Dressings for the prevention of surgical site infection
Here is the recent Cochrane Review [summary & abstract only] that I had the pleasure of participating in. You can read the whole paper on www.cochrane.org
Plain Language Summary
No recommendations regarding type of wound dressing for the prevention of surgical site infection
Millions of surgical procedures are conducted globally each year. The majority of procedures result in wounds in which the edges are brought together to heal using stitches, staples, clips or glue – this is called ‘healing by primary intention’. Afterwards, wounds are often covered with a dressing that acts as a barrier between them and the outside environment.
One advantage of this may be to protect the wound from micro-organisms, and thus infection. Many different dressing types are available for use on surgical wounds, however, it is not clear whether one type of dressing is better than any other at preventing surgical site infection, or, indeed, whether it is better not to use a dressing at all. We conducted a review of all available, relevant, evidence regarding the impact of dressings on the prevention of surgical site infections in surgical wounds healing by primary intention.
The review examined data from 16 randomised controlled trials and found no evidence to suggest either that one dressing type was better than any other, or that covering these wounds with dressings at all was better, at preventing surgical site infection, or that any dressing type improves scarring, pain control, patient acceptability or ease of removal.
It is important to note that many trials in this review were small and of poor quality, at high or unclear risk of bias. Decisions on wound dressing should be based on dressing costs and the need for management of specific symptoms e.g., absorption of exudate.
This is a Cochrane review abstract and plain language summary prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2011 Issue 7, Copyright © 2011 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This record should be cited as: Dumville JC, Walter CJ, Sharp CA, Page T. Dressings for the prevention of surgical site infection. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD003091. DOI: 10.1002/14651858.CD003091.pub2
Editorial Group: Wounds Group
This version first published online: July 6. 2011
Last assessed as up-to-date: May 10. 2011
Abstract
Background
Surgical wounds (incisions) heal by primary intention when the wound edges are brought together and secured – often with sutures, staples, clips or glue. Wound dressings, usually applied after wound closure, provide physical support, protection from bacterial contamination and absorb exudate. Surgical site infection (SSI) is a common complication of surgical wounds that may delay healing.
Objectives
To evaluate the effects of wound dressings for preventing SSI in people with surgical wounds healing by primary intention.
Search strategy
We searched the Cochrane Wounds Group Specialised Register (searched 10 May 2011); The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011 Issue 2); Ovid MEDLINE (1950 to April Week 4 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, May 9, 2011); Ovid EMBASE (1980 to 2011 Week 18); EBSCO CINAHL (1982 to 6 May 2011). There were no restrictions based on language or date of publication.
Selection criteria
Randomised controlled trials (RCTs) comparing alternative wound dressings or wound dressings with leaving wounds exposed for postoperative management of surgical wounds healing by primary intention.
Data collection and analysis
Two review authors performed study selection, risk of bias assessment and data extraction independently.
Main results
Sixteen RCTs were included (2578 participants). All trials were at unclear or high risk of bias. Nine trials included people with wounds resulting from surgical procedures with a contamination classification of ‘clean’, two trials included people with wounds resulting from surgical procedures with a ‘clean/contaminated’ contamination classification and the remaining trials evaluated people with wounds resulting from various surgical procedures with different contamination classifications. Two trials compared wound dressings with leaving wounds exposed. The remaining 14 trials compared two alternative dressing types. No evidence was identified to suggest that any dressing significantly reduced the risk of developing an SSI compared with leaving wounds exposed or compared with alternative dressings in people who had surgical wounds healing by secondary intention.
Authors’ conclusions
At present, there is no evidence to suggest that covering surgical wounds healing by primary intention with wound dressings reduces the risk of SSI or that any particular wound dressing is more effective than others in reducing the rates of SSI, improving scarring, pain control, patient acceptability or ease of dressing removal. Most trials in this review were small and of poor quality at high or unclear risk of bias. However, based on the current evidence, we conclude that decisions on wound dressing should be based on dressing costs and the symptom management properties offered by each dressing type e.g. exudate management.
Hi Kate
Whilst I am currently undertaking study to become a Naturopath I recently left the nursing Industry predominately as a result of the ignorance & misguided decisions regularly made by senior managers in the health industry, particularly nurses.
As an RN (of 28yrs +) & having been a Nurse Unit Manager for 16 years (in a Vascular & Colorectal unit) & also in Senior Nursing Management roles I know for a fact that the perception of saving a dollar & ticking boxes in claims of meeting benchmarks has always been to the detriment of patient care & more desirable outcomes .
I too would suggest that it is not cost effective at all & support your concerns regarding the safety of both patients & nurses.
The use of gauze is so primitive & contradicts the evidence-based facts known about moist wound healing. Issues also arise about their packaging/sterility & as you suggest the tape which is generally carried around in pockets, placed in pan rooms, patient’s lockers etc — hardly aseptic practices!
I have been very involved in both teaching & practicing wound care & suggest that the cost of real & appropriate dressing materials like Alginates, Hydrocolloids etc are more cost effective, reduce infection rates & reduce nursing hours (which, lets face it is a major consideration).
Patients should be encouraged to insist on only the best for their recovery & wellbeing and nurses should demand not to be placed in any more hazardous situations than they are already exposed to.
To all nurses — please consider yourselves professional enough to advocate for doing what is not only scientifically correct but also morally appropriate for the wellbeing of all.
I urge you to not feel pressured into taking these short cuts. You have power & skill as the clinicain to demonstrate what is not only in the best interest of the patient & their recovery but also in demonstrating that this in itself cost effective, more likely to reduce length of stay & readmission rates.
Kind Regards
Jo