(1)�Within the class of debriding agents, only the following subclasses are approved for use by the clinician on a patient:

(a)�papain-based ointments;

(b)�papain with urea additives;

(c)�anti-inflammatories;

(d)�collangenases;

(e)�endogenous platelet-derived growth factors;

(f)�antibiotic ointments;

(g)�fibrinolytics;

(h)�antimicrobial agents; and

(i)�bactericidal agents.

(2)�Clinicians may use papain-based ointments as directed by a licensed medical practitioner with prescriptive authority.

(a)�Papain-based ointments act via a proteolytic enzyme that digests nonviable proteins, but which is harmless to viable tissues.

(b)�Papain-based ointments are indicated when there is a need to debride necrotic tissue and liquefy slough in acute and chronic lesions, trauma wounds or infected lesions.

(c)�Papain-based ointments are contraindicated for patients with known sensitivities to papain or any other ingredient of the medication.

(3)�Clinicians may use papain with urea additive agents as directed by a licensed medical practitioner with prescriptive authority.

(a)�Papain with urea additive acts as a denaturant to proteins, helps expose papain's activators by a solvent action, rendering them more susceptible to enzymatic digestion.

(b)�Papain with urea additive indications are to treat acute and chronic lesions such as:

(i)�venous ulcers;

(ii)�diabetic and decubitus ulcers;

(iii)�burns;

(iv)�postoperative wounds;

(v)�pilonidal cyst wounds;

(vi)�carbuncles; and

(vii)�traumatic or infected wounds.

(c)�Papain with urea additive has no known contraindications.

(4)�Clinicians may use anti-inflammatory agents as directed by a licensed medical practitioner with prescriptive authority.

(a)�Anti-inflammatory agents act to decrease histamine reactions to peri-wound areas, decreasing inflammation, and encouraging remodeling.

(b)�Anti-inflammatory agents are indicated to relieve inflammation and pruritis caused by dermatosis.

(c)�Anti-inflammatory agents are contraindicated for patients with known sensitivity to any components of the preparation.

(5)�Clinicians may use collagenase agents as directed by a licensed medical practitioner with prescriptive authority.

(a)�Collagenase agents act by digesting collagens in necrotic tissues, without destroying healthy granulation, and by encouraging epithelialization.

(b)�Collagenase agents are indicated for the debridement of chronic dermal ulcers and severely burned areas.

(c)�Collagenase agents are contraindicated for patients with local or systemic hypersensitivity to collangenases.

(6)�Clinicians may use endogenous platelet derived growth factor agents as directed by a licensed medical practitioner with prescriptive authority.

(a)�Endogenous platelet derived growth factor agents act by promoting chemotactic recruitment and the proliferative stage of healing.�They enhance formation of granulation tissue.

(b)�Endogenous platelet derived growth factors are indicated for diabetic neuropathic ulcers that extend into subcutaneous tissue with an adequate blood supply.

(c)�Endogenous platelet derived growth factor agents are contraindicated for patients with known hypersensitivity, such as parabens.�Endogenous platelet derived growth factor agents are not for use with wounds that close by primary intention because they are a nonsterile, low bioburden, preserved product.

(7)�Clinicians may use antibiotic ointments as directed by a licensed medical practitioner with prescriptive authority.

(a)�Antibiotic ointments act to kill bacteria and microbes.

(b)�Antibiotic ointments are indicated on culture-proven infected wounds.

(c)�Antibiotic ointments are contraindicated in patients with proven sensitivities or allergic reactions to the antibiotic prescribed.

(8)�Clinicians may use fibrinolytics as directed by a licensed medical practitioner with prescriptive authority.

(a)�Fibrinolytics act by contributing to collagen synthesis, where over-production of collagen can cause poor remodeling of the wound.

(b)�Fibrinolytics are indicated in patients who exhibit painful, indurated wounds.�Fibrinolytics are also indicated in slow healing venous wounds.�Fibrinolytics are only used adjunctively in therapy.

(c)�Fibrinolytics are contraindicated in patients who are allergic or exhibit a sensitivity to steroids.�Fibrinolytics are contraindicated when used alone in the treatment of wounds.

(9)�Clinicians may use antimicrobial agents as directed by a licensed medical practitioner with prescriptive authority.

(a)�Antimicrobial agents contain a broad spectrum-silver cascade that acts to reduce the bioburden in wounds for up to seven days.

(b)�Antimicrobial agents are indicated for managing full and partial thickness wounds and may be used over debrided or grafted partial thickness wounds.

(c)�Antimicrobial agents have no known contraindications.

(10)�Clinicians may use bacterial agents only for debridement as directed by a licensed medical practitioner with prescriptive authority.

(a)�Bactericidal agents act by killing bacteria.

(b)�Bactericidal agents are indicated for the presence of bacteria.

(c)�Bactericidal agents are contraindicated in patients with allergic or sensitive response to the agent.