AQUACEL AG+

Biofilm is recognised as a major barrier to healing in chronic wounds, and standard silver dressings are effective against planktonic bacteria but have limited ability to disrupt the protective matrix surrounding a biofilm community. AQUACEL Ag+ is a next-generation silver hydrofiber dressing from Convatec that addresses this by adding EDTA and benzethonium chloride to the established AQUACEL Ag CMC hydrofiber with ionic silver. These two additional agents work alongside the silver to specifically target and disrupt wound biofilm. The result is a dressing that combines the exudate management, vertical wicking, and cohesive gel properties of AQUACEL Ag with enhanced biofilm management capability. Available in Extra sheet and Ribbon formats. No prescription is required.

AQUACEL Ag+ is a regulated Class IIb medical device from Convatec. It is the next-generation version of AQUACEL Ag, retaining the ionic silver CMC hydrofiber technology of the original product and adding two further active agents: EDTA (ethylenediaminetetraacetic acid) and benzethonium chloride. These additions are specifically targeted at wound biofilm, which is a recognised barrier to healing in chronic wounds and is not effectively managed by silver alone.

Standard silver dressings including AQUACEL Ag are effective against planktonic bacteria, free-floating bacteria in the wound fluid and wound surface. Biofilm, however, is a structured community of microorganisms embedded in a self produced protective matrix called an extracellular polymeric substance. This matrix acts as a physical barrier that limits the penetration of silver ions and other antimicrobials to the bacteria within the biofilm. AQUACEL Ag+ addresses this through its additional active components.

EDTA is a chelating agent that destabilises the biofilm matrix by removing calcium and magnesium ions that the biofilm requires for structural integrity. By chelating these metal ions, EDTA disrupts the extracellular polymeric substance matrix, making the bacteria within the biofilm more accessible to the antimicrobial action of the ionic silver. Benzethonium chloride is a cationic antiseptic that acts directly on bacterial cell membranes and also contributes to biofilm disruption at the cellular level.

AQUACEL Ag+ retains all the CMC hydrofiber properties of AQUACEL Ag: vertical wicking to protect periwound skin, cohesive gel formation on contact with exudate, and the same broad ionic silver antimicrobial activity. It is available in an Extra sheet format for flat and moderately deep wounds, and a Ribbon format for cavity wounds and sinus tracts.

AQUACEL Ag+ is applied dry to the wound. The wound exudate activates the CMC hydrofiber gelling mechanism and the release of ionic silver, EDTA, and benzethonium chloride. Do not pre-wet before application. A gel residue will remain on the wound at removal. Irrigate with sterile saline to clear this before applying the next dressing. For ribbon packing of cavity wounds, always leave a retrieval portion outside the wound and count ribbons in and out at every change.

Ionic Silver: Broad Antimicrobial Activity

As with standard AQUACEL Ag, the ionic silver in AQUACEL Ag+ is released from the CMC fibres as the dressing gels. Silver ions act on wound pathogens through multiple mechanisms: disrupting cell membranes, interfering with enzyme systems, and preventing DNA replication. This broad spectrum action covers a wide range of wound pathogens including Staphylococcus aureus, MRSA, Pseudomonas aeruginosa, and Candida species.

EDTA: Biofilm Matrix Disruption

EDTA is a chelating agent that binds to the calcium and magnesium ions within the extracellular polymeric substance matrix that surrounds and protects a biofilm community. By removing these structural ions, EDTA destabilises the biofilm matrix, reducing its integrity and its ability to shield the bacteria within from antimicrobial agents. This matrix disruption makes the bacteria within the biofilm accessible to the silver ions and benzethonium chloride released alongside the EDTA.

Benzethonium Chloride: Antiseptic and Biofilm Disruption

Benzethonium chloride is a quaternary ammonium antiseptic compound that acts on bacterial cell membranes. It has direct antimicrobial activity against a range of wound pathogens and contributes to biofilm disruption at the cellular level. Combined with the matrix-disrupting action of EDTA and the broad antimicrobial activity of ionic silver, benzethonium chloride completes a three-agent approach to managing both planktonic bacteria and biofilm communities within the wound.

CMC Hydrofiber: Vertical Wicking and Cohesive Gel

The CMC hydrofiber structure of AQUACEL Ag+ retains the vertical wicking and cohesive gel properties of AQUACEL Ag. Exudate is absorbed vertically into the dressing rather than spreading laterally onto periwound skin, reducing maceration risk. The dressing gels on contact with wound fluid and holds together as a cohesive mass at removal, reducing the risk of retained material in the wound. For the ribbon format, the cohesive gel property is particularly important for reliable retrieval from wound cavities.

Before Application

• Wash hands and use appropriate gloves.
• Clean the wound with sterile saline or as directed by a healthcare professional.
• Dry the periwound skin and apply a skin barrier to any macerated periwound area.
• Remove AQUACEL Ag+ from its sterile packaging immediately before use. Do not pre-wet.

Sheet Application

• Place the dry sheet over the wound, ensuring it covers the wound bed and extends slightly beyond the wound margin.
• Apply an appropriate secondary dressing to secure and provide additional absorbency as needed.
• Label with the date and time of application.

Ribbon Application for Cavity Wounds

• Select 1cm x 45cm for narrow sinus tracts and small cavity openings. Select 2cm x 45cm for wider cavities.
• Loosely introduce the dry ribbon into the cavity using sterile forceps. Do not pack tightly.
• Always leave a visible retrieval portion of the ribbon outside the wound opening.
• Apply a secondary dressing to cover the wound surface. Document the number of ribbons used.

Removal

• Irrigate the wound with sterile saline to soften the gelled dressing before removal.
• Remove the sheet or ribbon gently. The cohesive gel should come away as a single piece.
• For ribbon removal, retrieve by the accessible end and count ribbons out to confirm full retrieval.
• Irrigate after removal to clear gel residue. Assess the wound bed before applying the next dressing.

AQUACEL Ag+ Extra Sheet Format

The Extra sheet format of AQUACEL Ag+ has a thicker CMC hydrofiber construction for greater absorbent capacity, suited to moderately to heavily exuding wounds.

AQUACEL Ag+ 5cm x 5cm (Extra)

Suitable for small wounds, digit wounds, and localised infection where a compact silver biofilm managing sheet is needed.

AQUACEL Ag+ 4cm x 10cm (Extra)

A narrow rectangular size suited to elongated wounds, linear wounds, and donor sites where a 4cm width provides better coverage than a square.

AQUACEL Ag+ 10cm x 10cm (Extra)

A versatile medium size for moderate-sized wounds including pressure ulcers, venous leg ulcer areas, and diabetic foot wounds with infection or biofilm concerns.

AQUACEL Ag+ 15cm x 15cm (Extra)

A larger size for more extensive wound areas including larger pressure ulcers, venous leg ulcers with significant infection, and more extensive burn areas.

AQUACEL Ag+ 20cm x 30cm (Extra)

The largest sheet size, for extensive wound areas with heavy exudate and infection or biofilm. Primarily for clinical settings. Can be cut to fit with sterile scissors.

AQUACEL Ag+ Ribbon Format

AQUACEL Ag+ Ribbon 1cm x 45cm

The narrower ribbon for sinus tracts, narrow cavities, and wound openings where a 2cm ribbon would not fit. Always leave a retrieval portion outside the wound.

AQUACEL Ag+ Ribbon 2cm x 45cm

The wider ribbon for larger cavities with a wider wound opening. Provides greater wound contact surface area within the cavity. Always leave a retrieval portion outside the wound.

Contraindications

• Known sensitivity or allergy to silver, EDTA, benzethonium chloride, CMC hydrofiber, or any component of the dressing.
• Dry or minimally exuding wounds - the dressing requires exudate to activate gelling.
• Concurrent use with oil-based topical products under the dressing, as these impair active agent release.

Precautions

• Single use only. Do not reuse or resterilise.
• Silver containing dressings may cause grey or blue grey discolouration (argyria) of the wound bed and periwound skin. Expected, localised, and reversible.
• For ribbon use: pack loosely, always leave a retrieval portion outside the wound, and count ribbons in and out at every dressing change.
• Do not use MRI scanning with the dressing in place.
• AQUACEL Ag+ is not a substitute for systemic antibiotic therapy where there is spreading cellulitis or systemic infection.

Adverse Effects

• Grey or blue grey discolouration from silver deposition. Expected and reversible.
• Skin sensitivity or irritation. Discontinue if persistent.
• Wound desiccation if exudate falls significantly. Reassess dressing choice.

AQUACEL Ag+ Is Suitable For

• Infected or at-risk chronic wounds with known or suspected biofilm including venous leg ulcers, pressure ulcers, and diabetic foot ulcers that have not responded to standard silver dressings
• Wounds with clinical signs of biofilm such as a wound that fails to progress despite appropriate management, recurring infection, or a wound surface with a shiny or slimy appearance
• Cavity wounds, sinus tracts, and tunnelling wounds with infection or biofilm using the ribbon format
• Adults and children under healthcare professional supervision

Standard AQUACEL Ag uses ionic silver with CMC hydrofiber. AQUACEL Ag+ adds EDTA and benzethonium chloride specifically to target wound biofilm. Choose AQUACEL Ag+ when biofilm is a known or suspected clinical concern — particularly for chronic wounds that have not progressed as expected despite silver dressing use, or where biofilm is clinically suspected. For straightforward infection management without a specific biofilm concern, AQUACEL Ag provides equivalent silver antimicrobial activity with the same CMC hydrofiber properties.

AQUACEL Ag+ is a regulated medical device and does not require a prescription. It can be purchased directly through Pharmacy Planet without a clinical consultation. It is available in seven configurations: Extra sheet - 5cm x 5cm, 4cm x 10cm, 10cm x 10cm, 15cm x 15cm, 20cm x 30cm; Ribbon - 1cm x 45cm, 2cm x 45cm.

Pharmacy Planet stocks the full AQUACEL Ag range including AQUACEL Ag+, AQUACEL Ag, AQUACEL Ag Extra, AQUACEL Ag Foam Adhesive, and AQUACEL Ag Ribbon alongside a comprehensive range of wound care products.

For complex wounds, wounds not healing as expected, or wounds with suspected biofilm, seek clinical assessment from a tissue viability nurse, district nurse, or GP alongside your dressing purchase.

• Store in a cool, dry place away from direct sunlight and moisture.
• Store below 25°C.
• Keep in the original sealed packaging until immediately before use.
• Each dressing is individually sterile packed. Do not use if the packaging is damaged or compromised.
• Check the expiry date before use. Do not use after the expiry date.
• Once opened, apply immediately.
• Keep out of the reach of children.
• Dispose of used dressings as clinical waste in accordance with local guidelines.

Pharmacy Planet is a GPhC registered online pharmacy providing access to AQUACEL Ag+ in all seven available configurations alongside the full AQUACEL Ag range. All products are genuine and sourced through regulated supply chains.

Our pharmacists are available to advise on whether AQUACEL Ag+ or another AQUACEL Ag format is most appropriate for a specific wound and patient, and on when clinical referral for wound assessment is appropriate.

References

1. Convatec. AQUACEL Ag+ Antimicrobial Dressing — Instructions for Use. Convatec Ltd. https://www.convatec.com. Accessed May 2026.
2. International Wound Infection Institute (IWII). Wound infection in clinical practice: principles of best practice. https://www.woundinfection-institute.com. Accessed May 2026.
3. Wounds UK. Best Practice Statement: Debridement of hard-to-heal wounds. https://www.wounds-uk.com. Accessed May 2026.
4. National Institute for Health and Care Excellence (NICE). Wound care products — Drug Tariff prescribing and selection. https://www.nice.org.uk. Accessed May 2026.