No-leaching. No-resistance. No-toxicity. >99.999% Introducing BIOGUARD. Best-in-class dressings for your infection control program

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1 Introducing BIOGUARD No-leaching. >99.999% No-resistance. No-toxicity. Just cost-efficient, broad-spectrum, rapid effectiveness you can rely on. Best-in-class dressings for your infection control program

2 A perfect dressing for infection prevention BIOGUARD Barrier Dressings with their patented active component and patented method of fabrication are designed specifically to act as a barrier to bacterial invasion of wounds. No Toxicity. Due to its patented manufacturing process, the active component within BIOGUARD Barrier Dressings is intrinsically bound to the base substrate it does not leach away from the dressing. This is important as leaching antimicrobials can be toxic to good cells. BIOGUARD is the only non-leaching dressing of its kind. No Resistance. Due to the active components relatively large size, and the non-leaching attributes of the dressing, bacteria can not develop resistance to BIOGUARD dressings. This is a vital benefit of a dressing being considered for infection protection and widespread usage. BIOGUARD Barrier Dressings offer clinicians a truly unique and ideal line of barrier dressings that can play an important role in a facility s overall infection protection program.

3 BIOGUARD Barrier Dressings have Wound infection, by the numbers: 2.7%: The percentage of surgical interventions complicated by a Surgical Site Infection (SSI) (over 500,000 in the US annually) 1 2 out of 3: Surgical treatments of skin and debridement of wound infections are 2 out of 3 of the top procedures associated with the treatment of MRSA infections : The year deaths attributable to MRSA began to exceed deaths attributable to HIV/Aids in the US 3 $25,546: The average incremental cost of an SSI 4 October 1, 2008: The day Medicare stopped paying for certain catheter associated infections and surgical site infections CFUs wound bacteria per cubic meter of air: is released with each gauze dressing change increasing potential of cross contamination 6 Three: The number of key characteristics wound care physicians consistently describe as the ideal dressing for prophylaxis use: + Non-toxic must not disrupt wound healing. + Elimination of antimicrobial resistance with widespread usage on large numbers of wounds, this is a must-have. + Cost-effective and easy to use Transitions easily into existing care protocols. been proven to prevent bacterial penetration and inhibit growth within wound dressings. BIOGUARD provides a barrier to bacterial penetration, and results in >5-log (99.999%) kill of a broad spectrum of microbes including antibiotic resistant organisms. The active component within BIOGUARD is a cationic biocide called PolyDADMAC (poly diallyl dimethyl ammonium chloride). PolyDADMAC shares the same compound class as PHMB (poly hexadine methyl biguanide), with two key differences: It is intrinsically bound to the base dressing substrate, unlike PHMB, which leaches away from the dressing. It is significantly larger than PHMB, with a molecular weight of 200, ,000 g/mol (PHMB molecular weight = 2,000 4,000 g/mol).* *See method of action

4 Why does leaching matter? Figure 1: A Short Course on Zone of Inhibition (ZOI) For wounds that are either critically colonized or infected, bacterial control even at the expense of some good cells is paramount. For antimicrobials such as silver dressings, this is standard course of action. That s why these dressings are generally limited to critically colonized/infected situations for a maximum duration of 4 weeks. For wounds that are sterile, contaminated, or colonized, the main goal is wound healing (while avoiding critical colonization or infection). For these wound types, only dressings that are non-toxic to healthy cells should be considered. (See Fig.1) Also when considering dressings as prophylaxis and as an important part of an infection prevention program, only dressings that consistently demonstrate no chance of causing antimicrobial resistance should be considered. Leaching leads to sub-minimum inhibitory concentrations, which can lead to resistant strain formation. What about size? Most causes of antimicrobial resistance occur when the active component enters into the cell of the pathogen. With a molecular weight up to 100x larger than PHMB, PolyDADMAC simply won t fit through holes in the damaged cell walls of microbes Figure 1. BIOGUARD SILVER DRESSING BIOGUARD shows no zone of inhibition, and direct contact testing with L929 fibroblast cell line shows normal healthy growing cells. This market leading silver dressing shows a zone of inhibition where the chemical leaches out of the dressing: the effect of leached silver is shown in the direct contact assay by malformed and depopulated cells. Figure 2: Direct Exposure to the Treated Surface In this standard antimicrobial resistance assay (See Fig.2), consistent exposure to PolyDADMAC for a prolonged period of time showed no resistance to the biocide treated substrate. Throughout a 10-round step-by-step adaptation training test, bacterial cells were exposed to PolyDADMAC. From each round only bacterial survivors were propagated into a new inoculum. Even after continued exposure to the biocide (10X), no resistance was formed. Inactivation %

5 Method of Action The active in BIOGUARD Barrier Dressings PolyDADMAC is an advanced cationic biocide polymer with a high charge density and high molecular weight, permanently bound to the barrier dressing. Cationic biocides include surface active quaternary ammonium compounds, or Quats. Quats attract bacterial cells and bind rapidly to the cellular envelope to displace otherwise stable calcium ions and physically disrupts the cell wall structures (See Fig.3). Cationic biocides cause the membrane to fragment, leading to generalized cellular leakage. The higher the charge density, the more likely the Quat s effects will not be diluted in high levels of exudate or other bodily fluids. SEM image of health, highly-populated Escherichia coliform cells on untreated gauze. Escherichia coliform cells after exposure to Bioguard. Since the active agent is permanently bound to the barrier dressing, there is no leaching and no depletion of the biocide reservoir. This means the active agent within the dressing can never fall below the minimum inhibitory concentration (MIC). Additionally, bacteria cannot develop resistance to an agent that they cannot internalize. Due to the relatively high molecular weight of its active agent, only BIOGUARD Barrier Dressings do not pose this risk. Figure 3: Unique 3-Stage Method of Action Attract Bind Disrupt & Destroy Broad spectrum and fast-acting Test Species* Average Log Reduction Methicillin resistant staphylococcus aureus: 7.76 MRSA Staphylococcus aureus 6.90 Escherichia coliform 7.94 Pseudomonas aeruginosa 7.61 Micrococcus luteus 6.42 Streptococcus pyogenes 7.72 Enterococcus faecium 5.74 Staphylococcus epidermidis 7.73 Listeria monocytogenes 7.59 Vancomycin Resistant Enterococcus faecium: VRE 7.30 Serratia marcescens 7.43 Klebsiella pneumoniae 7.39 *Testing method AATCC 100. The clinical significance of this testing is not proven. Time Staph. Aureus E. Coli P. Aeruginosa 1 min % % % 10 min % % % 20 min % % % 30 min % % % 60 min % % % 4 hrs % % % 8 hrs % % % 12 hrs % % %

6 Target pathogens effectively and cost-efficiently with BIOGUARD Barrier dressings. + Completely Non-Toxic + Proven broad spectrum activity + Quick, durable action + No chance of causing resistant strains Conforming Bandages " x 4.1 yds 1 roll/pkg, 100 pkgs/case A " x 4.1 yds 1 roll/pkg, 100 pkgs/case A " x 4.1 yds 1 roll/pkg, 100 pkgs/case A6266 Large Gauze Roll ply, 4 ½" x 4.1 yds 1 roll/pkg, 100 pkgs/case A6266 Gauze Sponges Ply, 2" x 2", 2 s 100 dressings per tray, A trays/case Ply, 4" x 4", 2 s 50 dressings per tray, A trays/case Packing Strips ¼" x 5 yds 12/cs A ½" x 5 yds 12/cs A " x 5 yds 12/cs A6266 Non-Adherent Dressings " x 4" 50/box, 18/cs A " x 8" 50/box, 12/cs A6223 Island Dressings " x 10" 25/box, 4 boxes/cs A " x 14" 25/box, 2 boxes/cs A " x 5" 25/box, 8 boxes/cs A " x 8" 25/box, 4 boxes/cs A6203 dermasciences.com Derma Sciences, Inc. 214 Carnegie Center, Suite 300 Princeton, NJ U.S. Market: (800) Canadian Market: (800) BIOGUARD is a registered trademark of Derma Sciences, Inc. Ready Cut Gauze Burn Dressing Ply, 18" x 18" 1pkg, 10 pkgs/cs A6224 US Patent Nos. 7,045,673, 7,709,694 and 7,790,217 and foreign counterparts. NIMBUS technology is licensed to Derma Sciences, Inc. by Quick-Med Technologies, Inc. NIMBUS is a registered trademark of Quick-Med Technologies, Inc. References: 1. Stone, P et al. Systematic review of economic analyses of health care-associated infections, Am J Infect Control 2005; , Vol 33 No Healthcare-Associated Methicillin Resistant Staphylococcus aureus (HA-MRSA); Centers for Disease Control and Prevention; 3. Invasive Methicillin-Resistant Staphylococcus aureus Infections in the United States. A CDC Report; Journal of the American Medical Association; Oct Stone, P et al. A systematic audit of economic evidence linking nosocomial infections and infection control intervention: Am J infect Control 2002; , Vol Medicare nonpayment for medical errors, National Conference of State Legislatures, Aug Lawrence, JC et al. Wound dressings and airborne dispersal of bacteria. Lancet 1992; 807, Vol 339. CATBIOBROCH 0713