Dressings for the prevention of surgical site infection (Review)


WIn the UK it has been estimated that 4% to 5% of patients undergoing a surgical procedure contract an SSI. Dumville JC and Coll conducted this review, including 29 trials (5718 participants). The scope of the work was to compare Dressings for the prevention of surgical site infection.

The majority of procedures result in surgical wounds that will heal by primary intention. This is where wound edges are re-approximated using sutures, staples, clips or glue, either alone, or in combination. Surgical wounds commonly leak fluid or blood within the first 24 hours and they are frequently covered with different types of dressing to manage the exudate, provide wound protection and prevent possible external contamination. In the UK it has been estimated that 4% to 5% of patients undergoing a surgical procedure contract an SSI. Whilst various patient factors can predict the likelihood of SSI, the type of surgical procedure performed exerts a major influence on risk. Surgical procedures involving ‘clean’ body cavities have much lower numbers of infection, around 3% to 5%, compared with procedures involving body cavities with infected, necrotic or dirty tissue, for example, colorectal surgery, which has surgical infection figures of around 10% to 30%.

A superficial SSI is defined as an infection occurring within 30 days after the operation. It involves the skin and subcutaneous tissue and it is associated with at least one of the following 1) purulent drainage 2) organisms isolated from an aseptically-obtained culture of fluid or tissue from the surgical site; 3) at least one of the following signs or symptoms of infection: pain or tenderness, localised swelling, redness or heat, and the superficial incision is deliberately opened by the surgeon and is culture-positive or not cultured.

A deep incisional SSI is defined as an infection that occurs within 30 days after the operative procedure. It involves fascial and muscle layers associated with one of the following: 1) purulent drainage from the deep incision, 2) a deep incision spontaneously dehisces with or without fever or localised pain or tenderness; 3) an abscess or other evidence of infection involving the deep incision is found.

Dumville JC and Coll conducted this review, including 29 trials (5718 participants). The scope of the work was to compare:

  1. film dressings compared with basic wound contact dressings following clean surgery
  2. hydrocolloid dressings compared with basic wound contact dressings following clean surgery
  3. hydrocolloid dressings compared with basic wound contact dressings s following potentially contaminated surgery
  4. silver-containing dressings compared with basic wound contact dressings following clean surgery
  5. silver-containing dressings compared with basic wound contact dressings following potentially contaminated surgery.

It is uncertain whether covering surgical wound healing by primary intention with wound dressings reduces the risk of SSI, or whether any particular wound dressing is more effective than others in reducing the risk of SSI, improving scarring, reducing pain, improving acceptability to patients, or is easier to remove. Most studies in this review were small and at a high or unclear risk of bias. Based on the current evidence, decision-makers may wish to base decisions about how to dress a wound following surgery on dressing costs as well as patient preference.

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