Antimicrobial and hemostatic activities of cotton-based dressings designed to address prolonged field care applications

Authors: Edwards, Judson - Vince; Prevost, Nicolette; YAGER, DORNE - Virginia Commonwealth University; Nam, Sunghyun; Graves, Elena; Santiago Cintron, Michael; Condon, Brian; DACORTA, JOSEPH - H&h Medical Corporation

Submitted to: Military Medicine
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/11/2020
Publication Date: 1/25/2021
Citation: Edwards, J.V., Prevost, N.T., Yager, D., Nam, S., Graves, E.E., Santiago Cintron, M., Condon, B.D., Dacorta, J. 2021. Antimicrobial and hemostatic activities of cotton-based dressings designed to address prolonged field care applications. Military Medicine. 186(1):116-121. https://doi.org/10.1093/milmed/usaa271.
DOI: https://doi.org/10.1093/milmed/usaa271

Interpretive Summary: Uncontrolled hemorrhage is the leading cause of death on the battlefield and second leading cause of death in civilian trauma. Moreover when battlefield trauma occurs in remote parts of the world there is a high risk for infection that accompanies open trauma. This necessitates special measures of prolonged field care be taken in consideration of the design features of trauma dressings used under these conditions. Thus there is a need for hemorrhage control dressings that also prevent the onset of wound infection. The work reported in the paper focuses on the design of dressings that will both control hemorrhage and prevent infection. Thus, cotton-based dressings were combined with procoagulant formularies that were also designed to prevent infection. To this end we have examined the performance of cotton nonwoven finishes along with procoagulant formulary to determine the response of both gram negative and gram positive bacteria while rapidly initiating blood clotting. The results suggest that fiber surface modifications can alter the antimicrobial effects in the presence of some types of hemorrhage control formulary while retaining it in others.

Technical Abstract: Developing affordable and effective hemostatic and antimicrobial wound dressings for prolonged field care (PFC) of open wounds is of interest to prevent infection, sepsis and to conserve tissue viability. The need for an effective hemostatic dressing that is also antimicrobial is obviated by the virulent activity of S. aureus, which has evolved mechanisms to gain control over blood coagulation. Thus, dressings that provide effective hemostasis and reduction in the frequency of dressing changes, while exerting robust antimicrobial activity are of interest for PFC. Highly cleaned and sterile unbleached cotton has constituents not found in bleached cotton that are beneficial to the hemostatic and inflammatory stages of wound healing. Here we demonstrate two approaches to cotton-based antimicrobial dressings that utilize the unique components of the cotton fiber with simple modification to confer a high degree of hemostatic and antimicrobial efficacy. Methods: Spun bond nonwoven unbleached cotton was treated using traditional pad dry cure methods with low concentration ascorbic acid (< 1% add-on). Similarly, nanosilver-embedded cotton fiber was blended with pristine cotton fibers at various weight ratios to produce hydroentangled nonwoven fabrics. The resulting treated fabrics were assessed for hemostasis using thromboelastographic and Lee White clotting assays, and antimicrobial activity utilizing AATCC 100. Results: The hemostatic activities of the dressings were retained or improved while the antimicrobial activity was greater than 99 percent against S. aureus, K. pneumoniae, and P. aeruginosa. Conclusion: Molecular components inherent to unbleached cotton promote antimicrobial activity in the presence of ascorbic acid and nanosilver treated dressings while retaining hemostatic efficacy, which provide a safe, economical, and shelf stable family of wound dressings for use in PFC.