# Advancements in Functional Dressings and a Case for Cotton Fiber Technology: Protease Modulation, Hydrogen Peroxide Generation, and ESKAPE Pathogen Antibacterial Activity

## TL;DR

This paper explores new wound dressings made from cotton that can control protease levels, generate hydrogen peroxide, and fight antibiotic-resistant bacteria.

## Contribution

The study introduces a modified cotton-based technology with antibacterial properties against ESKAPE pathogens and wound-healing functions.

## Key findings

- The cotton-based technology showed significant protease uptake and hydrogen peroxide generation.
- It demonstrated >99.99% efficacy against ESKAPE pathogens in antibacterial testing.
- The modified cotton outperformed traditional dressings in promoting wound healing functions.

## Abstract

The development of functionality in wound dressings has progressed since the discovery by Winter that moist wounds heal more rapidly. Approaches to incorporate functionality on several fronts of wound healing have been targeted. Here, we consider three functional features that have received increased attention for their role in promoting healing in hard-to-heal wounds: control of protease levels, hydrogen peroxide generation, and antibacterial efficacy against multidrug resistance bacteria, the ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pathogens. We review some clinically employed dressings used to treat chronic and burn wounds that have been characterized by their functional protease-modulating activity and contrast one well-studied analog with a cotton-based technology. Similarly, hydrogen peroxide generation profiles were obtained for dressings in different moist wound healing categories and contrasted with a modified form of a known hemostatic cotton-based technology. We examined ascorbic acid-modified forms of a cotton-based technology used for bleeding control in an ESKAPE antibacterial assessment using the AATCC 100 TM. The results for the cotton-based technology were significant protease uptake, hydrogen peroxide generation capacities at proliferative and antimicrobial levels, and >99.99% efficacy against ESKAPE pathogens. These results reflect the importance of considering new forms of cotton fiber technology for incorporation in advanced wound dressing approaches.