Silver has been used for centuries as an antimicrobial agent to reduce bioburden and prevent infection. Its usage diminished when antibiotics were introduced but remained one of the most popular agents for wound infections, especially in burned patients. Incorporation of silver into a range of hygiene and healthcare applications has increased, and this has raised concerns over the development of silver antimicrobial nano silver resistance, toxicity, methods of testing products and evidence of efficacy. The published evidence for resistance and toxicity is limited and associated with frequent and high levels of silver used. Increasing evidence of improved antimicrobial activity of nanoparticles of silver and possible dual immunomodulatory effects are exciting. This may lead to further product development as potential alternative preservatives as some currently available preservatives have an increasing incidence of allergic reactions. Acknowledging the role of the carrier is important, and as silver is active when in solution, opens a window of opportunity in personal hygiene area. This is important in an age when multiple antibiotic–resistant bacteria are becoming prevalent.