QMH

Susan Roemmele Staff Nurse, Dermatology Department, QMH

Islay Roy Plastic Surgery Nurse, ASD

Lesley Shiels Tissue Viability Nurse, Community East Fife

Mary Thomson Senior Prescribing Support Nurse

Caroline Turnbull Plastic Surgery Nurse, ASD

Catherine Ward Staff Nurse, Ward 10 VHK

Karen Whatton Senior Prescribing Support Nurse

Anne Wilson Vascular Nurse and Senior Prescribing Support Nurse



4

Wound Definition

For the purposes of these guidelines, the following definitions apply -

A simple wound is one where there is damage to the epidermal layer of the skin, including discolouration due to pressure damage.

A complex /chronic wound is one which heals by granulating from the base up and requires contraction and scar tissue to close. Debridement of slough and necrotic tissue may be necessary.

It is important to note that the term chronic suggests longevity; however, many wounds e.g. diabetic foot or rheumatoid lesions may be termed chronic at the onset. A more accurate term for a chronic /complex wound would be a compromised wound. It is the underlying host response to the wound, which will determine to a great extent its ability to heal.

Cavity Wounds Providing a single definition for a cavity wound is challenging as they vary in aetiology, size, depth and position. They may present with additional challenging features such as sinus formation, fistulae, undermining or bridging (Wounds UK, Cavity Wounds Quick Guide, 2016) For the purposes of these guidelines, the following definitions apply –

A wound extending beneath the layers of the dermis, potentially exposing structures such as fascia, tendon, muscle or bone.

A wound requiring more than a simple flat dressing – wounds that require a ‘filler’ dressing.

A wound deeper than 2cm.

Packing and Probing wounds

Guidance has been requested on how best to pack a wound and how to probe a wound to measure wound depth. A literature search was conducted; unfortunately there is no evidence to support robust guidance. However the consensus of the Fife Wound and Skin Care Forum Group is as follows:

Clinicians must use their clinical judgement when deciding to pack or probe a wound.

To gauge depth use a soft cotton tipped swab to gently probe, taking care not to damage tissue or structures.

Podiatrists, please seek local advice regarding probe type.

To pack a wound with a hydrogel or alginate gel, half fill the cavity and apply secondary dressing.

To pack a wound with dressing material, the end of the wound must be established to avoid dressing material being lost within the wound, it may be more appropriate to use a gel.

Pack dressing material loosely

Clearly document how many pieces of dressing material have been inserted and removed from the wound.



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Necrotic tissue

Necrotic tissue is a layer of dead tissue which can be brown/ black and or waxy in colour and is caused by an inadequate blood supply or infection. It may be soft or hard on the surface. The skin can remain intact and the necrosis can be of varying depth and it may produce an offensive smell.

Nursing staff must be cautious before attempting to remove necrotic tissue from a wound; this includes autolytic debridement with the use of hydrogels and dressing products. A full, holistic assessment of the patient must be undertaken first to ascertain any intrinsic or extrinsic factors which may cause complications if removal of necrotic tissue is initiated or necessary.

Necrosis should not be routinely removed in an ischemic area. This may cause significant

deterioration in the area.

Necrosis should not be routinely removed and at the end of life in the absence of any systemic

or local signs of infection unless required for symptomatic relief.

For example: debridement may be necessary e.g. wound is beginning to break down, a

collection of fluid is evident below the necrosis and when malodour or infection is an issue, this

must be discussed with the relevant clinicians before you attempt any form of necrotic tissue

removal.

Specialist advice should be sought when considering sharp debridement of a wound.

Mechanical or surgical removal such as sharps debridement of tissue should only be performed

by specialist practitioners.

Further information:

Guidelines For Practice, Effective Debridement in a Changing NHS – a UK Consensus, Wounds UK 2013. Available form: www.wounds-uk.com

Healthcare Improvement Scotland (2010) Tissue Viability Scottish Wound Assessment and Action Guide...\20100728_Wound_Assessment_Tool_Guide_Final SWAG.pdf

Comprehensive Wound Assessment

Recognised good practice is to assess a wound using a validated wound assessment chart (see page )

Compromised wound healing is usually a result of the patients underlying disease processes, ability to initiate an inflammatory response and fight infection. Intrinsic factors must therefore be taken into account whilst planning wound care.

Extrinsic factors at the wound bed (slough, necrotic tissue, biochemical and bacterial burden or damage to underlying structures, e.g tendon) may inhibit the healing process and wound bed preparation must be carried out to promote proliferation and epithelialisation. (See web site below).



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The condition of the surrounding skin must be considered when recognising if there are signs of infection, tracking or undermining of the wound. Consideration must be made as to whether adhesive or non-adhesive dressings should be used dependent on the vulnerability of the surrounding skin.

Address patient issues to establish if the patient/carer can be empowered to assist in their own wound care. It is important to determine if they have the ability to cope psychologically with the presence of a wound. It is important to recognise the need for adequate pain control / analgesia and this must be reviewed regularly.

It is not always possible to heal wounds due to the patients underlying aetiology (e.g. in fungating tumours or advanced disease). In this instance palliative care may be the aim, with management of symptoms in a way that is acceptable to the patient.

There should be an awareness in the non-healing compromised wound that further referral to the appropriate specialty may be required, e.g. vascular, dermatology, podiatry, plastic surgery or tissue viability.

Assessment tools have been developed by the National Association of Tissue Viability Nurses (Scotland) and the Scottish Wound Assessment and Action Guide can be accessed on-line:

..\20100728_Wound_Assessment_Tool_Guide_Final SWAG.pdf


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8

Characteristics of Ideal Dressings

1. Provide the optimum environment for wound healing - a moist environment - at the wound/dressing interface.

2. Allow gaseous exchange of oxygen, carbon dioxide and water vapour.

3. Provide thermal insulation - wound healing is temperature dependent.

4. Impermeable to micro-organisms (in both directions).

5. Free from particulate contaminants.

6. Non-adherent (many products are described as non-adherent but are low adherent).

7. Safe to use (non-toxic, non-sensitising, non-allergenic).

8. Acceptable to the patient.

9. High absorption characteristics (for exuding wounds).

10. Price effective.

11. Carrier for medicaments, e.g. antiseptics.

12. Capable of standardisation and evaluation.

13. Provide mechanical protection.

14. Conformable and mouldable (especially over sacrum, heels and elbows).

It is generally recognised that modern wound dressings are capable of being left on the wound bed for up to seven days, however this is dependent on exudate levels and whether there is infection present within the wound, therefore check with the instructions given within the box of dressings for further information.

Ordering Dressings

The most Price effective ordering route for both hospital and community is via the Area Distribution Centre/National Distribution Centre (ADC/NDC).

All dressings listed on the general pages of the Wound Management Guidelines are available on Drug Tariff.To order an item that is not on formulary, an Exception form must be completed and submitted to the Senior Prescribing Support Nurses ([email protected])

http://www.fifeadtc.scot.nhs.uk/formulary/woundcare-formulary/woundcare-catheter-product-request-and-exception-form.aspx


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10

Overgranulation

An essential aspect of secondary intention wound healing is the proliferation of granulation tissue, (McGrath, 2011). Granulation incorporates a dense network of blood vessels and newly growing capillaries with an irregular upper layer created by the capillaries looping together on the wound surface. This is what gives the appearance of red lumps or granules on the wound surface. When granulation ‘over grows’ beyond the surface of the wound, this is known as overgranulation, or hypergranulation. It is clinically recognised by a soft, fleshy, friable, often shiny appearance which is raised above the level of the surrounding skin. The wound will not continue to heal as the presence of this tissue will prevent the migration of epithelial tissue across the wound bed.

The exact cause of overgranulation is unknown, (Russell 2000). It is thought to be the consequence of a reaction to foreign bodies, infection/bio burden, mechanical trauma or allergies and hypersensitivities.

The research to date to support treatment options for overgranulation is limited, (McGrath, 2011). Reported treatments attempt to treat the causative factor, and focus on reducing bacteria present, applying pressure, using non occlusive dressings and the use of steroid therapies.

It is essential that the clinician can identify the causative factor of the overgranulation, in order to make informed clinical decisions on an effective treatment. A number of treatment options exist, and for this reason, the advice of an appropriate specialist should be sought, e.g. local Tissue Viability Nurse or Plastics Nurse.

ReferencesMcGrath A (2011) Overcoming the challenge of overgranulation. Wounds UK 7(1): 42-49Russell L (2000) Understanding physiology of wound healing and how dressings help. British Journal of Nursing 9(1): 10-21Stephen – Haynes J. Wound Care Alliance UK: Achieving effective outcomes in patients with overgranulation


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12

Bacterial Burden and Management of Infection

Bacterial burden and virulence are important factors in assessing the wound for infection. Host resistance is a major determinant in the body’s ability to fight infection and initiate an inflammatory response.This may be illustrated in the following equation:

Infection = dose x virulencehost resistance

Bacterial Burden Continuum

Bacterial Load Definition Wound Dressing

Contaminated Presence of non replicating bacteria in the wound

Topical antimicrobial and antibiotics not recommended.

Colonised Replicating bacteria adhering to the wound, with no detrimental effect to woundhealing

As above.

Critically colonised Presence of bacteria at the wound bed, whichcompromises healing but does not result in infection

Topical antimicrobial dressings can be used.In general, a two week treatment is advised. Ifno improvement in wound after this time, seek advice from local wound care specialist

Infection Invasion and multiplication ofmicro-organisms in bodytissues with overt hostresponse

If there is clinical evidence of invasiveinfection systemic antibiotics are required.Prescribe systemic antibiotic therapy inconjunction with appropriate dressing.

Wound Swabs for Microbiology

Wound infection is recognised by the presence of clinical signs of infection rather than the isolation of bacteria from a wound swab. A wound swab should only be taken when there is concern regardinginfection. They should not be taken as part of “routine practice”. Taking a wound swab will give aqualitative picture of bacteria present on the wound surface. These are most commonly colonisingbacteria and not responsible for infection. (Refer to The Adapted Ropper Lothian Ladder). N.B. Do notconfuse signs of inflammation with infection

For diabetic foot wounds consult local podiatrist for advice at an early stage as signs of infection may bemasked.

Organisms most commonly associated with soft tissue infections are S.aureus, and Group A, B, C, and GStreptococcus. The clinical presentation should be reviewed alongside the swab result to ensure themost appropriate treatment is prescribed.

Swabbing for culture and sensitivity is only recommended before antibiotics are commenced or toconfirm that the antibiotics commenced are appropriate. If a patient fails to respond to antibioticswithin 72hours, then consider re-swabbing or seek further Medical advice

The Price incurred for each Wound Swab is in excess of £35.88.



13

The wound bed must be cleansed prior to swabbing so as to avoid sampling slough or necrotic tissue that may only reveal surface organisms which are not causing underlying infection. Critically colonised or infected wounds can be treated with antimicrobial dressings but when significant infection is present systemic antibiotics should be commenced.

Procedure for taking a Wound Swab

Irrigate the wound with Sodium Chloride 0.9% solution.

Swab the edge of the wound adjacent to the good tissue which is inflamed. It is the organism infecting the good tissue which will be the major pathogen. This would normally tend to be nearer the edge of the wound as the tissue in the centre is more often necrotic.

The swab should be rotated between the fingers to ensure that all sides of the swab make contact with the wound.

Infected wound below, swab area as directed by arrows

Example of mostsuitable areas to swab



14

Wound Cleansing Guidelines

To Clean or Not To Clean?

There is no single correct way to clean a wound or the surrounding skin, although there are a number of important considerations

Does the wound really need cleansing?

What is the safest method that causes no ill effect and maintains the wound temperature?

What is acceptable to the patient?

Simple wound cleansing procedure (e.g. suture lines, superficial breaks)

Gentle skin washing with warm tap water (e.g. showering).

A minimalist approach is recommended to reduce interference at the wound bed.

Dry surrounding skin with non woven gauze to allow adherence of wound dressing.

Compromised / complex wound cleansing procedure

Aims:

Remove excess exudate, debris or old dressing materials.

Minimize pain and trauma.

Prevent infection.

Procedure

1 Explain procedure and rationale to patient.

2 Wash hands thoroughly as per hand hygiene policy prior to and following procedure.

3 Dressing packs are not always necessary.

4 Requirements: non woven swabs, clean surface, non-sterile gloves.

5 Remove dressing as per manufacturer’s instructions.

6 Assess wound type and carry out appropriate irrigation procedure (see pages 11 and 12).

7 Dry surrounding area with non woven swabs.

8 Do not touch surface of wound with swabs.

9 Apply new dressing.

Further guidance available, wound cleansing flowchart: www.tissueviabilityscotland.org


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17

Barrier Film

Sureprep® No Sting Barrier FilmSorbaderm® Cream

DescriptionSureprep® No Sting Barrier Film provides long lasting skin protection for up to 72 hours. Sorbaderm®Cream provides long lasting protection from bodily fluids whilst moisturising the skin

Indications

Intended to be used as a primary barrier and moisturiser against irritation from bodily fluids e.g. from urineand/or faeces. The no sting film acts as a protective barrier against adhesive wound dressings and surgical tapes, provides peri-wound protection from exudate damage and provides protection from damage causedby friction and shear. It is suitable for use in neonates.

Method of Use

Both film and cream should be applied to clean, dry skin. Sureprep® No Sting Barrier film should be appliedin a uniform coating over the entire treatment area when using the foam applicator. If using the spray,hold the nozzle 10 - 15cm from the treatment area and apply a smooth, even coat. Allow to dry for 60seconds before applying any adhesive dressings or surgical tapes. Reapply at least every 48 - 72 hrs (ormore frequently if required) Sorbaderm® Cream should be applied in small amounts, gently smoothing intothe skin over the affected area and allowed to dry for 30 seconds before applying any dressing

N.B. If the after feel of the skin is oily, then too much has been applied.

Dressing Size (Pack Size) SDT Price - Jan 2017 (Each)

Sureprep® No Sting Barrier Film 1ml foam applicator (25)3ml foam applicator (25)28ml spray bottle (1)

£0.77£1.32£5.00

Sorbaderm® Cream 2g sachet (20)28g (20)92g tube (1)

£0.33£2.20£3.20

Non-adherent Dressings

N-A® Ultra

Description A primary wound contact layer consisting of a knitted viscose rayon sheet with a silicone coating.

IndicationsProvides moisture retention or rehydration, thermal insulation and low-adherence. A secondary dressing is required to dress more heavily exuding wounds.

Method Of Use

Apply directly to the wound surface. Secondary dressings are required to retain dressing in position.

Frequency of changing the dressings depends on exudate/ strike through


N-A® Ultra 9.5cm x 9.5cm (40)9.5cm x 19cm (25)

£0.33£0.63



18

Hydrocolloid Dressings

Comfeel® Plus Transparent Duoderm® Extra Thin

DescriptionA hydrocolloid dressing is a micro granular suspension of various natural or synthetic polymers, e.g. gelatinor pectin, in an adhesive matrix. The dressings are interactive with wound exudate - by slowly absorbingfluid. They physically change to form a gel, which may be cohesive, and/or hydrophilic.

Comfeel® Plus Ulcer Absorbent hydrocolloid dressing with added alginate for absorption, a vapour-permeable film backing withbevelled edge to reduce rucking. There is a 1cm grid printed on backing to aid wound measurement.

IndicationsAids debridement in wounds covered with black necrotic tissue, suitable for softening eschar andpromoting granulation. Suitable for low to moderately exuding wounds. May also be used prophylactically on areas prone to breakdown and as a secondary dressing.

Method Of UseApply dressing of sufficient size to provide at least 2cm overlap onto intact skin. Smooth dressing intoplace - warmth of the hand improves initial adhesion. For best results aim to leave dressing in place for atleast 3 days. Dressings may be left in place for up to 7 days in low exuding wounds.

N.B. Owing to the occlusive nature of their backing hydrocolloids are not considered suitable for thetreatment of clinically infected or very heavily exuding wounds.


Comfeel® Plus Transparent 5cm x 7cm (10)5cm x 25cm (5)9cm x 14cm (10)

10cm x 10cm (10)15cm x 15cm (10)20cm x 20cm (5)

£0.66£2.53£2.39£1.25£3.27£3.34

Comfeel® Plus Ulcer 10cm x 10cm (10)15cm x 15cm (10)20cm x 20cm (5)

4cm x 6cm (10)18cm x 20cm (5)

£2.46£5.27£7.59£0.96£5.73

Duoderm® Extra Thin 5cm x 10cm (10)7.5cm x 7.5cm (5)


10cm x 10cm (10)15cm x 15cm (10)

£0.75£0.79£1.74£2.78£3.89£1.30£2.81

First Choice: Comfeel® Plus Transparent/Comfeel® Plus UlcerSecond Choice: Duoderm® Extra thin



19

Foam Dressings

Tegaderm® Foam / Tegaderm® Foam AdhesiveTegaderm® Foam Adhesive - Heel only

Description Highly absorbent polyurethane foam dressing with semipermeable film backing layer. Foam dressings ingeneral provide thermal insulation, do not shed fibres or particles and can be cut or shaped to fit thewound (non-adhesive). They help to maintain a moist environment at the surface of the wound and are gas permeable and non adherent. Should be used on moderate to highly exuding wounds.

Tegaderm® Foam / Tegaderm® Foam Adhesive Tegaderm Foam is suitable for use in moderate to highly exuding wounds. Tegaderm Foam Adhesive is suitable for low to highly exuding wounds. Can be used on clean granulating wounds or as a secondarydressing in sloughy or necrotic wounds, can be used under compression. Adhesive version is beneficial forpatients wishing to bathe or shower. Dressing should be renewed when exudate has reached within 1cm ofthe edges of the dressing. The dressing may be left in place for 3 - 7 days depending on the level ofexudate.

Tegaderm® Foam Adhesive - Heel onlyA highly absorbent polyurethane foam dressing with semipermeable film backing layer and adhesiveborder. Comprises of four layers for high fluid absorption.


Tegaderm® Foam 8.8cm x 8.8cm (10)10cm x 10cm (10)20cm x 20cm (5)10cm x 20cm (5)10cm x 60cm (Roll)

£2.23£2.19£5.92£3.71

£12.54

Tegaderm® Foam Adhesive 6.9cm x 7.6cm (10)10cm x 11cm (10)

14.3cm x 14.3cm (10)14.3cm x 15.6cm (5)

£1.46£2.39£3.54£4.24

Tegaderm® Foam - Heel 13.9cm x 13.9cm (5) £4.22



20

Hydrofibre Dressings

Aquacel® Extra/ Aquacel®

Description A soft, non woven pad composed of hydrocolloid fibres. This interacts with wound exudate and forms asoft gel which is easy to remove with little or no damage to healing tissue.

IndicationsUsed in the management of moderate to heavily exuding wounds. Can be used in acute and chronicwounds, e.g. abrasions, lacerations, leg ulcers, pressure sores. Infection is not a contraindication to use.

Method Of UseApply directly to the wound surface. Irrigation facilitates removal. Secondary dressing is required. May be left in place for up to seven days – depending on the level of exudate.

NB If “packing” a wound with Aquacel® Extra, always leave a small piece outside of the wound tofacilitate removal. Also record the number of pieces of used. (See wound chart).


Aquacel® Extra 5cm x 5cm (10)10cm x 10cm (10)15cm x 15cm (5)

£1.00£2.38£4.48

Aquacel® 1cm x 45cm Ribbon (5)2cm x 45cm Ribbon (5)

£1.86£2.48

Hydrofibre Foam Dressing

Aquacel® Foam

Aquacel® foam dressings have a soft absorbent pad, an aquacel contact layer, a gentle silicone adhesiveand a waterproof/ bacteria barrier. It can be used on a variety of moderate to heavily exuding wounds.


Aquacel® Foam Non Adhesive 5cm x 5cm (10)10cm x 10cm (10)15cm x 15cm (5) 15cm x 20cm (5)20cm x 20cm (5)

£1.35£2.51£4.30£5.88£7.01

Aquacel® Foam Adhesive 8cm x 8 cm (10)10cm x 10cm (10)

12.5cm x 12.5cm (10)17.5cm x 17.5cm (10)

21cm x 21cm (5)25cm x 30cm (5)

£1.39£2.16£2.68£5.36£7.84

£10.05



21

Hydrogel Dressings

First choice : Purilon®Gel

Description An amorphous gel with high water content, containing Calcium Alginate (Purilon®)

IndicationsHydrogels facilitate autolysis by rehydrating necrotic tissue and effecting debridement. They provide amoist environment which promotes healing. They are non-adherent and do not harm viable tissue orsurrounding skin. Bacterial colonisation of the wound is not a contraindication to the use of a hydrogel.

Method of UseApply the gel directly into the wound. A secondary moisture - retentive dressing is required e.g. Hydrogelshould be changed when the cover dressing leaks. Intervals should not exceed 3 days when used on sloughy or necrotic wounds or 7 days if used on clean granulating wounds.

N.B. When using in cavity wounds only half fill the cavity. Due to the effective debridement of necrotictissue, a wound being treated with gel may appear larger at first dressing change, however, this is anatural step in the healing process.


Purilon® Sterile 8g tube (10)Sterile 15g tube (10)

£1.76£2.30



22

Alginate Dressings

Kaltostat®

Description The basic elements of alginates are extracted from brown seaweed (Phaeophyceae). Their clinicalcomposition means that they are highly absorbent and biodegradeable. Alginates vary in composition (calcium/sodium salts of alginic acid) and in the arrangement of fibres.

IndicationsAlginate dressings are suitable for moderate to heavily exuding wounds. They form a gel on contact withthe wound exudate, and are effective at absorbing exudate, debriding slough and encouraging granulation tissue. Where bleeding is involved, Kaltostat® may be considered as a haemostatic agent.

Method Of UseApply to the wound surface/cavity, secondary dressing required to secure. Frequency of change will depend on level of exudate.


Kaltostat® 5cm x 5cm (10)7.5cm x 12cm (10)10cm x 20cm (10)15cm x 25cm (10)

£0.96£2.10£4.12£7.08



23

Deodourising Dressings

First choice : Clinisorb®Second choice : CarboFlex®

Clinisorb®

Description Clinisorb® is an activated charcoal cloth dressing, produced by carbonising and activating woven viscoserayon that is sandwiched between two layers of a nylon and viscose rayon blend. Clinisorb® has theoptimum combination of microporous activity and activated charcoal cloth weight, for significantlyreducing odour by attracting and permanently trapping bacteria. It is non-adhesive and contained in asterile peel pack.

IndicationsClinisorb® can be used to manage malodourous wounds such as fungating breast lesions, pressure ulcers,leg ulcers and diabetic foot ulcers.

Method Of UseClinisorb® can be used as a primary or secondary dressing and its soft, flexible construction can be cut to fitpractically any wound. Even unusually shaped fungating wounds on curved body sites can be easilydressed. Clinisorb® is highly effective wet or dry, can be used either side down, and can be left in place forup to one week.

CarboFlex®

Description A sterile non-adhesive dressing consisting of five layers - film layer, absorbent padding, activated charcoalcloth, film layer and absorbent wound contact layer containing Kaltostat® and Aquacel®.

IndicationsFor use in the management of malodourous acute and chronic wounds. May be used as a primary dressingfor shallow wounds or as a secondary dressing over wound fillers with deeper wounds.

Method Of UseThis dressing must not be cut to size or shape. The fibrous surface is placed directly on to the wound. Thismay be left undisturbed for up to three days depending on the level of exudate.


Clinisorb® 10cm x 10cm (10)10cm x 20cm (10)15cm x 25cm (10)

£1.91£2.54£4.09

CarboFlex® 8cm x 15cm (5) Oval10cm x 10cm (10)15cm x 20cm (5)

£3.89£3.24£7.38


24

Silicone Dressings

Mepitel® One

Description A sterile transparent soft silicone wound contact layer, which is non adherent to a moist wound bed.

IndicationsFor use in a wide range of painful, chronic and traumatic wounds and wounds with compromised or fragilesurrounding skin. The soft silicone adheres gently to the surrounding skin and ensures removal withminimal trauma and pain. Mepitel®One prevents the outer dressing sticking to the wound. The porous structure of Mepitel® One allows exudate to pass to an outer absorbent dressing.

Method Of UseApply directly to the wound or wound bed. It can be cut to size or shape of wound if desired. Requires asecondary dressing which can be changed independently as the Mepitel® One can remain in place for up to10 days. Mepitel® One may offer advantages when primary dressings are required to stay in place forlonger periods, since it is adhesive on one surface only.


Mepitel® One 6cm x 7cm (5)9cm x 10cm (5)

13cm x 15cm (5)24cm x 27.5cm (5)

£1.22£2.41£4.95

£14.25

Mepilex® Lite

Description A thin absorbent foam dressing with soft silicone contact layer and film backing

IndicationsFor use on non to low exuding woumds. May also be used as a protective dressing on compromised orfragile skin.

Method of Use Apply directly to wound or wound bed. Mepilex® Lite can be easily cut to fit an individual wound andmakes it ideal for difficult to dress wounds, such as armpits, breast etc.


Mepilex® Lite 6cm x 8.5cm (5)10cm x 10cm (5)15cm x 15cm (5)20cm x 50cm (5)

£1.82£2.17£4.22

£26.60


25

Silicone Foam Dressings

Allevyn® Gentle / Alleyvn ®Gentle Border Description An absorbent hydrocelluar pad sandwiched between a perforated soft gel adhesive woundcontact layer and highly permeable waterproof outer film. Alleyvn ®Gentle Border benefits from aneasy application and removal of the dressing with the ability to reposition through anadhesive technology based on the soft silicone gel in the dressing.

IndicationsDesigned for a wide range of moderate to highly exuding wounds e.g. leg, foot and pressure ulcers,traumatic wounds and secondary healing wounds.

Method of Use

During the early stages of wound management, Allevyn Gentle Border dressings should be inspected

frequently. Where the product is used on infected wounds, the infection should be inspected and treated

as per local clinical protocol.

Dressings can be left in place for up to 7 days depending on the condition of the wound and the

surrounding skin or until exudate is visible and approaches to within 1.5cm of the edge of the dressing pad,

whichever is sooner. If required, Allevyn®Gentle can be cut.

Contraindications

Do not use Allevyn® Gentle Border dressings with oxidising agents such as hypochlorite solutions (e.g.

Eusol or Hydrogen peroxide, as these can break down the absorbent polyurethane component of the

dressing. If reddening or sensitisation occurs discontinue use.


Allevyn® Gentle Border 7.5cm x 7.5cm (10)10cm x 10cm (10)

12.5cm x 12.5cm (10)15cm x 15cm (10)

17.5cm x 17.5cm (10)10cm x 20cm (10)

£1.51£2.21£2.71£4.04£5.34£3.56

Allevyn® Gentle 5cm x 5cm (10)10cm x 10cm (10)15cm x 15cm (10)10cm x 20cm (10)20cm x 20cm (10)

£1.27£2.53£4.25£4.07£6.78

Allevyn® Gentle Border Sacrum 16.8cm x 17.1cm (10)21.6cm x 23cm (10)

£4.00£5.66

Allevyn® Gentle Border Lite 5cm x 5cm (10)7.5cm x 7.5 cm (10)10cm x 10cm (10)15cm x 15cm (10)

5.5cm x 12cm (10)8cm x 15cm (10)

10cm x 20cm (10)

£0.90£1.39£2.16£3.81£1.85£3.43£3.43


26

Super Absorbent Dressings

Kliniderm®

Description Super absorbent secondary dressing compromising of four layers: a hydrophillic wound contact layer, a distribution layer, a super absorbent inner core and a fluid repellent wound conact layer

IndicationsModerate to heavily exuding wounds. May be used under compression

IndicationsNot to be used on dry wounds, heavy bleeding wounds and surgical implantation. The dressing must not be cut.

Eclypse®

Description Super absorbent secondary dressing

Indications Moderate to heavily exuding wounds

IndicationsNot to be used on arterial bleeds or heavily bleeding wounds. If a wound has a potential to dry out, a nonadherent wound contact layer should be applied beforehand. Do not cut dressing.


Kliniderm® 10cm x 10cm (50)10cm x 15cm (10)20cm x 20cm (15)20cm x 30cm (10)

£0.49£0.69£0.99£1.49

Eclypse® 15cm x 15 cm (20)20cm x 30 cm (20)60cm x 40cm (10)

£0.97£2.14£8.15


27

Specialised Dressings & Therapies

onthe advice of the relevant specialist, Acute or Community

Antimicrobial Dressings

Antimicrobials are agents which kill or inhibit the growth and division of micro-organisms. Commonly used in wound management are honey, iodine and silver.

There is no robust clinical evidence that dressings containing antimicrobials (e.g. silver, iodine or honey) are more effective than undedicated dressings for the prevention of wound infections.

Indiscriminate use of topical antimicrobial dressings should also be discouraged because of concerns over bacterial resistance and toxicity.

You may be asked by your local pharmacist, GP Practice or Wound Specialist Nurse to give a rationale for using these products. Please use the following tips to aid your selection.

10 Top Tips when using Antimicrobial Dressings

GENERAL POINTS

Is the wound clinically infectedo Check for signs of infectiono Don’t confuse normal signs of

inflammation with infection Systemic antibiotics are indicated in cases of

overt wound infection where classical signs are evident

Check the correct antimicrobial is chosen according to the wound exudate levels

If no improvement in wound after two weeks, review wound and antimicrobial choice

Check cautions as stated in manufacturer instructions, and BNF when using antimicrobial preparations.

SILVER DRESSINGS

Some silver products oxidise in contact with air and this may be displayed as a brown/black discolouration on the wound bed and/or surrounding skin

HONEY PRODUCTS

Patients may experience pain due to osmotic effects of dressing on wound (e.g. “drawing sensation”). Monitor pain levels, consider simple analgesia and only remove if the dressing is not tolerated.

Wound exudate may increase when using honey ointments and therefore use an appropriate absorbent secondary dressing.

IODINE PREPARATIONS

These products are rapidly deactivated by wound exudate therefore consider other antimicrobials for moderate – highly exudating wounds

All iodine products change from orange/brown to white when iodine is inactive/”used up”.

Please see Ropper Lothian Ladder on next page for further guidance

Initiation of these products should be on the advice of the relevant specialist e.g. Acute or Community Tissue Viability Nurse, Podiatry, Vascular, Plastic

Surgery or Dermatology Service.


28

Each stage builds on the previous signs noted

Stage 4: Overt signs of local infection and signs of systemic infection: may lead to sepsis if not treated Spreading cellulitis Pus/abscess Patient systemically unwell

e.g. confusion Pyrexia Raised white cell count/CRP Malodour of wound

Stage 4 – Treatment If systemic signs only, consider other source of infection Swab wound using standardised method Consider taking blood cultures prior to starting antibiotics Start broad spectrum systemic antibiotics* while awaiting culture

results Consider combination therapy with topical antimicrobials** e.g. in

PVD, diabetes Monitor wound progress, review wound at 2 weeks and stop

topical antimicrobials when signs of infection cease Once topical antimicrobial stopped continue with correct dressing

regime for wound/tissue type

Stage 3: Overt signs of local infection: evidence of surrounding tissue involvement, wound deteriorating Localised cellulitis Discoloured or bleeding granulation tissue Pain in or around wound Exudate: thick, haemopurulent or purulent

and/or high volumes Localised oedema Malodour

Stage 3 – Treatment Swab wound using standardized method Drain any local collections of pus/fluid Consider combination therapy with broad spectrum systemic

antibiotics* and topical antimicrobials** Monitor wound progress, review wound at 2 weeks and stop

topical antimicrobials when signs of infection cease Once topical antimicrobial stopped continue with correct dressing

regime for wound/tissue type If no progress after two weeks and/or signs of systemic infection

move to Stage 4

Stage 2: Increasing signs of infection (Critical colonisation): healing not progressing normally Exudate – high volumes Malodour Pain in or around wound Discolouration of granulation tissue Slough/Necrosis

Stage 2 – Treatment Select topical antimicrobial** Monitor wound progress, review wound 1-2 weeks If no improvement:

i. Consider swabbing wound using standardised method ii. Consider alternative topical antimicrobial**

If improved stop topical antimicrobials when signs of infection cease

Once topical antimicrobial stopped continue with correct dressing regime for wound/tissue type

If no progress after two weeks and/or increasing signs of systemic infection move to Stage 3

Stage 1: Few subtle signs: healing progressing normally

Exudate – low to moderate volume Pain – minimal Odour – minimal Slough/necrosis – minimal

Stage 1 – Treatment Promote moist wound healing using correct dressing regime for

wound/tissue type & exudate level Monitor wound progress, if no improvement in 1-2 weeks

reassess wound and dressing choice Check underlying aetiology of wound, if required refer to

appropriate specialist e.g. vascular, diabetic podiatry, tissue viability, lymphoedema etc.

If no progress after a further 1-2 weeks and/or increasing signs of infection/critical colonisation move to Stage 2

START

This guidance should be used along with clinical judgement in complex patients; in particular patients with diabetic wounds, vascular problems and immuno compromised patients may require topical antimicrobials for prophylaxis as well as treatment. *Systemic Antibiotics – Follow NHS Fife Antibiotic Guidance for the Treatment of Community Managed Infections Sept 2010. **Topical Antimicrobial – NHS Fife Joint Wound Formulary 2010. Topical antimicrobials can include honey, iodine, silver, PHMB, DACC and enzymatic products. Contact TVN team for more info if required.

References::European Wound Management Association (2005) Position Document: Identifying criteria for wound infection, MEP, London European Wound Management Association (2006) Position Document: Management of wound infection, MEP, London Best Practice Statement: Use of topical antiseptic/antimicrobial agents in wound management, Wounds UK, Aberdeen (2010) Good Practice Recommendation for Antimicrobial Use in Frail Elderly 2013

Adapted & reproduced with permission of R. Ropper, TVN CNS NHS

Lothian


The Adapted Ropper Lothian Ladder Guidelines for identifying infected wounds and when to start & stop using topical antimicrobial dressings

29

Specialised Dressings & Therapies

Silver Containing Dressings

Aquacel® Ag+ RibbonAquacel® Ag+ ExtraUrgotul®SSD

Aquacel® Ag+ Ribbon/Extra

DescriptionAquacel®Ag+ Ribbon is a versatile primary dressing. The combination of Hydrofiber® Technology with ionicsilver (Ag+), enhanced with anti – biofilm technology, produces a dressing that is highly absorbent and hasfavourable gelling characteristics with the aid of broad-spectrum antimicrobial activity

IndicationsFor use in moderate to highly exuding chronic and acute wounds where there is infection or an increasedrisk of infection. Also suitable for cavity wounds

Contraindications Should not be used on patients who are sensitive to, or have had an allergic reaction to silver or sodiumcarboxymethycellulose.

Urgo®SSDDescription A non adherent, non occlusive, antibacterial contact layer. The contact layer is a polyester meshimpregnated with hydrocolloid petroleum jelly and silver sulphadiazine particles.

IndicationsFor use on non to lightly exuding wounds with signs of infection. Can be combined with an absorbent layerfor heavily exuding wounds. Can also be used in cavity wounds.

Contraindications Do not use on patients with a known sensitivity to any components of the dressing.Caution: Do not use on patients undergoing MRI scans. Avoid contact with electrodes or conductive gels

during electronic measurement procedures.


Aquacel® Ag+ Ribbon 1cm x 45cm (5)2cm x 45cm (5)

£3.12£4.76

Aquacel ® Ag+ Extra 5cm x 5cm (5)10cm x 10cm (5)15cm x 15cm (5)

2cm x 30cm (5) 4cm x 10cm (5) 4cm x 20cm (5) 4cm x 30cm (5)

£1.95£4.64£8.75

£21.71£2.83£3.69£5.52

Urgotul® SSD 10cm x 12cm (10)15cm x 20cm (10)

£3.17£8.99

Initiation of these products should be on the advice of the relevant specialistpractitioner and follow local policies for use.


30

Prontosan Solution

Prontosan solution is a wound irrigation solution containing betaine, a gentle surfactant that penetrates,disturbs and removes Biofilm and wound debris, and PHMB to help control bacteria levels on the wound.


Prontosan Solution 40ml ampoule (24)350ml bottle

£14.18£4.78

Prontosan Wound Gel

Prontosan Wound Gel contains betaine, is a gentle surfactant that penetrates, disturbs and removesbiofilm and wound debris, it also contains PHMB to help control bacterial levels on the wound.


Prontosan Wound Gel 30g50g

£6.38£11.80

Cutimed® SorbactCutimed® Sorbact dressings are coated with a fatty acid derivative (DACC) which give them highlyhydrophobic properties. In the moist environment of an infected wound, bacteria are attracted to the dressing and become bound to it. The bacteria cannot multiply and are removed with the dressing.

Cutimed®Sorbact Hydroactive is a Semipermeable polyurethane film which contains Bacteria-binding

Sorbact® acetate mesh

N.B. Using the dressing in combination with cream/ointments impairs the effect of the DACC.


Cutimed® Sorbact Ribbon

Cutimed® Sorbact Swab

Cutimed®Sorbact Hydroactive


unfolded 11cm x 16cm7cm x 9cm (5)

unfolded 17cm x 27cm7cm x 8.5cm (10)

14cm x 14cm (10)19cm x 19cm (10)14cm x 24cm (10)24cm x 24cm (10)

£3.96£7.81£1.62

£2.70

£3.68£5.37

£10.10£8.60

£15.31


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Honey Preparations

Honey provides a moist healing environment with antibacterial and deodorizing properties as well asautolytic and osmotic debriding actions. It can be used on a variety of acute and chronic wounds.

Medihoney® Products

For use in acute and chronic wounds: leg/foot ulcers, pressure ulcers, sloughy wounds, necrotic wounds,infected wounds, malodorous wounds, donor and recipient graft sites, and burns, diabetic wounds andsurgical wounds.

Activon®Products

Activon®(ointment) is ideal for debriding necrotic tissue. Ideal for topping up dressings where the honey iswashed away or for using directly into cavities. Can be washed out using normal saline solution.

Actilite®Actilite® is a light viscose net dressing coated with antibacterial Manuka honey & Manuka oil. The dressingis designed to protect a wound, promote healing and allow the passage of exudate. The antibacterial effectof Actilite has been enhanced by combining high grade antibacterial Manuka oil with Manuka honey.

The combination of Manuka honey and Manuka oil has been demonstrated in-vitro to be effective againsta number of major wound infecting organisms including MRSA and VRE.


Medihoney® Antibacterial HoneyApinateMedihoney® Tulle

5cm x 5cm (10) 10cm x 10cm (5)

5cm x 5cm (5)10cm x 10cm (5)

£2.00£3.40£1.70£2.98

Medihoney ® Antibacterial MedicalHoneyActivon®Medical Grade ManukaHoney

20g tube (5)

25g tube (12)

ADC only £9.00

Prescription only £2.05

Actilite® 5cm x 5cm (10)10cm x 10cm (10)10cm x 20cm (10)

£0.57£0.98£1.90

Initiation of these products should be on the advice of the relevant specialistpractitioner and local policies should be followed.


32

Iodine Dressings

CAUTION: Care must be taken when these dressings are used for patients with Thyroid or Renal Patients.

Inadine®A sterile low-adherent fabric dressing impregnated with 10% povidone iodine in a water soluble slowrelease base. Povidone iodine is a potent antibacterial agent with a broad spectrum of activityIt is used as a primary wound dressing providing prophylactic treatment against infections in superficialwounds and minor skin injuries. The dressing should be changed daily or when the orange/ brown colourturns to white.

lodoflex® Iodoflex is a sterile Cadexomer Iodine paste containing Iodine in an inert base. The sachet consists of thepaste sandwiched in protective gauze. Used for the topical treatment of a variety of chronic and acutewounds. When applied to the wound lodoflex® cleans and reduces' bacteria at the wound surface and isparticularly useful in highly exuding wounds.

Remove the protective gauze on both sides of the paste, lodoflex® can then be moulded into shape andapplied to the wound surface. An appropriate secondary dressing can then be applied. The dressing shouldbe changed every 72 hours.

N.B. Maximum single application is 50g; weekly maximum must not exceed 150g; treatment durationshould not exceed three months.


Inadine® 5cm x 5cm (25)9.5cm x 9.5cm (10)

33p49p

Iodoflex® 5g (5)10g (3)17g (2)

£4.13£8.25

£13.06

Antimicrobial Alginate Gel

Flaminal®

Flaminal® is an antimicrobial alginate gel, indicated for a variety of wounds. It maintains a moist woundenvironment, helps debride and restore bacterial balance. It comes in two preparations, Flaminal® Fortefor medium to heavily exuding wounds, and Flaminal® Hydro for low to moderately exuding wounds.


Flaminal® Forte 15g (5)50g (5)

£7.61£25.18

Flaminal® Hydro 15g (5)50g (5)

£7.61£25.18

N.B. Flaminal® preparations are intended for single patient use, but can be used for multiple applicationson the same patient, as this will make the product more Price effective.


33

Pain Management Dressing

ActiFormCool®

A transparent, non-adhesive high water content hydrogel, formed around a supporting blue polyethylenematrix. It can be particularly useful for painful wounds, e.g. leg ulcers and diabetic ulcers.


ActiFormCool® 5cm x 6.5cm (5)10cm x 10cm (5)10cm x 15cm (5)20cm x 20cm (5)

£1.81£2.66£3.83£8.01

Foam/Fibre Dressing For Heavily Exuding Wounds

Allevyn® Life

A dressing which is a multi-layered design incorporating hydrocellular foam with a hyper-absorber lockaway core. It has a highly waterproof outer film and incorporates a mesh screen on the pad which allows the levels of exudate to be visible. This indicates when the dressing should be changed.


Alleyvn® LIfe 10cm x 10.3cm (10)12.9cm x 12.9cm (10)15.4cm x 15.4cm (10)

21cm x 21cm (10)

£1.71£2.51£3.06£6.04

Cutimed® Sorbion Sachet S

A versatile fibre dressing with high wearing comfort for highly exuding wounds. The dressing absorbs wound exudate and locks it in, creating a moist wound environment by gel formation. It provides a large capacity for wound exudate and ensures high retention of absorbed fluids.

Dressing Size (Pack Size) SDT Price – Jan 2017(Each)

Cutimed® Sorbion Sachet S 7.5cm x 7.5cm (10)10cm x 10cm (10) 20cm x 10cm (10)20cm x 20cm (10)

£1.78£2.25£3.73£7.00

Debridement Products

Debrisoft® PadDebrisoft® consists of soft, polyester fibres which are secured and knitted together. These fibres are cut ata special angle, length and thickness to ensure good effect and flexibility. The pad comes in a 10cm x 10xmsize and is used to remove slough and other debris from the wound bed to aid debridement. It can be usedon sloughy leg ulcers and surrounding skin to remove debris.


34

Debrisoft ® LollyComprises of monofilament polyester fibres with a blue X-ray detectable polypropylene thread. The Debrisoft ® Lolly is intended for the debridement of deep – including surgically invasive – to superficial wounds for wound bed preparation. It is used to absorb exudates, debris and keratoses during debridement.

Dressing Size (Pack Size) SDT Price -Jan 2017(Each)

Debrisoft ® Pad 10cm x 10cm (5) £6.45

Debrisoft Lolly £5.79

Tulle Dressings

Urogtul®A non adherent, non – occlusive flexible contact layer derived from Technology Lipido-Colloid (TLC

Technology). It is composed of a flexible polyester mesh impregnated with hydrocolloid and petroleumjelly particles. Can be used on acute wounds, skin abrasions and may be left for up too 7 days.


Urgotul® 5cm x 5cm (10)10cm x 10cm (10)15cm x 15cm (10)10cm x 40cm (10)15cm x 20cm (10)20cm x 30cm (5)

£1.55£3.11£6.60

£10.44£8.79

£14.13

Technology Lipidocolloid (TLC) - Urgo Dressings

Urgo® Clean Pad & Rope

Description A TLC Healing Matrix dressing which allows a pain free desloughing action, trapping and binding sloughwith its polyabsorbent fibres.It is also available as a rope which has similar absorption properties to Aquacel

IndicationsFor use in moderate to heavily exuding wounds. Change Urgo® Clean 1-2 days during the desloughingphase, then as often as required (up to 7 days)depending on levels of exudate.

Contraindications Do not use Urgo®Clean in combination with hydrogen peroxide organomercuric antiseptics orheocamidine.


Urgo® Clean Pad 6cm x 6cm(10)10cm x 10cm (10)20cm x 15cm (10)

£0.96£2.14£4.02

Urgo® Clean Rope/Probe 5cm x 40cm (10)2.5cm x 40cm (10)

£3.18£2.41


35

Urgo® Start/Urgo® Start Contact

Description

Urgo® Start is a soft adherent TLC foam dressing which stimulates fibroblast proliferation. The dressing neutralises excess proteases and re –establishes wound equilibrium. The semi-permeable backing prevents maceration. Urgo ®Start Contact is a contact layer which should be used with a pad or absorbent dressing for heavily exuding wounds.

IndicationsFor use on low to moderately exuding chronic wounds, leg ulcers, pressure and diabetic foot ulcers, Can beused under compression and may be left in place for 7 days. Urgo ®Start Contact can also be used in cavitywounds.

Contraindications Urgo® Start/Urgo® Start Contact should not be used on infected or critically colonised wounds. Not to beused in cancerous or fistula wounds which may reveal a deep abcess. It is also not recommended to use asfirst line treatment in acute wounds or in the treatment of Epidermolysis Bullosa (EB).

Dressing Size (Pack Size) SDT Price – Jan 2017 (Each)

Urgo® Start 6cm x 6cm (10)10cm x 10cm (10)20cm x 15cm (10)

£4.45£6.16

£11.08

Urgo® Start Contact 5cm x 7cm (10) 10cm x 10cm (10)15cm x 20cm(10)16cm x 21cm (10)

£3.00£4.24

£10.12£9.95

Specialist Plastic Surgery Dressings

PolyMem

Description PolyMem is polyurethane foam dressing with a vapour permeable backing. Dressing structure contains atissue – friendly wound cleansing agent and glycerol. PolyMem is available in a non adhesive and adhesiveversion.

IndicationsLow to moderatley exuding wounds including skin tears and other traumnatic wounds

Contraindications Not suitable for full thickness burns. Do not use in conjunction with solutions containing hypochlorite


Polymem® Non-Adhesive 8cm x 8cm (15)10cm x 10cm (15)13cm x 13cm (15)

£1.59£2.47£4.12


36

17cm x 19cm (15)10cm x 61cm (4) roll20cm x 60cm (4) roll

£6.08£13.10£30.90

Polymem®Adhesive 5cm x 5cm (15) 15cm x 15cm (15) 10cm x 13cm (15)5cm x 7.6cm (15)

8.8cm x 12.7cm (15) oval16.5cm x 20.9cm (10) oval18.4cm x 20cm (10)Sacral

£0.52£2.93£2.18£1.15£2.05£6.74£4.57

Scar Management Products

Mepiform® Dressing

Description Self adherent, silicone gel scar dressing


Mepiform® Dressing 5cm x 7cm (5)9cm x 18cm (5)4cm x 31cm (5)

£3.49£13.64£11.02

Kelcote® SprayDermatix®Gel

Description Silicone spray/gel for the reduction or prevention of hypertrophic & keloid scars


Kel-cote® Spray 100mls £51.00

Dermatix ® Gel 15g60g

£16.66£60.53

Specialist Use Only ( Dermatology, Vascular, Podiatry)

Granulox ® Spray

Description Granulox® Spray increases levels of oxygen at the wound bed, speeding up the rate of healing


Granulox® Spray 12mls £125.00


37

Larvae Therapy

Larvae reduce or eliminate odour and combat infection by ingesting and killing bacteria.Sterile larvae of the common green-bottle Lucilia Sericata are used to treat most types of sloughy, infectedor necrotic wounds. They may also reduce wound pain and stimulate the formation of granulation tissue.Larvae therapy is available on a GP10 prescription.


BioBag® Dressing 2.5cm x 4cm (1)5cm x 6cm (1)10cm x 10cm (1)

£195.00£245.00£295.00

Negative Pressure Wound Therapy (NPWT)

Negative Pressure Wound Therapy (NPWT) is a treatment used across the wound through a dressingpositioned in the wound cavity or over a flap or graft. Excess fluid is collected in a disposable canister. NPWT helps to reduce oedema, increase blood supply and decrease bacterial colonisation. It has proven tobe effective with acute surgical wounds, pressure ulcers, chronic wounds, including diabetic feet, and skingrafts.

Patients may be discharged from the Acute Services Division into Community with NPWT in situ. Community staff should consult local policy, as permission must be granted from the Lead Nurse for hire ofunit and dressings. The NPWT pumps used (Acelity) are free of charge. Dressings and canisters areavailable on drug tariff. All pumps once discontinued must be returned to the original source. Within theAcute Services Division return units to Ward 33. For community rentals, return to Acelity.

PICO® (Disposable NPWT system)A disposable and portable system designed to kick start wound healing. It can be used on both acute andchronic wounds, diabetic or pressure ulcers, flaps and grafts and surgically closed incision sites. The packcontains one PICO® device and two PICO® dressings. Advice should be sought from the local tissue viability nurse or specialist nurse before using.

ContraindicationsContraindicated in the presence of: malignancy in the wound bed or wound margins (except in palliativecare to enhance quality of life).

Dressing Size (Pack Size) SDT Price – Jan 2017 (Each)

PICO® 10cm x 20cm (1)10cm x 30cm (1)10cm x 40cm (1)15cm x 15cm (1)15cm x 20cm (1)15cm x 30cm (1)20cm x 20cm (1)25cm x 25cm (1)

£123.50£123.50£141.61£123.50£123.50£141.61£141.61£141.61


38

Wound Drainage Bag

Wound drainage bags have a central hydrocolloid island that can be cut and shaped to fit the wound. Theyare particularly useful in large abdominal wounds with high levels of exudate, where conventionaldressings would need to be changed more than twice daily.


Biotrol®Draina S Fistula Mini (30)Medium (30)Large (20)

£2.59£3.88£4.77

Eakin® Wound Pouches(fold and tuck or bung closures)

Small (10)Medium (10)Large (10)Extra Large (5)

From £4.77From £6.89From £9.00

From £15.89

Other sizes/styles are available, contact companies directly for sizes and prices.


39

Glossary of Wound Terms

Angiogenesis Generation of new blood vessels initially seen at the base of a wound.

Autolysis Breakdown of devitalised tissue by leucocytes.

Biofilm A thin but robust layer of micro – organisms that cannot be seen by the naked eye, adhering to a solid surface and containing a community of bacteria and other organisms.

Cellulitis A spreading non-suppurative infection of the soft tissue.

Colonisation Multiplication of micro-organisms without a corresponding host reaction.

Contraction Function of the healing process in granulating wounds whereby the edges of the wound are drawn towards each other.

Debridement Removal of devitalised tissue and foreign matter from a wound.

Epithelialisation Final stage of the proliferative phase.

Eschar Scab consisting of dried serum and devitalised dermal cells.

Granulation Formulation of new tissue filling the defect which takes place during the proliferative phase of healing. The name is derived from the fact that the buds of new tissue take on the appearance of small granules.

Healing by first intention Also called Primary Intention. Wounds are closed with sutures, staples or skin glue, leaving a minimal defect.

Healing by secondary intention

Wound left open and allowed to heal by granulation.

Healing by third intention Also called Tertiary intention, or delayed closure. Wound left open often to assist drainage and closed surgically at a later date.

Infection Micro-organisms present and multiplying, producing an associated host reaction. Reaction may take various forms.

Maceration Softening or sogginess of the tissue owing to retention of excessive moisture.

Necrosis Local death of tissue. Tissue is often black/brown in colour and leathery/waxy in texture.

Overgranulation

Granulation tissue is raised above the peri-wound area.

Slough

Devitalised tissue which has yellow/white/grey hue.


40

Reading List

Barwell et al (2015) Diabetes Foot Infection Antibiotic Protocol

Briggs et al (2004) Principles of best practice: Minimising pain at wound dressing – related procedures. A consensus document http://www.woundsinternational.com/media/issues/79/files/content_39.pdf

Cooper R (2009) Biofilms: hard to detect, easy to under estimate, but most definitely here to stay. Wounds UK. 9 (1) p.12.

Cope G (2014) The effects of smoking on wound healing. Wounds UK Vol 10 (2)

Dow G (2003) Bacterial swabs and the chronic wound: When, how and what do they mean. Ostomy Wound Management. 49; 5A supplement: p. 8-13.

Drugs and Therapeutic bulletin (2010) Silver dressings - do they work? Dtb.bmj.com. p. 38-42.

European Wound Management Association (2004) Position Document Wound bed preparation in practice.London: MEP Ltd.

European Wound Management Association (2005) Position Document Identifying criteria for wound infection. London: MEP Ltd.

European Wound Management Association (2006) Position Document Management of wound Infection. London: MEP Ltd.

European Wound Management Association (2007) Position Document Topical Negative Pressure In wound Management. London: MEP. Ltd

European Wound Management Association (2008) Position Document Hard-to-heal wounds: A holistic approach. London: MEP Ltd.

Gottrup F, Apelqvist J et al (2013) EWMA Document: Antimicrobials and Non-healing wounds- Evidence. Controversies and suggestions. Journal of Wound Care. 22 (5 suppl): S1-S92.

Guy H (2012) The Difference Between Moisture Lesions and Pressure Ulcers. Wound Essentials. Vol. 1 p. 36-44. Available at: www.wounds-uk.com

Healthcare Improvement Scotland (2015)., Antimicrobial Wound Dressings for Chronic Wounds – HTA Report 13, Edinburgh: HIS. Available at www.healthcareimprovementscotland.org

King B (2003) A review of research investigating pain and wound care. Journal of Wound Care. 12(6) p. 219-223.

Medlin S (2012) Nutrition For Wound Healing. British Journal of Nursing (Tissue Viability Supplement) Vol, 21, No 12. S11-15.


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NHS Quality Improvement Scotland (2009) Best Practice Statement. Prevention and Management of Pressure Ulcers. Available at www.healthcareimprovementscotland.org

Phillips PL, Wolcott RD, et al. (2010) Biofilms Made Easy. Wounds International 1(3). Available at www.woundsinternational.com

Strohal R, Apelqvist J, Dissemond J et al (2013) EWMA Document: Debridement. Journal of Wound Care. 22 (suppl.1) S1-S52.

Toit DF (2009) An in vitro evaluation of the cell toxicity of honey and silver dressings. Journal of Wound Care. 18 (9) p.383-399.

Yates S (2012) Differentiating Between Pressure Ulcers and Moisture Lesions. Wound Essentials. Vol 2. p.16-22. Available at www.wounds-uk.com.

White R, Cutting K (2008) Critical colonisation of chronic wounds: microbial mechanisms. Wounds UK. 4(1) P70-78.

Wounds International (2012) Appropriate use of Silver Dressings in Wounds. An expert working group consensus. London. Available to download from www.woundsinternational.com

Wounds UK (2016) Cavity Wounds, Quick Guide www.woundsuk.com

Wounds UK (2010) PHMB and its potential contribution to wound management. Wounds UK, Aberdeen. Available at www.wounds-uk.com.

Winter GD (1962) Formation of the scab and rate of epithelialisation of superficial wounds in the skin of young domestic pig. Nature 193: 293-294.

Resources/ Links

Local Tissue Viability Resource: NHS Fife Tissue Viability Webpage (Intranet)

Tissue Viability Resource: www.tissueviabilityscotland.org

Tissue Viability Resource: www.wounds-uk.com

Skin Tear Guidelines: www.tissueviabilityscotland.org

Best practice for leg ulcer management: www.legulcerforum.org

Diabetic Foot Infection Guidelines: ..\..\Desktop\Diabetic Foot Guidance Final - April 2014.pdf

Learn Pro Modules: Preventing and Managing Pressure Ulcers, CPR For Feet (NHS Education for Scotland)


42

Related policies, standard operating procedures and guidance

NHS Fife Procedure for Prevention and Management of Pressure Ulcers (2016)

NHS Fife Policy for Obtaining Informed Consent (2013)

SIGN Guidelines 120. Management of Chronic Venous Leg Ulcers (August 2010)

Healthcare Improvement Scotland, Prevention and Management of Pressure Ulcer Standards, 2016 ..\..\Desktop\HIS Pressure Ulcer Standards 2016.pdf

NHS Fife Podiatry Foot Protection and Offloading Guidance 2015

NHS Fife Community Exception Form http://www.fifeadtc.scot.nhs.uk/formulary/woundcare-formulary/woundcare-catheter-product-request-and-exception-form.aspxThe lists above are not exhaustive. It is the practitioner’s responsibility to be aware of up todate policies and procedures.


43

Appendix 1 – Wound Assessment Chart

Assessment Chart for Wound Management For multiple wounds complete formal wound assessment for each wound. Add Inserts as needed.

Factors which could delay healing: (Please tick relevant box)

Immobility □ Poor Nutrition □ Diabetes □ Incontinence □Respiratory / CirculatoryDisease □ Anaemia □ Medication □ Chemotherapy □

Wound Infection □ Previous History of MRSA Infection □

Inotropes □ Anti-Coagulants □ Oedema □ Steroids □

Other ………….. Allergies & Sensitivities ……………………….

Body Diagram

Front Back

Mark location with ‘X’ and number each wound

Type of Wound Total number & duration of each type of wound

Leg Ulcer …………………………………..

Surgical Wound ……………………………….

Diabetic Ulcer ………………………….…

Pressure Ulcer ………………………………..

Other, specify ………………………………

Feet Diagram

Right Left

Mark location with ‘X’ and number each wound

Date referred to:

TVN …………….Physiotherapist…………….

Podiatrist………………Dietician……………...

Other (please specify)………………………….

Assessors signature: ………………………..

Date: ………………………..…………………...

WRITE, IMPRINT OR ATTACH LABEL

Surname ……………….... CHI No ….…………..

Forenames ………………… Sex…………………..

DoB ………………..

Location……………………………………………………


44

Formal Wound Assessment Complete on initial assessment and thereafter complete at every dressing change

Date of Assessment

Number of wound

Analgesia required (Refer to local pain assessment tool)

Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No Yes/No

Regular/ongoing analgesia Pre-dressing only

Wound Dimensions (enter size) Length (cm/mm) Width (cm/mm) Depth (cm/mm) Or trace wound circumference Is wound tracking/undermining Photography Tissue type on wound bed ( enter percentages) Necrotic (Black)

Sloughy (Yellow/Green)

Granulating (Red)

Epithelialising (Pink)

Hypergranulating (Red)

Haematoma

Bone/tendon

Wound exudate levels/ type (tick all relevant boxes) Low Moderate High * Serous (Straw) Haemoserous (Red/Straw) Purulent (Green/Brown/Yellow)* Peri-wound skin (tick relevant boxes) Macerated (White) Oedematous * Erythema (Red)* Excoriated (Red) Fragile Dry/scaly Healthy/intact Signs of Infection * 1 or more of these signs may indicate possible infection Heat * New slough/necrosis(deteriorating wound bed)* Increasing pain* Increasing exudate* Increasing odour* Friable granulation tissue* Treatment objectives (tick relevant box) Debridement Absorption Hydration Protection Palliative / conservative Reduce bacterial load Assessors Print Initials Dressing Renewed (planned or unplanned dressing change)

Re-assessment date


45

Wound Treatment Plan and Evaluation of Care

To be completed when treatment or dressing type / regime altered NB Please write clearly

Date Wound

Number Cleansing Method, Dressing Choice & Rationale

Frequency

Evaluation & Rationale for changing dressing type

Signature

Packing Yes / No (circle) Amount …………………






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Prinect PDF Report 3.1.098 - 1 - 01/27/2017 10:36:48 AM

Document overviewFile name: 48451 Woundcare Formulary Jan 2017 FINAL DRAFT 260117.pdfLocation: E:\PTJobs\Jobs\48001_48500\48451_FHB Wound Care 48pp\Sy stem\Pagefiles\CurrentTitle: NHS Fife Woundcare GuidelinesCreator: Microsoft® Word 2013Producer: Microsoft® Word 2013Author: David MitchellCreation Date: 01/27/2017 09:57:55 AMModification Date: 01/27/2017 10:36:42 AMFile size: 7.2 MByte / 7378.1 KByteTrapped: UnknownOutput Intent: -PDF/X Version: -PDF Version: 1.5Number of pages: 48Media Box: 210.00 x 297.00 mmTrim Box: 148.00 x 210.00 mm

Summary Error Warning Fixed InfoDocument - 1 - -PDF/X - - - -Pages - - - -Colors - - - 42Fonts - 524 110 -Images - 18 - -Content - 6 35 -

DocumentPDF Version 1.5 is below 1.6

ColorsColor space: Device RGB (1-4,6-28,30-39,41-44,46)

FontsCourier is used inside trim box (2)CourierNewPSMT is used inside trim box (28)Arial: Font size 3.6 pt is below 6.0 pt (44)Arial: Font size 4.2 pt is below 6.0 pt (44)Arial: Font size 5.7 pt is below 6.0 pt (29,44)ArialMT: Font size 5.7 pt is below 6.0 pt (44)Calibri: Font size 2.1 pt is below 6.0 pt (30)Calibri: Font size 2.8 pt is below 6.0 pt (30)Calibri: Font size 3.6 pt is below 6.0 pt (13,18)Calibri: Font size 4.2 pt is below 6.0 pt (37)Calibri: Font size 4.9 pt is below 6.0 pt (13,18,29)Calibri: Font size 5.7 pt is below 6.0 pt (3,29,31,36)SymbolMT: Font size 5.7 pt is below 6.0 pt (29)


Arial,Bold: Font size 3.6 pt is below 6.0 pt (44)Arial,Bold: Font size 4.2 pt is below 6.0 pt (44)Arial,Bold: Font size 5.7 pt is below 6.0 pt (28-29,44)ComicSansMS: Font size 2.1 pt is below 6.0 pt (30)ComicSansMS: Font size 2.8 pt is below 6.0 pt (30)ComicSansMS: Font size 4.2 pt is below 6.0 pt (13)ComicSansMS: Font size 4.9 pt is below 6.0 pt (28)Arial,Italic: Font size 5.7 pt is below 6.0 pt (45)Arial-BoldMT: Font size 5.7 pt is below 6.0 pt (29)Calibri-Bold: Font size 0.3 pt is below 6.0 pt (35)Calibri-Bold: Font size 0.7 pt is below 6.0 pt (18)Calibri-Bold: Font size 2.8 pt is below 6.0 pt (30)Calibri-Bold: Font size 3.6 pt is below 6.0 pt (35)Calibri-Bold: Font size 4.2 pt is below 6.0 pt (35)Calibri-Bold: Font size 5.7 pt is below 6.0 pt (29)Arial,BoldItalic: Font size 5.7 pt is below 6.0 pt (45)Black font Arial (5.7 pt) is knockout (44)Black font Arial (8.5 pt) is knockout (6,9,13-15,28)Black font ArialMT (5.7 pt) is knockout (44)Black font Calibri (3.6 pt) is knockout (13,18)Black font Calibri (4.2 pt) is knockout (37)Black font Calibri (4.9 pt) is knockout (13,18)Black font Calibri (5.7 pt) is knockout (3,31,36)Black font Calibri (6.4 pt) is knockout (36)Black font Calibri (7.0 pt) is knockout (2,33,35)Black font Calibri (7.8 pt) is knockout (2,39)Black font Calibri (8.5 pt) is knockout (3-4,6-9,13-22,24-28,30-39,41-43)Black font Calibri (9.9 pt) is knockout (14,42)Black font Courier (7.8 pt) is knockout (2)Black font SymbolMT (8.5 pt) is knockout (6,13-15,28)Black font Arial,Bold (5.7 pt) is knockout (28,44)Black font ComicSansMS (4.2 pt) is knockout (13)Black font ComicSansMS (4.9 pt) is knockout (28)Black font ComicSansMS (6.4 pt) is knockout (2,42)Black font ComicSansMS (7.0 pt) is knockout (4,7,15-17,20,22,27,30-33,36,38,42,44)Black font ComicSansMS (7.8 pt) is knockout (31)Black font ComicSansMS (8.5 pt) is knockout (19,34)Black font Calibri-Bold (0.3 pt) is knockout (35)Black font Calibri-Bold (0.7 pt) is knockout (18)Black font Calibri-Bold (3.6 pt) is knockout (35)Black font Calibri-Bold (4.2 pt) is knockout (35)Black font Calibri-Bold (7.8 pt) is knockout (2,31,46)Black font Calibri-Bold (8.5 pt) is knockout (3-4,7-9,13-28,30-39,42-43)Black font Calibri-Bold (9.9 pt) is knockout (2-4,6,9,13-15,18,20-22,27-28,30-38,42-43)Black font Candara-Bold (8.5 pt) is knockout (17,37-38)Black font Calibri-Italic (8.5 pt) is knockout (19-20,28,33-36,38,41-42)


Black font CourierNewPSMT (8.5 pt) is knockout (28)Black font ComicSansMS-Bold (7.0 pt) is knockout (28)Black font ComicSansMS-Bold (7.8 pt) is knockout (14)Black font ComicSansMS-Bold (8.9 pt) is knockout (34)Black font ComicSansMS-Bold (9.9 pt) is knockout (46)Black font Calibri-BoldItalic (8.5 pt) is knockout (18-21,25,30,33-38)Black font TimesNewRoman,Bold (8.5 pt) is knockout (14,20)Black font TimesNewRoman,Bold (9.9 pt) is knockout (14)Arial: TrueType font (5-7,9,13-15,28-29,35-36,42,44,46)Tahoma: TrueType font (6,41-42)Calibri: TrueType font (1-43,45,47-48)Courier: TrueType font (2)SegoeUI: TrueType font (41)Arial,Bold: TrueType font (28-29,44-46)ComicSansMS: TrueType font (2-48)Arial,Italic: TrueType font (42,44-45)Calibri-Bold: TrueType font (1-9,11,13-44,46-48)Candara-Bold: TrueType font (17,37-38)TimesNewRoman: TrueType font (1,3-48)Calibri-Italic: TrueType font (5-6,19-21,23,28,33-36,38,41-42)CourierNewPSMT: TrueType font (28)Arial,BoldItalic: TrueType font (45)ComicSansMS-Bold: TrueType font (14,19,28,34,41,44-46)Calibri-BoldItalic: TrueType font (18-27,30,32-38)TimesNewRoman,Bold: TrueType font (14,20)Verdana-BoldItalic: TrueType font (30)ArialMT: TrueType CID font (29,44)Calibri: TrueType CID font (2-3,5-6,11,13,15,21,28-30,35-36,40-41,47-48)SymbolMT: TrueType CID font (5-7,13-15,28-29)ComicSansMS: TrueType CID font (44)Arial-BoldMT: TrueType CID font (29)Calibri-Bold: TrueType CID font (17,21,34,36,38,43-44,46-47)Calibri-Italic: TrueType CID font (28)Arial: Font is not embedded (5-7,9,13-15,28-29,35-36,42,44,46)Arial,Bold: Font is not embedded (28-29,44-46)Arial,Italic: Font is not embedded (42,44-45)TimesNewRoman: Font is not embedded (1,3-48)Arial,BoldItalic: Font is not embedded (45)TimesNewRoman,Bold: Font is not embedded (14,20)Calibri and Tahoma have the same unique identifierCalibri and Calibri have the same unique identifierCalibri and Courier have the same unique identifierCalibri and ComicSansMS have the same unique identifierComicSansMS and SegoeUI have the same unique identifierCalibri and Calibri-Bold have the same unique identifierCalibri and Candara-Bold have the same unique identifier


Calibri and Calibri-Italic have the same unique identifierCalibri and CourierNewPSMT have the same unique identifierCalibri and ComicSansMS-Bold have the same unique identifierCalibri and MyriadPro-Regular have the same unique identifierCalibri and Calibri-BoldItalic have the same unique identifierComicSansMS and Verdana-BoldItalic have the same unique identifier

ImagesColor image resolution 35 dpi is below 220 dpi (11,14)Color image resolution 97 dpi is below 220 dpi (11)Color image resolution 102 dpi is below 220 dpi (11)Color image resolution 136 dpi is below 220 dpi (44)Color image resolution 137 dpi is below 220 dpi (12)Color image resolution 140 dpi is below 220 dpi (44)Color image resolution 142 dpi is below 220 dpi (10)Color image resolution 150 dpi is below 220 dpi (44)Color image resolution 195 dpi is below 220 dpi (1)Color image resolution 205 dpi is below 220 dpi (14)Bitmap resolution 462 dpi is below 800 dpi (28)Images using lossy JPEG compression are present (10-12,14)1-bit image (28)4-bit image (1)

ContentTransparency is present (11,14,28,30,32,44)Line weight 0.030 mm is below hairline threshold 0.051 mm (8,13,16-27,29-39,47-48)Action, JavaScript or Annotation within printable area (6-7,9,15-16,41-43)

Additional informationColor separations: 4

CMYK

Color spacesDeviceCMYK / DeviceGray / SeparationDeviceRGB

Fonts: 37Arial TrueType / WinAnsi / embeddedArial,Bold TrueType / WinAnsi / embeddedArial,BoldItalic TrueType / WinAnsi / embeddedArial,Italic TrueType / WinAnsi / embeddedArial-BoldMT TrueType (CID) / Identity-H / embeddedArialMT TrueType (CID) / Identity-H / embeddedCalibri (4x) TrueType / WinAnsi / embedded subsetCalibri (4x) TrueType (CID) / Identity-H / embedded subsetCalibri-Bold (3x) TrueType / WinAnsi / embedded subsetCalibri-Bold TrueType (CID) / Identity-H / embedded subsetCalibri-BoldItalic TrueType / WinAnsi / embedded subset


Calibri-Italic TrueType / WinAnsi / embedded subsetCalibri-Italic TrueType (CID) / Identity-H / embedded subsetCandara-Bold TrueType / WinAnsi / embedded subsetComicSansMS (2x) TrueType / WinAnsi / embedded subsetComicSansMS TrueType (CID) / Identity-H / embedded subsetComicSansMS-Bold TrueType / WinAnsi / embedded subsetCourier (2x) TrueType / WinAnsi / embedded subsetCourierNewPSMT TrueType / WinAnsi / embedded subsetMyriadPro-Regular Type1 / WinAnsi / embeddedMyriadPro-Regular Type1 / WinAnsi / embedded subsetSegoeUI TrueType / WinAnsi / embedded subsetSymbolMT TrueType (CID) / Identity-H / embeddedTahoma TrueType / WinAnsi / embedded subsetTimesNewRoman TrueType / WinAnsi / embeddedTimesNewRoman,Bold TrueType / WinAnsi / embeddedVerdana-BoldItalic TrueType / WinAnsi / embedded subset


Document overviewFile name: 48451 Woundcare Formulary Jan 2017 FINAL DRAFT 260117.pdfLocation: E:\PTShare\PDF StoreTitle: NHS Fife Woundcare GuidelinesCreator: Microsoft® Word 2013Producer: Microsoft® Word 2013Author: David MitchellCreation Date: 01/27/2017 09:57:55 AMModification Date: 01/30/2017 11:53:55 AMFile size: 8.5 MByte / 8667.8 KByteTrapped: NoOutput Intent: -PDF/X Version: -PDF Version: 1.6Number of pages: 48Media Box: 210.00 x 297.00 mm / 148.00 x 210.00 mmTrim Box: 148.00 x 210.00 mm

Summary Error Warning Fixed InfoDocument - - - -PDF/X - - - -Pages - - 1 -Colors - 4 - -Fonts - 511 98 -Images - 14 - -Content - 4 - -

PagesTrim box is not set directly or identical to media box (10)

ColorsColor space: Device CMYK is overprinting (26,31-32,34)

FontsCourier is used inside trim box (2)CourierNewPSMT is used inside trim box (28)Arial: Font size 3.6 pt is below 6.0 pt (44)Arial: Font size 4.2 pt is below 6.0 pt (44)Arial: Font size 5.7 pt is below 6.0 pt (29,44)ArialMT: Font size 5.5 pt is below 6.0 pt (10)ArialMT: Font size 5.7 pt is below 6.0 pt (10,44)Calibri: Font size 2.1 pt is below 6.0 pt (30)Calibri: Font size 2.8 pt is below 6.0 pt (30)Calibri: Font size 3.6 pt is below 6.0 pt (13,18)Calibri: Font size 4.2 pt is below 6.0 pt (37)Calibri: Font size 4.9 pt is below 6.0 pt (13,18,29)Calibri: Font size 5.7 pt is below 6.0 pt (3,29,31,36)SymbolMT: Font size 5.7 pt is below 6.0 pt (29)


Arial,Bold: Font size 3.6 pt is below 6.0 pt (44)Arial,Bold: Font size 4.2 pt is below 6.0 pt (44)Arial,Bold: Font size 5.7 pt is below 6.0 pt (28-29,44)ComicSansMS: Font size 2.1 pt is below 6.0 pt (30)ComicSansMS: Font size 2.8 pt is below 6.0 pt (30)ComicSansMS: Font size 4.2 pt is below 6.0 pt (13)ComicSansMS: Font size 4.9 pt is below 6.0 pt (28)Arial,Italic: Font size 5.7 pt is below 6.0 pt (45)Arial-BoldMT: Font size 5.5 pt is below 6.0 pt (10)Arial-BoldMT: Font size 5.7 pt is below 6.0 pt (29)Calibri-Bold: Font size 0.3 pt is below 6.0 pt (35)Calibri-Bold: Font size 0.7 pt is below 6.0 pt (18)Calibri-Bold: Font size 2.8 pt is below 6.0 pt (30)Calibri-Bold: Font size 3.6 pt is below 6.0 pt (35)Calibri-Bold: Font size 4.2 pt is below 6.0 pt (35)Calibri-Bold: Font size 5.7 pt is below 6.0 pt (29)Arial,BoldItalic: Font size 5.7 pt is below 6.0 pt (45)MyriadPro-Regular: Font size 3.7 pt is below 6.0 pt (10)Black font Arial (5.7 pt) is knockout (44)Black font Arial (8.5 pt) is knockout (6,9,13-15,28)Black font ArialMT (5.5 pt) is knockout (10)Black font ArialMT (5.7 pt) is knockout (10,44)Black font ArialMT (6.0 pt) is knockout (10)Black font Calibri (3.6 pt) is knockout (13,18)Black font Calibri (4.2 pt) is knockout (37)Black font Calibri (4.9 pt) is knockout (13,18)Black font Calibri (5.7 pt) is knockout (3,36)Black font Calibri (6.4 pt) is knockout (36)Black font Calibri (7.0 pt) is knockout (2,33,35)Black font Calibri (7.8 pt) is knockout (2,39)Black font Calibri (8.5 pt) is knockout (3-4,6-9,13-22,24-25,27-28,30,33,35-39,41-43,47)Black font Calibri (9.9 pt) is knockout (14,42)Black font Courier (7.8 pt) is knockout (2)Black font SymbolMT (8.5 pt) is knockout (6,13-15,28)Black font Arial,Bold (5.7 pt) is knockout (28,44)Black font Arial-Black (6.0 pt) is knockout (10)Black font ComicSansMS (4.2 pt) is knockout (13)Black font ComicSansMS (4.9 pt) is knockout (28)Black font ComicSansMS (6.4 pt) is knockout (2,42)Black font ComicSansMS (7.0 pt) is knockout (4,7,14-17,20,22,27,30,33,36,38,42,44)Black font ComicSansMS (8.5 pt) is knockout (19)Black font Arial-BoldMT (5.5 pt) is knockout (10)Black font Arial-BoldMT (6.0 pt) is knockout (10)Black font Arial-BoldMT (7.0 pt) is knockout (10)Black font Arial-BoldMT (8.0 pt) is knockout (10)Black font Calibri-Bold (0.3 pt) is knockout (35)


Black font Calibri-Bold (0.7 pt) is knockout (18)Black font Calibri-Bold (3.6 pt) is knockout (35)Black font Calibri-Bold (4.2 pt) is knockout (35)Black font Calibri-Bold (7.8 pt) is knockout (2,46)Black font Calibri-Bold (8.5 pt) is knockout (3-4,7-9,13-25,27-28,30,33,35-39,42-43,47)Black font Calibri-Bold (9.9 pt) is knockout (2-4,6,9,13-15,18,20-22,27-28,30,33,35-38,42-...Black font Candara-Bold (8.5 pt) is knockout (17,37-38)Black font Calibri-Italic (8.5 pt) is knockout (19-20,28,33,35-36,38,41-42)Black font CourierNewPSMT (8.5 pt) is knockout (28)Black font MyriadPro-Bold (7.0 pt) is knockout (10)Black font ComicSansMS-Bold (7.0 pt) is knockout (28)Black font ComicSansMS-Bold (7.8 pt) is knockout (14)Black font ComicSansMS-Bold (9.9 pt) is knockout (46)Black font Calibri-BoldItalic (8.5 pt) is knockout (18-21,25,30,33,35-38)Black font TimesNewRoman,Bold (8.5 pt) is knockout (14,20)Black font TimesNewRoman,Bold (9.9 pt) is knockout (14)Arial: TrueType font (5-7,9,13-15,28-29,35-36,42,44,46)Tahoma: TrueType font (6,41-42)ArialMT: TrueType font (10,44)Calibri: TrueType font (1-9,11-43,45,47-48)Courier: TrueType font (2)SegoeUI: TrueType font (41)Arial,Bold: TrueType font (28-29,44-46)Arial-Black: TrueType font (10)ComicSansMS: TrueType font (2-9,12-13,15-27,29,31,33-43,45-48)Arial,Italic: TrueType font (42,44-45)Arial-BoldMT: TrueType font (10)Calibri-Bold: TrueType font (1-9,11,13-44,46-48)Candara-Bold: TrueType font (17,37-38)TimesNewRoman: TrueType font (1,3-9,11-25,27-30,32-33,35-48)Calibri-Italic: TrueType font (5-6,19-21,23,28,33-36,38,41-42)Arial,BoldItalic: TrueType font (45)ComicSansMS-Bold: TrueType font (19,41,45-46)Calibri-BoldItalic: TrueType font (18-27,30,32-38)TimesNewRoman,Bold: TrueType font (14,20)ArialMT: TrueType CID font (29,44)Calibri: TrueType CID font (2-3,5-6,13,15,21,29,35-36,40-41,47-48)SymbolMT: TrueType CID font (5-7,13-15,28-29)ComicSansMS: TrueType CID font (11,14,28,30,32,44)Arial-BoldMT: TrueType CID font (29)Calibri-Bold: TrueType CID font (17,21,34,36,38,43,46-47)CourierNewPSMT: TrueType CID font (28)ComicSansMS-Bold: TrueType CID font (14,28,44)Verdana-BoldItalic: TrueType CID font (30)Arial: Font is not embedded (5-7,9,13-15,28-29,35-36,42,44,46)Arial,Italic: Font is not embedded (42,44-45)


TimesNewRoman: Font is not embedded (1,3-9,11-25,27-30,32-33,35-48)Arial,BoldItalic: Font is not embedded (45)ArialMT and ArialMT have the same unique identifierCalibri and Calibri have the same unique identifierArialMT and ComicSansMS have the same unique identifierCalibri and Calibri-Bold have the same unique identifierComicSansMS and SymbolMT have the same unique identifierArial,Bold and Arial,Bold have the same unique identifierCalibri-Italic and SymbolMT have the same unique identifierArialMT and ComicSansMS-Bold have the same unique identifierCalibri-Bold and Calibri-Bold have the same unique identifierComicSansMS and ComicSansMS-Bold have the same unique identifierCalibri-Italic and Calibri-Italic have the same unique identifierCalibri-Italic and CourierNewPSMT have the same unique identifierComicSansMS and TimesNewRoman,Bold have the same unique identifierMyriadPro-Regular and MyriadPro-Regular have the same unique identifierCalibri-BoldItalic and Calibri-BoldItalic have the same unique identifierCalibri-BoldItalic and Verdana-BoldItalic have the same unique identifier

ImagesColor image resolution 96 dpi is below 220 dpi (11,14)Color image resolution 97 dpi is below 220 dpi (11)Color image resolution 102 dpi is below 220 dpi (11)Color image resolution 136 dpi is below 220 dpi (44)Color image resolution 137 dpi is below 220 dpi (12)Color image resolution 140 dpi is below 220 dpi (44)Color image resolution 150 dpi is below 220 dpi (44)Color image resolution 195 dpi is below 220 dpi (1)Color image resolution 197 dpi is below 220 dpi (10)Color image resolution 205 dpi is below 220 dpi (14)Bitmap resolution 462 dpi is below 800 dpi (28)1-bit image (28)4-bit image (1)

ContentObject requires PostScript Level 3 (14,28,30,32)


CMYK

Color spacesDeviceCMYK / DeviceGray / Separation

Fonts: 97Arial (5x) TrueType / WinAnsi / embeddedArial,Bold (3x) TrueType / WinAnsi / embedded subsetArial,BoldItalic TrueType / WinAnsi / embedded


Arial,Italic (2x) TrueType / WinAnsi / embeddedArial-Black TrueType / WinAnsi / embedded subsetArial-BoldMT TrueType (CID) / Identity-H / embeddedArial-BoldMT TrueType / WinAnsi / embedded subsetArialMT TrueType (CID) / Identity-H / embeddedArialMT (2x) TrueType / WinAnsi / embedded subsetArialMT TrueType (CID) / Identity-H / embedded subsetCalibri (14x) TrueType / WinAnsi / embedded subsetCalibri (4x) TrueType (CID) / Identity-H / embedded subsetCalibri-Bold (18x) TrueType / WinAnsi / embedded subsetCalibri-Bold TrueType (CID) / Identity-H / embedded subsetCalibri-BoldItalic (4x) TrueType / WinAnsi / embedded subsetCalibri-Italic (4x) TrueType / WinAnsi / embedded subsetCandara-Bold TrueType / WinAnsi / embedded subsetComicSansMS (2x) TrueType / WinAnsi / embedded subsetComicSansMS (7x) TrueType (CID) / Identity-H / embedded subsetComicSansMS-Bold TrueType / WinAnsi / embedded subsetComicSansMS-Bold (3x) TrueType (CID) / Identity-H / embedded subsetCourier (2x) TrueType / WinAnsi / embedded subsetCourierNewPSMT TrueType (CID) / Identity-H / embedded subsetMyriadPro-Bold (2x) Type1 / WinAnsi / embedded subsetMyriadPro-Regular Type1 / WinAnsi / embeddedMyriadPro-Regular (2x) Type1 / WinAnsi / embedded subsetSegoeUI TrueType / WinAnsi / embedded subsetSymbolMT TrueType (CID) / Identity-H / embeddedSymbolMT (2x) TrueType (CID) / Identity-H / embedded subsetTahoma TrueType / WinAnsi / embedded subsetTimesNewRoman (4x) TrueType / WinAnsi / embeddedTimesNewRoman,Bold (2x) TrueType / WinAnsi / embedded subsetVerdana-BoldItalic TrueType (CID) / Identity-H / embedded subset

Prinect PDF Report 3.1.098 - 1 - 01/30/2017 02:13:50 PM

Document overviewFile name: 48451 Woundcare Formulary Jan 2017 FINAL DRAFT 260117.pdfLocation: E:\PTShare\PDF StoreTitle: NHS Fife Woundcare GuidelinesCreator: Microsoft® Word 2013Producer: Microsoft® Word 2013Author: David MitchellCreation Date: 01/27/2017 09:57:55 AMModification Date: 01/30/2017 02:11:27 PMFile size: 8.9 MByte / 9111.3 KByteTrapped: NoOutput Intent: -PDF/X Version: -PDF Version: 1.6Number of pages: 48Media Box: 210.00 x 297.00 mm / 148.00 x 210.00 mmTrim Box: 148.00 x 210.00 mm

Summary Error Warning Fixed InfoDocument - - - -PDF/X - - - -Pages - - 1 -Colors - 4 - -Fonts - 490 71 -Images - 14 - -Content - 4 - -

PagesTrim box is not set directly or identical to media box (10)

ColorsColor space: Device CMYK is overprinting (26,31-32,34)

FontsCourier is used inside trim box (2)CourierNewPSMT is used inside trim box (28)Arial: Font size 3.6 pt is below 6.0 pt (44)Arial: Font size 4.2 pt is below 6.0 pt (44)Arial: Font size 5.7 pt is below 6.0 pt (29,44)ArialMT: Font size 5.5 pt is below 6.0 pt (10)ArialMT: Font size 5.7 pt is below 6.0 pt (10,44)Calibri: Font size 2.1 pt is below 6.0 pt (30)Calibri: Font size 2.8 pt is below 6.0 pt (30)Calibri: Font size 3.6 pt is below 6.0 pt (13,18)Calibri: Font size 4.2 pt is below 6.0 pt (37)Calibri: Font size 4.9 pt is below 6.0 pt (13,18,29)Calibri: Font size 5.7 pt is below 6.0 pt (3,29,31,36)SymbolMT: Font size 5.7 pt is below 6.0 pt (29)


Arial,Bold: Font size 3.6 pt is below 6.0 pt (44)Arial,Bold: Font size 4.2 pt is below 6.0 pt (44)Arial,Bold: Font size 5.7 pt is below 6.0 pt (29,44)ComicSansMS: Font size 2.1 pt is below 6.0 pt (30)ComicSansMS: Font size 2.8 pt is below 6.0 pt (30)ComicSansMS: Font size 4.2 pt is below 6.0 pt (13)Arial,Italic: Font size 5.7 pt is below 6.0 pt (45)Arial-BoldMT: Font size 5.5 pt is below 6.0 pt (10)Arial-BoldMT: Font size 5.7 pt is below 6.0 pt (29)Calibri-Bold: Font size 0.3 pt is below 6.0 pt (35)Calibri-Bold: Font size 0.7 pt is below 6.0 pt (18)Calibri-Bold: Font size 2.8 pt is below 6.0 pt (30)Calibri-Bold: Font size 3.6 pt is below 6.0 pt (35)Calibri-Bold: Font size 4.2 pt is below 6.0 pt (35)Calibri-Bold: Font size 5.7 pt is below 6.0 pt (29)Arial,BoldItalic: Font size 5.7 pt is below 6.0 pt (45)MyriadPro-Regular: Font size 3.7 pt is below 6.0 pt (10)Black font Arial (5.7 pt) is knockout (44)Black font Arial (8.5 pt) is knockout (6,9,13-15)Black font ArialMT (5.5 pt) is knockout (10)Black font ArialMT (5.7 pt) is knockout (10,44)Black font ArialMT (6.0 pt) is knockout (10)Black font Calibri (3.6 pt) is knockout (13,18)Black font Calibri (4.2 pt) is knockout (37)Black font Calibri (4.9 pt) is knockout (13,18)Black font Calibri (5.7 pt) is knockout (3,36)Black font Calibri (6.4 pt) is knockout (36)Black font Calibri (7.0 pt) is knockout (2,33,35)Black font Calibri (7.8 pt) is knockout (2,39)Black font Calibri (8.5 pt) is knockout (3-4,6-9,13-16,18-22,24-25,27,30,33,35-39,41-43,47)Black font Calibri (9.9 pt) is knockout (14,42)Black font Courier (7.8 pt) is knockout (2)Black font SymbolMT (8.5 pt) is knockout (6,13-15)Black font Arial,Bold (5.7 pt) is knockout (44)Black font Arial-Black (6.0 pt) is knockout (10)Black font ComicSansMS (4.2 pt) is knockout (13)Black font ComicSansMS (6.4 pt) is knockout (2,42)Black font ComicSansMS (7.0 pt) is knockout (4,7,14-16,20,22,27,30,33,36,38,42,44)Black font ComicSansMS (8.5 pt) is knockout (19)Black font Arial-BoldMT (5.5 pt) is knockout (10)Black font Arial-BoldMT (6.0 pt) is knockout (10)Black font Arial-BoldMT (7.0 pt) is knockout (10)Black font Arial-BoldMT (8.0 pt) is knockout (10)Black font Calibri-Bold (0.3 pt) is knockout (35)Black font Calibri-Bold (0.7 pt) is knockout (18)Black font Calibri-Bold (3.6 pt) is knockout (35)


Black font Calibri-Bold (4.2 pt) is knockout (35)Black font Calibri-Bold (7.8 pt) is knockout (2,46)Black font Calibri-Bold (8.5 pt) is knockout (3-4,7-9,13-16,18-25,27,30,33,35-39,42-43,47)Black font Calibri-Bold (9.9 pt) is knockout (2-4,6,9,13-15,18,20-22,27,30,33,35-38,42-43)Black font Candara-Bold (8.5 pt) is knockout (37-38)Black font Calibri-Italic (8.5 pt) is knockout (19-20,33,35-36,38,41-42)Black font MyriadPro-Bold (7.0 pt) is knockout (10)Black font ComicSansMS-Bold (7.8 pt) is knockout (14)Black font ComicSansMS-Bold (9.9 pt) is knockout (46)Black font Calibri-BoldItalic (8.5 pt) is knockout (18-21,25,30,33,35-38)Black font TimesNewRoman,Bold (8.5 pt) is knockout (14,20)Black font TimesNewRoman,Bold (9.9 pt) is knockout (14)Arial: TrueType font (5-7,9,13-15,29,35-36,42,44,46)Tahoma: TrueType font (6,41-42)ArialMT: TrueType font (10,44)Calibri: TrueType font (1-9,11-43,45,47-48)Courier: TrueType font (2)SegoeUI: TrueType font (41)Arial,Bold: TrueType font (29,44-46)Arial-Black: TrueType font (10)ComicSansMS: TrueType font (2-9,12-13,15-27,29,31,33-43,45-48)Arial,Italic: TrueType font (42,44-45)Arial-BoldMT: TrueType font (10)Calibri-Bold: TrueType font (1-9,11,13-44,46-48)Candara-Bold: TrueType font (17,37-38)TimesNewRoman: TrueType font (1,3-9,11-16,18-25,27,29-30,32-33,35-48)Calibri-Italic: TrueType font (5-6,19-21,23,28,33-36,38,41-42)Arial,BoldItalic: TrueType font (45)ComicSansMS-Bold: TrueType font (19,41,45-46)Calibri-BoldItalic: TrueType font (18-27,30,32-38)TimesNewRoman,Bold: TrueType font (14,20)ArialMT: TrueType CID font (29,44)Calibri: TrueType CID font (2-3,5-6,13,15,21,29,35-36,40-41,47-48)SymbolMT: TrueType CID font (5-7,13-15,28-29)ComicSansMS: TrueType CID font (11,14,28,30,32,44)Arial-BoldMT: TrueType CID font (29)Calibri-Bold: TrueType CID font (17,21,34,36,38,43,46-47)CourierNewPSMT: TrueType CID font (28)ComicSansMS-Bold: TrueType CID font (14,44)Verdana-BoldItalic: TrueType CID font (30)Arial: Font is not embedded (5-7,9,13-15,29,35-36,42,44,46)Arial,Italic: Font is not embedded (42,44-45)TimesNewRoman: Font is not embedded (1,3-9,11-16,18-25,27,29-30,32-33,35-48)Arial,BoldItalic: Font is not embedded (45)ArialMT and ComicSansMS have the same unique identifierCalibri and Calibri-Bold have the same unique identifier


ComicSansMS and SymbolMT have the same unique identifierCourierNewPSMT and SymbolMT have the same unique identifierArialMT and ComicSansMS-Bold have the same unique identifierCalibri-Bold and Calibri-Bold have the same unique identifierComicSansMS and ComicSansMS-Bold have the same unique identifier

ImagesColor image resolution 96 dpi is below 220 dpi (11,14)Color image resolution 97 dpi is below 220 dpi (11)Color image resolution 102 dpi is below 220 dpi (11)Color image resolution 136 dpi is below 220 dpi (44)Color image resolution 137 dpi is below 220 dpi (12)Color image resolution 140 dpi is below 220 dpi (44)Color image resolution 150 dpi is below 220 dpi (44)Color image resolution 195 dpi is below 220 dpi (1)Color image resolution 197 dpi is below 220 dpi (10)Color image resolution 205 dpi is below 220 dpi (14)Bitmap resolution 462 dpi is below 800 dpi (28)1-bit image (28)4-bit image (1)

ContentObject requires PostScript Level 3 (14,28,30,32)


CMYK

Color spacesDeviceCMYK / DeviceGray / Separation

Fonts: 96Arial (4x) TrueType / WinAnsi / embeddedArial,Bold (3x) TrueType / WinAnsi / embedded subsetArial,BoldItalic TrueType / WinAnsi / embeddedArial,Italic (2x) TrueType / WinAnsi / embeddedArial-Black TrueType / WinAnsi / embedded subsetArial-BoldMT TrueType (CID) / Identity-H / embeddedArial-BoldMT TrueType / WinAnsi / embedded subsetArialMT TrueType (CID) / Identity-H / embeddedArialMT (2x) TrueType / WinAnsi / embedded subsetArialMT TrueType (CID) / Identity-H / embedded subsetCalibri (14x) TrueType / WinAnsi / embedded subsetCalibri (4x) TrueType (CID) / Identity-H / embedded subsetCalibri-Bold (17x) TrueType / WinAnsi / embedded subsetCalibri-Bold (2x) TrueType (CID) / Identity-H / embedded subsetCalibri-BoldItalic (3x) TrueType / WinAnsi / embedded subsetCalibri-Italic (4x) TrueType / WinAnsi / embedded subset


Candara-Bold TrueType / WinAnsi / embedded subsetComicSansMS (3x) TrueType / WinAnsi / embedded subsetComicSansMS (7x) TrueType (CID) / Identity-H / embedded subsetComicSansMS-Bold TrueType / WinAnsi / embedded subsetComicSansMS-Bold (2x) TrueType (CID) / Identity-H / embedded subsetCourier (2x) TrueType / WinAnsi / embedded subsetCourierNewPSMT TrueType (CID) / Identity-H / embedded subsetMyriadPro-Bold (2x) Type1 / WinAnsi / embedded subsetMyriadPro-Regular Type1 / WinAnsi / embeddedMyriadPro-Regular (2x) Type1 / WinAnsi / embedded subsetSegoeUI TrueType / WinAnsi / embedded subsetSymbolMT TrueType (CID) / Identity-H / embeddedSymbolMT (2x) TrueType (CID) / Identity-H / embedded subsetTahoma TrueType / WinAnsi / embedded subsetTimesNewRoman (5x) TrueType / WinAnsi / embeddedTimesNewRoman,Bold (2x) TrueType / WinAnsi / embedded subsetVerdana-BoldItalic TrueType (CID) / Identity-H / embedded subset

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