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Sun W, Chen M, Duan D, Liu W, Cui W, Li L. Effectiveness of moist dressings in wound healing after surgical suturing: A Bayesian network meta-analysis of randomised controlled trials. Int Wound J 2022; 20:69-78. [PMID: 35546485 PMCID: PMC9797923 DOI: 10.1111/iwj.13839] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/25/2022] [Accepted: 04/29/2022] [Indexed: 02/05/2023] Open
Abstract
The moist healing theory proves that a moderately moist and airtight environment is conducive to wound healing. However, different moist dressings have different functions. We aim to evaluate the effects of moist dressings on wound healing after surgical suturing and identify superior moist dressings. Randomised controlled trials investigating the application of moist dressings were retrieved from electronic databases, including PubMed, EMBASE, Web of Science, and the Cochrane Library. Wound healing, surgical site infection (SSI), and times of dressing change were assessed. The values of the surface under the cumulative ranking (SUCRA) curve were calculated based on the Bayesian network meta-analysis. Inconsistency tests and funnel plots were applied to analyse the consistency and publication bias. All the analysis complies with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 Checklist and AMSTAR (Assessing the Methodological Quality of Systematic Reviews) Guidelines. Sixteen randomised controlled trials involving 4444 patients were pooled in the network meta-analysis. The ionic silver dressing (SUCRA, 93%) ranked first in wound healing, the metallic silver dressing (SUCRA, 75.9%) ranked first in SSI, and the hydrocolloid dressing (SUCRA, 73.9%) ranked first in times of dressing change. Inconsistency was only observed in wound healing, and no publication bias was observed in this study. The effects of moist dressings are better than gauze dressings in the process of wound healing. The ionic silver dressing is effective in wound healing, whereas the metallic silver dressing is effective in SSI prevention. The hydrocolloid dressing requires the fewest times of dressing change. More high-quality RCTs are required to support the network meta-analysis.
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Affiliation(s)
- Wenjing Sun
- Department of Neurosurgery, West China HospitalSichuan UniversityChengduChina
| | - Maojun Chen
- Department of Neurosurgery, West China HospitalSichuan UniversityChengduChina
| | - Dan Duan
- Department of Neurosurgery, West China HospitalSichuan UniversityChengduChina
| | - Wenjie Liu
- Department of Neurosurgery, West China HospitalSichuan UniversityChengduChina
| | - Wenyao Cui
- Department of Neurosurgery, West China HospitalSichuan UniversityChengduChina
| | - Li Li
- Department of Neurosurgery, West China HospitalSichuan UniversityChengduChina
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Hasan N, Lee J, Ahn HJ, Hwang WR, Bahar MA, Habibie H, Amir MN, Lallo S, Son HJ, Yoo JW. Nitric Oxide-Releasing Bacterial Cellulose/Chitosan Crosslinked Hydrogels for the Treatment of Polymicrobial Wound Infections. Pharmaceutics 2021; 14:22. [PMID: 35056917 PMCID: PMC8779945 DOI: 10.3390/pharmaceutics14010022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 12/16/2021] [Accepted: 12/21/2021] [Indexed: 01/15/2023] Open
Abstract
Polymicrobial wound infections are a major cause of infectious disease-related morbidity and mortality worldwide. In this study, we prepared a nitric oxide (NO)-releasing oxidized bacterial cellulose/chitosan (BCTO/CHI) crosslinked hydrogel to effectively treat polymicrobial wound infections. Linear polyethyleneimine diazeniumdiolate (PEI/NO) was used as the NO donor. The aldehyde group of BCTO and the amine of CHI were used as crosslinked hydrogel-based materials; their high NO loading capacity and antibacterial activity on the treatment of polymicrobial-infected wounds were investigated. The blank and NO-loaded crosslinked hydrogels, namely BCTO-CHI and BCTO-CHI-PEI/NO, were characterized according to their morphologies, chemical properties, and drug loading. BCTO-CHI-PEI/NO exhibited sustained drug release over four days. The high NO loading of BCTO-CHI-PEI/NO enhanced the bactericidal efficacy against multiple bacteria compared with BCTO-CHI. Furthermore, compared with blank hydrogels, BCTO-CHI-PEI/NO has a favorable rheological property due to the addition of a polymer-based NO donor. Moreover, BCTO-CHI-PEI/NO significantly accelerated wound healing and re-epithelialization in a mouse model of polymicrobial-infected wounds. We also found that both crosslinked hydrogels were nontoxic to healthy mammalian fibroblast cells. Therefore, our data suggest that the BCTO-CHI-PEI/NO developed in this study improves the efficacy of NO in the treatment of polymicrobial wound infections.
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Affiliation(s)
- Nurhasni Hasan
- College of Pharmacy, Pusan National University, Busan 46241, Korea; (N.H.); (J.L.)
- Faculty of Pharmacy, Hasanuddin University, Jl. Perintis Kemerdekaan KM 10, Makassar 90245, Indonesia; (M.A.B.); (H.H.); (M.N.A.); (S.L.)
| | - Juho Lee
- College of Pharmacy, Pusan National University, Busan 46241, Korea; (N.H.); (J.L.)
| | - Hye-Jin Ahn
- School of Mechanical and Aerospace Engineering, Gyeongsang National University, Jinju 52828, Korea; (H.-J.A.); (W.R.H.)
| | - Wook Ryol Hwang
- School of Mechanical and Aerospace Engineering, Gyeongsang National University, Jinju 52828, Korea; (H.-J.A.); (W.R.H.)
| | - Muhammad Akbar Bahar
- Faculty of Pharmacy, Hasanuddin University, Jl. Perintis Kemerdekaan KM 10, Makassar 90245, Indonesia; (M.A.B.); (H.H.); (M.N.A.); (S.L.)
| | - Habibie Habibie
- Faculty of Pharmacy, Hasanuddin University, Jl. Perintis Kemerdekaan KM 10, Makassar 90245, Indonesia; (M.A.B.); (H.H.); (M.N.A.); (S.L.)
| | - Muhammad Nur Amir
- Faculty of Pharmacy, Hasanuddin University, Jl. Perintis Kemerdekaan KM 10, Makassar 90245, Indonesia; (M.A.B.); (H.H.); (M.N.A.); (S.L.)
| | - Subehan Lallo
- Faculty of Pharmacy, Hasanuddin University, Jl. Perintis Kemerdekaan KM 10, Makassar 90245, Indonesia; (M.A.B.); (H.H.); (M.N.A.); (S.L.)
| | - Hong-Joo Son
- College of Natural Resources and Life Science/Life and Industry Convergence Research Institute, Pusan National University, Miryang 627706, Korea;
| | - Jin-Wook Yoo
- College of Pharmacy, Pusan National University, Busan 46241, Korea; (N.H.); (J.L.)
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Hasan N, Lee J, Kwak D, Kim H, Saparbayeva A, Ahn HJ, Yoon IS, Kim MS, Jung Y, Yoo JW. Diethylenetriamine/NONOate-doped alginate hydrogel with sustained nitric oxide release and minimal toxicity to accelerate healing of MRSA-infected wounds. Carbohydr Polym 2021; 270:118387. [PMID: 34364628 DOI: 10.1016/j.carbpol.2021.118387] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/12/2021] [Accepted: 06/27/2021] [Indexed: 12/17/2022]
Abstract
This study demonstrates the development of a nitric oxide (NO)-releasing hydrogel wound dressing and its efficacy at accelerating methicillin-resistant Staphylococcus aureus (MRSA)-infected wound healing. A DETA/NONOate-doped alginate (Alg-DETA/NO) hydrogel was synthesized using alginate as a hydrogel-forming wound dressing material and diethylenetriamine/diazeniumdiolate (DETA/NONOate) as an NO donor. Alg-DETA/NO exhibited a prolonged NO release profile over a period of 4 days. The rheological properties of Alg-DETA/NO did not differ significantly from those of pure alginate. Importantly, Alg-DETA/NO showed potent antibacterial activity against MRSA, with minimal toxicity to mouse fibroblasts. The application of Alg-DETA/NO to MRSA-infected wounds in a mouse model showed a favorable wound healing with accelerated wound-size reduction and reduced skin bacterial infection. Additionally, histological examination revealed that Alg-DETA/NO reduced inflammation at the wound site and promoted re-epithelialization, angiogenesis, and collagen deposition. Thus, Alg-DETA/NO presented herein could serve as a safe and potent hydrogel dressing for the treatment of MRSA-infected wounds.
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Affiliation(s)
- Nurhasni Hasan
- College of Pharmacy, Pusan National University, Busan 46241, South Korea
| | - Juho Lee
- College of Pharmacy, Pusan National University, Busan 46241, South Korea
| | - Dongmin Kwak
- College of Pharmacy, Pusan National University, Busan 46241, South Korea
| | - Hyunwoo Kim
- College of Pharmacy, Pusan National University, Busan 46241, South Korea
| | | | - Hye-Jin Ahn
- School of Mechanical and Aerospace Engineering, Gyeongsang National University, Jinju 52828, South Korea
| | - In-Soo Yoon
- College of Pharmacy, Pusan National University, Busan 46241, South Korea
| | - Min-Soo Kim
- College of Pharmacy, Pusan National University, Busan 46241, South Korea
| | - Yunjin Jung
- College of Pharmacy, Pusan National University, Busan 46241, South Korea
| | - Jin-Wook Yoo
- College of Pharmacy, Pusan National University, Busan 46241, South Korea..
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Hasan N, Cao J, Lee J, Kim H, Yoo JW. Development of clindamycin-loaded alginate/pectin/hyaluronic acid composite hydrogel film for the treatment of MRSA-infected wounds. JOURNAL OF PHARMACEUTICAL INVESTIGATION 2021. [DOI: 10.1007/s40005-021-00541-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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5
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Brega C, Calvi S, Albertini A. Use of a negative pressure wound therapy system over closed incisions option in preventing post-sternotomy wound complications. Wound Repair Regen 2021; 29:848-852. [PMID: 33780088 DOI: 10.1111/wrr.12914] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 03/04/2021] [Accepted: 03/16/2021] [Indexed: 11/28/2022]
Abstract
Post-sternotomy surgical site infections may be serious complications responsible for increased morbidity, mortality and length of hospital stay. A variety of wound-healing strategies can be used over closed surgical incisions, including negative pressure wound therapy (NPWT). The aim of the study is to assess sternal wound complications after heart surgery using NPWT in patients at risk for surgical site complication. Considered risk factors affecting wound healing were type 2 diabetes, Body Mass Index (BMI) >30, chronic obstructive pulmonary disease (COPD), chronic renal failure (CRF) and myocardial revascularization by double mammary artery harvesting. With these premises, 90 patients were selected: 30 patients received traditional gauze dressings, 30 advanced dressings (hydrocolloid and carboxymethyl cellulose) and 30 patients NPWT. Thirty-four patients (37.7%) had two risk factors, 41 patients (45.5%) were affected by three risk factors and 15 patients (16.6%) by four risk factors. The NPWT group had lower rates of diabetes and CRF and only one patient presented four risk factors. With regard to surgical times and types of surgical procedure, no significant differences were observed within the three groups. The patients who received NPWT over closed incision experimented a significantly lower rate of deep sternal complication over traditional gauze and hydrocolloid and carboxymethyl cellulose dressings.
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Affiliation(s)
- Carlotta Brega
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Simone Calvi
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Alberto Albertini
- Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
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Reeves BC, Rooshenas L, Macefield RC, Woodward M, Welton NJ, Waterhouse BR, Torrance AD, Strong S, Siassakos D, Seligman W, Rogers CA, Rickard L, Pullyblank A, Pope C, Pinkney TD, Pathak S, Owais A, O'Callaghan J, O'Brien S, Nepogodiev D, Nadi K, Murkin CE, Munder T, Milne T, Messenger D, McMullan CM, Mathers JM, Mason M, Marshall M, Lovegrove R, Longman RJ, Lloyd J, Lim J, Lee K, Korwar V, Hughes D, Hill G, Harris R, Hamdan M, Brown HG, Gooberman-Hill R, Glasbey J, Fryer C, Ellis L, Elliott D, Dumville JC, Draycott T, Donovan JL, Cotton D, Coast J, Clout M, Calvert MJ, Byrne BE, Brown OD, Blencowe NS, Bera KD, Bennett J, Bamford R, Bakhbakhi D, Atif M, Ashton K, Armstrong E, Andronis L, Ananthavarathan P, Blazeby JM. Three wound-dressing strategies to reduce surgical site infection after abdominal surgery: the Bluebelle feasibility study and pilot RCT. Health Technol Assess 2020; 23:1-166. [PMID: 31392958 DOI: 10.3310/hta23390] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Surgical site infection (SSI) affects up to 20% of people with a primary closed wound after surgery. Wound dressings may reduce SSI. OBJECTIVE To assess the feasibility of a multicentre randomised controlled trial (RCT) to evaluate the effectiveness and cost-effectiveness of dressing types or no dressing to reduce SSI in primary surgical wounds. DESIGN Phase A - semistructured interviews, outcome measure development, practice survey, literature reviews and value-of-information analysis. Phase B - pilot RCT with qualitative research and questionnaire validation. Patients and the public were involved. SETTING Usual NHS care. PARTICIPANTS Patients undergoing elective/non-elective abdominal surgery, including caesarean section. INTERVENTIONS Phase A - none. Phase B - simple dressing, glue-as-a-dressing (tissue adhesive) or 'no dressing'. MAIN OUTCOME MEASURES Phase A - pilot RCT design; SSI, patient experience and wound management questionnaires; dressing practices; and value-of-information of a RCT. Phase B - participants screened, proportions consented/randomised; acceptability of interventions; adherence; retention; validity and reliability of SSI measure; and cost drivers. DATA SOURCES Phase A - interviews with patients and health-care professionals (HCPs), narrative data from published RCTs and data about dressing practices. Phase B - participants and HCPs in five hospitals. RESULTS Phase A - we interviewed 102 participants. HCPs interpreted 'dressing' variably and reported using available products. HCPs suggested practical/clinical reasons for dressing use, acknowledged the weak evidence base and felt that a RCT including a 'no dressing' group was acceptable. A survey showed that 68% of 1769 wounds (727 participants) had simple dressings and 27% had glue-as-a-dressing. Dressings were used similarly in elective and non-elective surgery. The SSI questionnaire was developed from a content analysis of existing SSI tools and interviews, yielding 19 domains and 16 items. A main RCT would be valuable to the NHS at a willingness to pay of £20,000 per quality-adjusted life-year. Phase B - from 4 March 2016 to 30 November 2016, we approached 862 patients for the pilot RCT; 81.1% were eligible, 59.4% consented and 394 were randomised (simple, n = 133; glue, n = 129; no dressing, n = 132); non-adherence was 3 out of 133, 8 out of 129 and 20 out of 132, respectively. SSI occurred in 51 out of 281 participants. We interviewed 55 participants. All dressing strategies were acceptable to stakeholders, with no indication that adherence was problematic. Adherence aids and patients' understanding of their allocated dressing appeared to be key. The SSI questionnaire response rate overall was 67.2%. Items in the SSI questionnaire fitted a single scale, which had good reliability (test-retest and Cronbach's alpha of > 0.7) and diagnostic accuracy (c-statistic = 0.906). The key cost drivers were hospital appointments, dressings and redressings, use of new medicines and primary care appointments. LIMITATIONS Multiple activities, often in parallel, were challenging to co-ordinate. An amendment took 4 months, restricting recruitment to the pilot RCT. Only 67% of participants completed the SSI questionnaire. We could not implement photography in theatres. CONCLUSIONS A main RCT of dressing strategies is feasible and would be valuable to the NHS. The SSI questionnaire is sufficiently accurate to be used as the primary outcome. A main trial with three groups (as in the pilot) would be valuable to the NHS, using a primary outcome of SSI at discharge and patient-reported SSI symptoms at 4-8 weeks. TRIAL REGISTRATION Phase A - Current Controlled Trials ISRCTN06792113; Phase B - Current Controlled Trials ISRCTN49328913. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 39. See the NIHR Journals Library website for further project information. Funding was also provided by the Medical Research Council ConDuCT-II Hub (reference number MR/K025643/1).
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Affiliation(s)
- Barnaby C Reeves
- Clinical Trials and Evaluation Unit, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Leila Rooshenas
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rhiannon C Macefield
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mark Woodward
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Nicky J Welton
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Andrew D Torrance
- Department of Surgery, Sandwell and West Birmingham NHS Trust, West Bromwich, UK
| | - Sean Strong
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,North Bristol NHS Trust, Bristol, UK
| | - Dimitrios Siassakos
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,North Bristol NHS Trust, Bristol, UK
| | | | - Chris A Rogers
- Clinical Trials and Evaluation Unit, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lloyd Rickard
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Caroline Pope
- Clinical Trials and Evaluation Unit, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Thomas D Pinkney
- Academic Department of Surgery, Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK
| | - Samir Pathak
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Anwar Owais
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | - Dmitri Nepogodiev
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Department of Surgery, Queen Elizabeth Hospital, University of Birmingham, Birmingham, UK
| | | | - Charlotte E Murkin
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Tonia Munder
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Tom Milne
- North Bristol NHS Trust, Bristol, UK
| | - David Messenger
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Christel M McMullan
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan M Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Matthew Mason
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | | | | | | | - Jeffrey Lim
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Kathryn Lee
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Daniel Hughes
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Rosie Harris
- Clinical Trials and Evaluation Unit, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mohammed Hamdan
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK.,North Bristol NHS Trust, Bristol, UK
| | | | - Rachael Gooberman-Hill
- Musculoskeletal Research Unit, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - James Glasbey
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Caroline Fryer
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Lucy Ellis
- Clinical Trials and Evaluation Unit, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Daisy Elliott
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jo C Dumville
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | | | - Jenny L Donovan
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West at University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - David Cotton
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Joanna Coast
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Madeleine Clout
- Clinical Trials and Evaluation Unit, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Melanie J Calvert
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.,Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
| | - Benjamin E Byrne
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Oliver D Brown
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Natalie S Blencowe
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Katarzyna D Bera
- Clinical Academic Graduate School, University of Oxford, Oxford, UK
| | | | - Richard Bamford
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Muhammad Atif
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Kate Ashton
- Clinical Trials and Evaluation Unit, Department of Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Lazaros Andronis
- Health Economics Unit, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | | | - Jane M Blazeby
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,University Hospitals Bristol NHS Foundation Trust, Bristol, UK
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Wood MD, Powers J, Rechter JL. Comparative Evaluation of Chest Tube Insertion Site Dressings: A Randomized Controlled Trial. Am J Crit Care 2019; 28:415-423. [PMID: 31676515 DOI: 10.4037/ajcc2019645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Little empirical evidence is available to guide decisions on what type of dressing to use and how often to change the dressing after placement of a thoracostomy tube. OBJECTIVES This prospective randomized controlled study was conducted to compare various dressing types and procedures after placement of thoracic and mediastinal chest tubes. Outcome measures included length of time between dressing changes, skin integrity, air leak presence, and patient-reported pain. METHODS The study involved a convenience sample of 127 patients with 236 chest tubes from 3 intensive care units at a midwestern regional medical center. The patients were randomized to 1 of 3 groups: (1) gauze and tape dressing changed once daily, (2) gauze and tape dressing changed every 3 days, and (3) silicone foam dressing changed every 3 days. RESULTS Patients with silicone foam dressings reported less pain at the insertion site than did patients with standard gauze and tape dressings, and patients with daily dressing changes reported significantly more pain with dressing removal than did patients with dressing changes every 3 days. The silicone foam dressing was associated with better skin integrity than the gauze and tape dressing. Dressing intactness, number of days with a chest tube inserted, and patient demographic characteristics did not differ significantly among the 3 groups. CONCLUSIONS Overall, the best type of dressing for promoting skin integrity and patient comfort was the silicone foam dressing. The results of this study may help identify best practices for dressing type and procedures among patients with chest tubes.
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Affiliation(s)
- Michelle D. Wood
- Michelle D. Wood is a clinical nurse specialist for Parkview Heart Institute, Jan Powers is director of nursing research and professional practice, and Jennifer L. Rechter is clinical nurse specialist for the medical intensive care unit, Parkview Health, Fort Wayne, Indiana
| | - Jan Powers
- Michelle D. Wood is a clinical nurse specialist for Parkview Heart Institute, Jan Powers is director of nursing research and professional practice, and Jennifer L. Rechter is clinical nurse specialist for the medical intensive care unit, Parkview Health, Fort Wayne, Indiana
| | - Jennifer L. Rechter
- Michelle D. Wood is a clinical nurse specialist for Parkview Heart Institute, Jan Powers is director of nursing research and professional practice, and Jennifer L. Rechter is clinical nurse specialist for the medical intensive care unit, Parkview Health, Fort Wayne, Indiana
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Abstract
AIMS to explore cardiothoracic nurses' knowledge and self-reported competence of wound care following cardiac surgery and to ascertain if there were any differences in knowledge between nurses working in public and private hospitals. BACKGROUND cardiothoracic nurses are the main providers of wound care for patients post cardiac surgery, however, there is a lack of research about their knowledge of wound care. DESIGN a descriptive, quantitative design was used in the form of a cross-sectional, self-reported questionnaire. METHOD the questionnaire was developed to ascertain nurses' knowledge of cardiac wound management. Census sampling was used and the questionnaire was distributed to 503 nurses in 6 hospitals in the Republic of Ireland. Total knowledge scores were calculated and data analysed using descriptive and inferential statistics. RESULTS the response rate was 31.2% (n=158). The main knowledge deficits identified were wound healing, the signs and symptoms of surgical site infection and cardiac-specific wound care. Some nurses reported using inappropriate products for cleansing wounds and variable time for initial postoperative dressing removal. CONCLUSION the combination of low total knowledge scores and requests for further training and education suggest the need for ongoing wound care education. Audit of the use of wound cleansing products, support bras and wound assessment charts is recommended.
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Affiliation(s)
- Nicola Moran
- Staff Nurse, Emergency Department, St James's Hospital, Dublin
| | - Gobnait Byrne
- Assistant Professor, School of Nursing and Midwifery, Trinity College Dublin
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Vos RJ, Van Putte BP, Kloppenburg GTL. Prevention of deep sternal wound infection in cardiac surgery: a literature review. J Hosp Infect 2018; 100:411-420. [PMID: 29885873 DOI: 10.1016/j.jhin.2018.05.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 05/31/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Deep sternal wound infection (DSWI) is a dreaded complication of cardiac surgery with considerable consequences in terms of mortality, morbidity and treatment costs. In addition to standard surgical site infection prevention guidelines, multiple specific measures in the prevention of DSWI have been developed and evaluated in the past decades. This review focuses on these specific measures to prevent DSWI. METHODS An extensive literature search was performed to assess interventions in the prevention of DSWI. Articles describing results of a randomized controlled trial were categorized by type of intervention. Results were yielded and, if possible, pooled. RESULTS From a total of 743 articles found, 48 randomized controlled trials were selected. Studies were divided into 12 categories, containing pre-, peri- and postoperative preventive measures. Specific measures shown to be effective were: antibiotic prophylaxis with a first-generation cephalosporin for at least 24 h, application of local gentamicin before chest closure, sternal closure with figure-of-eight steel wires, and postoperative chest support using a corset or vest. CONCLUSION This study identified several measures that prevent DSWI after cardiac surgery that are not frequently applied in current practice. It is recommended that the guidelines on prevention of surgical site infection in cardiac surgery should be updated.
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Affiliation(s)
- R J Vos
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands.
| | - B P Van Putte
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands; Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - G T L Kloppenburg
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
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10
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Elliott D. Developing outcome measures assessing wound management and patient experience: a mixed methods study. BMJ Open 2017; 7:e016155. [PMID: 29180591 PMCID: PMC5719294 DOI: 10.1136/bmjopen-2017-016155] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/13/2017] [Accepted: 07/19/2017] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To develop outcome measures to assess practical management of primary surgical wounds and patient experience. DESIGN Mixed methods, including qualitative interviews and data extraction from published randomised controlled trials (RCTs). SETTING Two university-teaching NHS hospitals and three district NHS hospitals in the South West and Midlands regions of England. PARTICIPANTS Sixty-four patients and 15 healthcare professionals from abdominal general surgical specialities and obstetrics (caesarean section). METHODS Measures were developed according to standard guidelines to identify issues relevant to patients' experiences of surgical wounds and dressings, including analysis of existing RCT outcomes and semi-structured interviews. These were written into provisional questionnaire items for a single outcome measure. Cognitive interviews with patients and healthcare professionals assessed face validity, acceptability and relevance. Findings from interviews were regularly shared with the study team who suggested amendments to modify and reword items to improve understanding before further iterative testing with patients and healthcare professionals. RESULTS Analyses of existing RCT outcomes and interviews produced a total of 69 issues. Pretesting and iterative revision established the need for two separate measures. One measure addresses healthcare professionals' experience of wound management in two key areas: exudate and its impact, and allergic reactions to the dressing. The other measure addresses patients' experience of wounds in seven key areas: wound comfort, dressing removal, dressings to protect the wound, impact on daily activities, ease of movement, anxiety about the wound and satisfaction with dressing. Each measure took less than five min to complete and both were understood and acceptable to patients and healthcare professionals. CONCLUSION This in-depth study has developed two measures to assess practical management of primary surgical wounds and patient experience. Further work to test their validity, reliability and application to other settings is now required. TRIAL REGISTRATION NUMBER HTA - 12/200/04; Pre-results.
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Affiliation(s)
- Daisy Elliott
- Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS
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Dumville JC, Gray TA, Walter CJ, Sharp CA, Page T, Macefield R, Blencowe N, Milne TKG, Reeves BC, Blazeby J. Dressings for the prevention of surgical site infection. Cochrane Database Syst Rev 2016; 12:CD003091. [PMID: 27996083 PMCID: PMC6464019 DOI: 10.1002/14651858.cd003091.pub4] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Surgical wounds (incisions) heal by primary intention when the wound edges are brought together and secured, often with sutures, staples, or clips. Wound dressings applied after wound closure may provide physical support, protection and absorb exudate. There are many different types of wound dressings available and wounds can also be left uncovered (exposed). Surgical site infection (SSI) is a common complication of wounds and this may be associated with using (or not using) dressings, or different types of dressing. OBJECTIVES To assess the effects of wound dressings compared with no wound dressings, and the effects of alternative wound dressings, in preventing SSIs in surgical wounds healing by primary intention. SEARCH METHODS We searched the following databases: the Cochrane Wounds Specialised Register (searched 19 September 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library 2016, Issue 8); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations, MEDLINE Daily and Epub Ahead of Print; 1946 to 19 September 2016); Ovid Embase (1974 to 19 September 2016); EBSCO CINAHL Plus (1937 to 19 September 2016).There were no restrictions based on language, date of publication or study setting. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing wound dressings with wound exposure (no dressing) or alternative wound dressings for the 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 We included 29 trials (5718 participants). All studies except one were at an unclear or high risk of bias. Studies were small, reported low numbers of SSI events and were often not clearly reported. There were 16 trials that included people with wounds resulting from surgical procedures with a 'clean' classification, five trials that included people undergoing what was considered 'clean/contaminated' surgery, with the remaining studies including people undergoing a variety of surgical procedures with different contamination classifications. Four trials compared wound dressings with no wound dressing (wound exposure); the remaining 25 studies compared alternative dressing types, with the majority comparing a basic wound contact dressing with film dressings, silver dressings or hydrocolloid dressings. The review contains 11 comparisons in total. PRIMARY OUTCOME SSIIt is uncertain whether wound exposure or any dressing reduces or increases the risk of SSI compared with alternative options investigated: we assessed the certainty of evidence as very low for most comparisons (and low for others), with downgrading (according to GRADE criteria) largely due to risk of bias and imprecision. We summarise the results of comparisons with meta-analysed data below:- film dressings compared with basic wound contact dressings following clean surgery (RR 1.34, 95% CI 0.70 to 2.55), very low certainty evidence downgraded once for risk of bias and twice for imprecision.- hydrocolloid dressings compared with basic wound contact dressings following clean surgery (RR 0.91, 95% CI 0.30 to 2.78), very low certainty evidence downgraded once for risk of bias and twice for imprecision.- hydrocolloid dressings compared with basic wound contact dressings following potentially contaminated surgery (RR 0.57, 95% CI 0.22 to 1.51), very low certainty evidence downgraded twice for risk of bias and twice for imprecision.- silver-containing dressings compared with basic wound contact dressings following clean surgery (RR 1.11, 95% CI 0.47 to 2.62), very low certainty evidence downgraded once for risk of bias and twice for imprecision.- silver-containing dressings compared with basic wound contact dressings following potentially contaminated surgery (RR 0.83, 95% CI 0.51 to 1.37), very low certainty evidence downgraded twice for risk of bias and twice for imprecision. Secondary outcomesThere was limited and low or very low certainty evidence on secondary outcomes such as scarring, acceptability of dressing and ease of removal, and uncertainty whether wound dressings influenced these outcomes. AUTHORS' CONCLUSIONS It is uncertain whether covering surgical wounds 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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Affiliation(s)
- Jo C Dumville
- University of ManchesterDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthManchesterUKM13 9PL
| | - Trish A Gray
- University of ManchesterDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthManchesterUKM13 9PL
| | - Catherine J Walter
- Gloucestershire NHS Foundation TrustColorectal SurgeryCheltenham GeneralSandford RoadCheltenhamUKGL53 7AN
| | - Catherine A Sharp
- The Wound CentrePO Box 3207BlakehurstSydneyNew South WalesAustralia2221
| | - Tamara Page
- Royal Adelaide HospitalLevel 4, Margaret Graham BuildingNorth TerraceAdelaideAustraliaSA5000
- University of AdelaideLevel 3, Eleanor Harrald BuildingNorth TerraceAdelaideAustraliaSA 5000
| | - Rhiannon Macefield
- University of BristolUniversity of Bristol, School of Social and Community MedicineCanynge Hall, 39 Whatley RoadBristolUKBS28 2PS
| | - Natalie Blencowe
- University of BristolUniversity of Bristol, School of Social and Community MedicineCanynge Hall, 39 Whatley RoadBristolUKBS28 2PS
| | - Thomas KG Milne
- University of BristolUniversity of Bristol, School of Social and Community MedicineCanynge Hall, 39 Whatley RoadBristolUKBS28 2PS
| | - Barnaby C Reeves
- University of BristolSchool of Clinical SciencesLevel 7, Bristol Royal InfirmaryMarlborough StreetBristolUKBS2 8HW
| | - Jane Blazeby
- University of BristolBristol Centre for Surgical Research, School of Social & Community MedicineCanynge Hall39 Whatley RoadBristolUKBS8 2PS
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Veiga DF, Damasceno CAV, Veiga-Filho J, Paiva LF, Fonseca FEM, Cabral IV, Pinto NLL, Juliano Y, Ferreira LM. Dressing Wear Time after Breast Reconstruction: A Randomized Clinical Trial. PLoS One 2016; 11:e0166356. [PMID: 27911904 PMCID: PMC5135046 DOI: 10.1371/journal.pone.0166356] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/23/2016] [Indexed: 11/25/2022] Open
Abstract
Background The evidence to support dressing standards for breast surgery wounds is empiric and scarce. Objective This two-arm randomized clinical trial was designed to assess the effect of dressing wear time on surgical site infection (SSI) rates, skin colonization and patient perceptions. Methods A total of 200 breast cancer patients undergoing breast reconstruction were prospectively enrolled. Patients were randomly allocated to group I (dressing removed on the first postoperative day, n = 100) or group II (dressing removed on the sixth postoperative day, n = 100). SSIs were defined and classified according to criteria from the Centers for Disease Control and Prevention. Samples collected before placing the dressing and after 1 day (group I) and 6 days (both groups) were cultured for skin colonization assessments. Patients preferences and perceptions with regard to safety, comfort and convenience were recorded and analyzed. Results A total of 186 patients completed the follow-up. The global SSI rate was 4.5%. Six patients in group I and three in group II had SSI (p = 0.497). Before dressing, the groups were similar with regard to skin colonization. At the sixth day, there was a higher colonization by coagulase-negative staphylococci in group I (p<0.0001). Patients preferred to keep dressing for six days (p<0.0001), and considered this a safer choice (p<0.05). Conclusions Despite group I had a higher skin colonization by coagulase-negative staphylococci on the sixth postoperative day, there was no difference in SSI rates. Patients preferred keeping dressing for six days and considered it a safer choice. Trial Registration ClinicalTrials.gov NCT01148823
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Affiliation(s)
- Daniela Francescato Veiga
- Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Division of Plastic Surgery, Department of Surgery, Universidade do Vale do Sapucaí, Pouso Alegre, Minas Gerais, Brazil
- * E-mail:
| | | | - Joel Veiga-Filho
- Division of Plastic Surgery, Department of Surgery, Universidade do Vale do Sapucaí, Pouso Alegre, Minas Gerais, Brazil
| | - Luiz Francisley Paiva
- Department of Microbiology, Universidade do Vale do Sapucaí, Pouso Alegre, Minas Gerais, Brazil
| | | | - Isaías Vieira Cabral
- Division of Plastic Surgery, Department of Surgery, Universidade do Vale do Sapucaí, Pouso Alegre, Minas Gerais, Brazil
| | - Natália Lana Larcher Pinto
- Division of Plastic Surgery, Department of Surgery, Universidade do Vale do Sapucaí, Pouso Alegre, Minas Gerais, Brazil
| | - Yara Juliano
- Department of Bioestatistics, Universidade do Vale do Sapucaí, Pouso Alegre, Minas Gerais, Brazil
- Department of Bioestatistics, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
| | - Lydia Masako Ferreira
- Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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Allegranzi B, Zayed B, Bischoff P, Kubilay NZ, de Jonge S, de Vries F, Gomes SM, Gans S, Wallert ED, Wu X, Abbas M, Boermeester MA, Dellinger EP, Egger M, Gastmeier P, Guirao X, Ren J, Pittet D, Solomkin JS. New WHO recommendations on intraoperative and postoperative measures for surgical site infection prevention: an evidence-based global perspective. THE LANCET. INFECTIOUS DISEASES 2016; 16:e288-e303. [PMID: 27816414 DOI: 10.1016/s1473-3099(16)30402-9] [Citation(s) in RCA: 476] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 08/28/2016] [Accepted: 09/13/2016] [Indexed: 12/11/2022]
Abstract
Surgical site infections (SSIs) are the most common health-care-associated infections in developing countries, but they also represent a substantial epidemiological burden in high-income countries. The prevention of these infections is complex and requires the integration of a range of preventive measures before, during, and after surgery. No international guidelines are available and inconsistencies in the interpretation of evidence and recommendations in national guidelines have been identified. Considering the prevention of SSIs as a priority for patient safety, WHO has developed evidence-based and expert consensus-based recommendations on the basis of an extensive list of preventive measures. We present in this Review 16 recommendations specific to the intraoperative and postoperative periods. The WHO recommendations were developed with a global perspective and they take into account the balance between benefits and harms, the evidence quality level, cost and resource use implications, and patient values and preferences.
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Affiliation(s)
- Benedetta Allegranzi
- Infection Prevention and Control Global Unit, Service Delivery and Safety, WHO, Geneva, Switzerland.
| | - Bassim Zayed
- Infection Prevention and Control Global Unit, Service Delivery and Safety, WHO, Geneva, Switzerland
| | - Peter Bischoff
- Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin, Germany
| | - N Zeynep Kubilay
- Infection Prevention and Control Global Unit, Service Delivery and Safety, WHO, Geneva, Switzerland
| | - Stijn de Jonge
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - Fleur de Vries
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | | | - Sarah Gans
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - Elon D Wallert
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | - Xiuwen Wu
- Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Mohamed Abbas
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marja A Boermeester
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, Netherlands
| | | | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin, Germany
| | | | - Jianan Ren
- Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Didier Pittet
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Joseph S Solomkin
- OASIS Global, Cincinnati, OH, USA; University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Andrew Glennie R, Dea N, Street JT. Dressings and drains in posterior spine surgery and their effect on wound complications. J Clin Neurosci 2015; 22:1081-7. [PMID: 25818940 DOI: 10.1016/j.jocn.2015.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 01/24/2015] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to systematically search, critically appraise and summarize published randomized control trials (RCT) and non-RCT examining the effect of drains and dressings on wound healing rates and complications in posterior spine surgery. The use of post-operative drains and the type of post-operative dressing is at the discretion of the treating surgeon with no available clinical guidelines. Drains will theoretically decrease incidence of post-operative hematoma and therefore, potentially decrease the risk of neurologic compromise when the neural elements have been exposed. Occlusive dressings have more recently been advocated, potentially maintaining a sterile barrier for longer time periods post-operatively. A systematic review of databases from 1969-2013 was undertaken. All papers examining drains in spine surgery and dressings in primary healing of surgical wounds were included. Revman (version 5.2; The Nordic Cochrane Centre, The Cochrane Collaboration, Oxford, UK) was used to test for overall treatment effect, clinical heterogeneity and risk of bias. Of the papers identified, 1348 examined post-operative drains in spine surgery and 979 wound dressings for primary wound healing of all surgical wounds. Seven studies were included for analysis for post-operative drains and 10 studies were analyzed for primary wound healing. The use of a post-operative drain did not influence healing rates and had no effect secondarily on infection (odds ratio [OR] 1.33; 95% confidence interval [CI] 0.76-2.30). We were not able to establish whether surgical drains prevent hematomas causing neurologic compromise. There was a slight advantage to using occlusive dressings versus non-occlusive dressings in wound healing (OR 2.09; 95% CI 1.44-3.02). Incisional vacuum dressings as both an occlusive barrier and superficial drainage system have shown promise for wounds at risk of dehiscence. There is a relatively high risk of bias in the methodology of many of the studies reviewed. We recommend favoring of occlusive dressings based on heterogeneous and potentially biased evidence. Drain use does not affect wound healing based on similar evidence. Incisional vacuum dressings have shown promise in managing potentially vulnerable wounds.
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Affiliation(s)
- R Andrew Glennie
- Dalhousie University, 1798 Summer Street, Halifax, Nova Scotia B3H 3A7, Canada; Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, BC, Canada.
| | - Nicolas Dea
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, BC, Canada
| | - John T Street
- Combined Neurosurgical and Orthopedic Spine Program, University of British Columbia, Vancouver, BC, Canada
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Gorj M, Revol M. Les rituels en chirurgie : quels fondements scientifiques ? ANN CHIR PLAST ESTH 2015; 60:3-11. [DOI: 10.1016/j.anplas.2014.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
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Dumville JC, Gray TA, Walter CJ, Sharp CA, Page T. Dressings for the prevention of surgical site infection. Cochrane Database Syst Rev 2014:CD003091. [PMID: 25178020 DOI: 10.1002/14651858.cd003091.pub3] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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 assess the effects of wound dressings for preventing SSI in people with surgical wounds healing by primary intention. SEARCH METHODS In February 2014 we searched: The Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); The Database of Abstracts of Reviews of Effects (DARE) (The Cochrane Library); The Health Technology Assessment Database (HTA) (The Cochrane Library); NHS Economic Evaluation Database (NHSEED) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. There were no restrictions based on language or date of publication or study setting. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing alternative wound dressings or wound dressing with no dressing (wound exposure) for the 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 Twenty RCTs were included (3623 participants). All trials were at unclear or high risk of bias. Twelve 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 18 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 primary intention. AUTHORS' CONCLUSIONS At present, there is insufficient evidence as to whether covering surgical wounds 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 rates of SSI, improving scarring, pain control, patient acceptability or ease of dressing removal. Most trials in this review were small and 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.
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Affiliation(s)
- Jo C Dumville
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK, M13 9PL
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Uçkay I, Hoffmeyer P, Lew D, Pittet D. Prevention of surgical site infections in orthopaedic surgery and bone trauma: state-of-the-art update. J Hosp Infect 2013; 84:5-12. [DOI: 10.1016/j.jhin.2012.12.014] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 12/31/2012] [Indexed: 01/05/2023]
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Veiga DF, Veiga-Filho J, Damasceno CAV, Sales EML, Morais TB, Almeida WE, Novo NF, Ferreira LM. Dressing wear time after breast reconstruction: study protocol for a randomized controlled trial. Trials 2013; 14:58. [PMID: 23432779 PMCID: PMC3604956 DOI: 10.1186/1745-6215-14-58] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 02/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One of the major risk variables for surgical site infection is wound management. Understanding infection risk factors for breast operations is essential in order to develop infection-prevention strategies and improve surgical outcomes. The aim of this trial is to assess the influence of dressing wear time on surgical site infection rates and skin colonization. Patients' perception at self-assessment will also be analyzed. METHODS/DESIGN This is a two-arm randomized controlled trial. Two hundred breast cancer patients undergoing immediate or delayed breast reconstruction will be prospectively enrolled. Patients will be randomly allocated to group I (dressing removed on postoperative day one) or group II (dressing removed on postoperative day six). Surgical site infections will be defined by standard criteria from the Centers for Disease Control and Prevention (CDC). Skin colonization will be assessed by culture of samples collected at predefined time points. Patients will score dressing wear time with regard to safety, comfort and convenience. DISCUSSION The evidence to support dressing standards for breast surgery wounds is empiric and scarce. CDC recommends protecting, with a sterile dressing for 24 to 48 hours postoperatively, a primarily closed incision, but there is no recommendation to cover this kind of incision beyond 48 hours, or on the appropriate time to shower or bathe with an uncovered incision. The results of the ongoing trial may support standard recommendations regarding dressing wear time after breast reconstruction. TRIAL REGISTRATION ClinicalTrials.gov identifier: http://NCT01148823.
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Affiliation(s)
- Daniela Francescato Veiga
- Division of Plastic Surgery, Department of Surgery, Universidade Federal de São Paulo, São Paulo, Brazil.
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Nadir A, Kaptanoglu M, Sahin E, Sarzep H. Post-thoracotomy wound separation (DEHISCENCE): a disturbing complication. Clinics (Sao Paulo) 2013; 68:1-4. [PMID: 23420149 PMCID: PMC3552452 DOI: 10.6061/clinics/2013(01)oa01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Accepted: 07/05/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We described the treatment of dehiscence of thoracotomy incisions in patients who underwent thoracic surgery in the present study. METHODS Twenty-four patients with either partial or complete dehiscence of their thoracotomy incisions were included in the study from 2005 to 2010. The patients were evaluated regarding their age, sex, indication for thoracotomy, and surgical approaches. We also described our method of re-closure. RESULTS The male/female ratio was 17/7. The youngest and oldest patients were 15 and 75 years old, respectively, and the mean age was 43 years. Among the indications for thoracotomy, empyema was the most common reason (determined in eight [33%] patients), followed by vertebral surgery (determined in six [25%] patients). Bacterial growth was detected in the wound site cultures from 13 (54%) patients. For the patients with dehiscence of their thoracotomy incisions, an en block approximation technique with debridement was performed under general or local anesthesia in 16 (66%) and eight (33%) of the cases, respectively. Three patients exhibited an open thorax with dehiscence of the thoracotomy incision. Thoracoplasty was required in two patients. Using this method, successful closure was obtained in 91.7% (n = 22) of the patients with dehiscence of their thoracotomy incisions. CONCLUSION Dehiscence of the thoracotomy incision is an important complication that causes concern in patients and their thoracic surgeons and strongly affects the success of the surgery. An en block approximation technique with significant debridement that enables removal of the necrotic tissues from the wound site can successfully be applied to patients with dehiscence of their thoracotomy incisions.
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Affiliation(s)
- Aydin Nadir
- Cumhuriyet University, School of Medicine Sivas, Department of Thoracic Surgery, Sivas/Turkey.
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Walter CJ, Dumville JC, Sharp CA, Page T. Systematic review and meta-analysis of wound dressings in the prevention of surgical-site infections in surgical wounds healing by primary intention. Br J Surg 2012; 99:1185-94. [PMID: 22777875 DOI: 10.1002/bjs.8812] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Postoperative surgical-site infections are a major source of morbidity and cost. This study aimed to identify and present all randomized controlled trial evidence evaluating the effects of dressings on surgical-site infection rates in surgical wounds healing by primary intention; the secondary outcomes included comparisons of pain, scar and acceptability between dressings. METHODS Randomized controlled trials comparing alternative wound dressings, or wound dressings with leaving wounds exposed for postoperative management of surgical wounds were included in the review regardless of their language. Databases searched included the Cochrane Wounds Group Specialised Register and Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase and EBSCO CINAHL from inception to May 2011. Two authors performed study selection, risk of bias assessment and data extraction, including an assessment of surgical contamination according to the surgical procedure. Where levels of clinical and statistical heterogeneity permitted, data were pooled for meta-analysis. RESULTS Sixteen controlled trials with 2594 participants examining a range of wound contamination levels were included. They were all unclear or at high risk of bias. There was no evidence that any dressing significantly reduced surgical-site infection rates compared with any other dressing or leaving the wound exposed. Furthermore, no significant differences in pain, scarring or acceptability were seen between the dressings. CONCLUSION No difference in surgical-site infection rates was demonstrated between surgical wounds covered with different dressings and those left uncovered. No difference was seen in pain, scar or acceptability between dressings.
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Affiliation(s)
- C J Walter
- Department of Colorectal Surgery, Division of Gastrointestinal Surgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
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Arıcan M, Hatipoglu F, Uyaroglu A, Ozdemir O, Ozkan K. Effect of Acticoat(®) and Cutinova Hydro(®) on wound healing. Int Wound J 2012; 10:549-54. [PMID: 22682153 DOI: 10.1111/j.1742-481x.2012.01021.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In this study, the effects of the wound-covering materials, Acticoat(®) and Cutinova Hydro(®) , on wound healing have been studied in rabbit models with open and tissue-lost wounds with full-thickness flank excisions. Rabbits were used as subjects with three groups of four rabbits each, and trial periods of 7, 14 and 21{\uns}days. Four circular wounds, of 1.5 cm diameter were made two on the right (one of them control) and two on the left (one of them control) of the dorsal sides of the abdomen. Acticoat(®) and Cutinova Hydro(®) were applied on the wounds with suture for a period of 21 days and one each placed on the right and left sides as control with gauze. Biopsy specimens were taken from the animals at the end of the research period to check the length of the epithelium, epithelial thickness, size of wounds, wound granulation tissue formation and histopathological evaluation for clarity. The Acticoat(®) group showed better healing and scar formation compared to the Cutinova Hydro(®) group by macroscopic examination. Epithelial wound length and clarity in terms of statistical difference occurred on day 21 (P <0.05); while the length of the wound epithelium decreased patency, epithelial thickness on days~7, 14 and 21, showed no statistical differences (P >0.05). As a result, the Acticoat(®) wound dressing was determined as a more reliable for the early wound healing. This study has shown the short-term clinical benefits of hydroactive, polyurethane dressings in the management of acute wounds. However, longer periods of wound healing procedure should be planned for reliable and safe results of wound dressing. It has also been concluded that microbiological analyses should be included for more robust and reliable comparisons.
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Affiliation(s)
- Mustafa Arıcan
- Department of Surgery, Faculty of Veterinary Science, The University of Selcuk, Konya, Turkey
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Zhou HB, Wu Y, Wang LQ, Zou SL, Qiao YZ, Wang LX. Feasibility and safety of early removal of incisional dressings following thoracic surgery. Med Princ Pract 2012; 21:379-82. [PMID: 22327773 DOI: 10.1159/000335987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 12/08/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the feasibility and safety of early dressing removal of clean wounds following thoracotomy. SUBJECTS AND METHODS A total of 230 patients (127 males, mean age 55.6 ± 16.7 years) were randomly divided into study and control groups. In the study group the cotton gauze dressing was removed 48 h after the surgery, whereas in the control group the dressing was kept on for 7-8 days until the removal of skin sutures. The infection and healing of the wounds were examined, and patients were followed up for 30 days. RESULTS There was no statistically significant difference in age, sex, smoking rates, concurrent illnesses and operational characteristics between the study and control groups (p > 0.05). The wound infection rate in the study and control groups was 6 (5.2%) and 7 patients (6.1%), respectively (p = 0.775). Two patients (1.7%) from the study group and 1 (0.9%, p = 0.561) from the control group had partial wound approximation by day 7. Surrounding skin integrity was normal in 106 (92.2%) of the study group and 107 (93.0%) of the control group patients by postoperative day 7 (p = 0.801). CONCLUSION Removal of wound dressing 48 h after thoracic surgery was not associated with an increased risk of surgical site infection. Hence the early removal of wound dressing did not appear to have an adverse impact on wound healing.
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Affiliation(s)
- Hai-Bin Zhou
- Department of Thoracic Medicine, Liaocheng People's Hospital and Liaocheng Clinical School of Taishan Medical University, Liaocheng, PR China
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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.
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Affiliation(s)
- Jo C Dumville
- Department of Health Sciences, University of York, York, UK, YO10 5DD
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Uçkay I, Agostinho A, Belaieff W, Toutous-Trellu L, Scherer-Pietramaggiori S, Andres A, Bernard L, Vuagnat H, Hoffmeyer P, Wyssa B. Noninfectious Wound Complications in Clean Surgery: Epidemiology, Risk Factors, and Association with Antibiotic Use. World J Surg 2011; 35:973-80. [DOI: 10.1007/s00268-011-0993-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Uçkay I, Harbarth S, Peter R, Lew D, Hoffmeyer P, Pittet D. Preventing surgical site infections. Expert Rev Anti Infect Ther 2010; 8:657-70. [PMID: 20521894 DOI: 10.1586/eri.10.41] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
The risk of surgical site infection (SSI) is approximately 1-3% for elective clean surgery. Apart from patient endogenous factors, the role of external risk factors in the pathogenesis of SSI is well recognized. However, among the many measures to prevent SSI, only some are based on strong evidence, for example, adequate perioperative administration of prophylactic antibiotics, and there is insufficient evidence to show whether one method is superior to any other. This highlights the need for a multimodal approach involving active post-discharge surveillance, as well as measures at every step of the care process, ranging from the operating theater to postoperative care. Multicenter or supranational intervention programs based on evidence-based guidelines, 'bundles' or safety checklists are likely to be beneficial on a global scale. Although theoretically reducible to zero, the maximal realistic extent by which SSI can be decreased remains unknown.
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Affiliation(s)
- Ilker Uçkay
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
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Bavnbek K, Ahsan SY, Sanders J, Lee SF, Chow AW. Wound management and restrictive arm movement following cardiac device implantation - evidence for practice? Eur J Cardiovasc Nurs 2010; 9:85-91. [PMID: 20075006 DOI: 10.1016/j.ejcnurse.2009.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2009] [Revised: 11/21/2009] [Accepted: 11/23/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND The rate of cardiac device implantation has risen significantly secondary to an increase in the number of indications. Wound infection and lead displacement are two common and potentially life-threatening complications. No national/international guidelines address postoperative care and controversy exists regarding wound management and arm movement following cardiac device implantation. AIMS We aimed to explore and review the evidence behind current practice but found that certain aspects of established practice. METHODS An electronic search of the databases EMBASE, British Nursing Index, CINAHL, Cochrane and PubMed to identify evidence regarding wound management and lead displacement. FINDINGS We found that certain aspects of established practice are based on tradition rather than evidence. Recent guidelines on wound management published by The National Institute for Health and Clinical Excellence in the UK recommend covering the wound postoperatively for 48 h with a low-adherent transparent dressing and letting patients shower thereafter. Since specific guidelines for cardiac device patients are lacking, we suggest that further research address whether or not the NICE guidelines can be extrapolated to this area. Studies showed that early mobilisation and allowing a full range of arm movements following device implantation is safe. Further research must validate these findings. CONCLUSION We discuss the reasons behind these gaps in the evidence base and support the idea that nursing education has not placed enough emphasis on how to critically appraise research. This accounts for the very small proportion of nurses that get involved in conducting research and generating guidelines. Additionally, we argue that nurses can play a key role in identifying and addressing research questions that lead to improved patient outcome. Thus, we support proposals to enhance nurses' opportunities to pursue academic careers to achieve adequate research skills.
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Affiliation(s)
- Katrine Bavnbek
- The Heart Hospital, University College London Hospitals, UK.
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Teshima H, Kawano H, Kashikie H, Nakamura K, Imada T, Oda T, Aoyagi S. A new hydrocolloid dressing prevents surgical site infection of median sternotomy wounds. Surg Today 2009; 39:848-54. [PMID: 19784722 DOI: 10.1007/s00595-008-3974-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 08/06/2008] [Indexed: 10/20/2022]
Abstract
PURPOSE This prospective and semi-randomized study was conducted to clarify the effectiveness of a new hydrocolloid dressing placed over median sternotomy wounds using an occlusive dressing technique. METHODS The subjects were 253 patients undergoing coronary artery bypass grafting (CABG), who were randomized to receive either the new hydrocolloid dressing (Karayahesive, n = 117) or a polyurethane foam dressing (Tegaderm plus Pad, n = 136) immediately after sternal wound closure. Karayahesive was left in place for 7 days, whereas the Tegaderm plus Pad was removed on postoperative day (POD) 2 and replaced with an adhesive wound dressing until POD 7. RESULTS In the Karayahesive group, complete integrity of the wound was achieved in 91% of the patients, with an infection developing in 3.4%: as a superficial surgical site infection (SSI) in three and as a deep SSI in one. On the other hand, in the Tegaderm plus Pad group, an infection developed in 10.3% (14 patients) of the patients: as a superficial SSI in nine and as a deep SSI in five (P < 0.05). The total treatment costs from the application of the dressing until completion of treatment was 699 yen for the Karayahesive and 910 yen for the Tegaderm plus Pad (P < 0.001). CONCLUSIONS The new hydrocolloid dressing, applied with an occlusive dressing technique to median sternotomy wounds, prevented SSI and was cost effective.
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Affiliation(s)
- Hideki Teshima
- Department of Cardiovascular Surgery, Omura Municipal Hospital, Cardiovascular Center, Nagasaki, Japan
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Kim SE, Heo DN, Lee JB, Kim JR, Park SH, Jeon SH, Kwon IK. Electrospun gelatin/polyurethane blended nanofibers for wound healing. Biomed Mater 2009; 4:044106. [DOI: 10.1088/1748-6041/4/4/044106] [Citation(s) in RCA: 190] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Lämås K, Willman A, Lindholm L, Jacobsson C. Economic evaluation of nursing practices: a review of literature. Int Nurs Rev 2009; 56:13-20. [PMID: 19239511 DOI: 10.1111/j.1466-7657.2008.00672.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The importance of cost-effectiveness of nursing practices and its influence on prioritizations has been discussed in literature. It is, however, unclear to what extent health economic analysis has been used in the area of nursing. AIM The aim of this paper was to investigate how studies of nursing practices apply economic evaluations. METHODS A literature review was conducted that included studies through August 2007. The search was performed using Medline, CINAHL, PsycINFO, Econlit, DARE, HTA, NHS EED, Cochrane reviews and clinical trials with a search term connected to nursing and health economics. Protocols were used in the screening procedure and the result is reported in a descriptive form. RESULTS The search identified 115 studies published between 1984 and August 2007. Studies were found in the following nursing practices: provision of support and treatment (n = 17); assessing suffering/well-being (n = 1); preventing or treating ill health (n = 53); and organization of individual care (n = 44). In 22% of all studies, the authors explicitly presented the health economic method used. In 25% of all studies, the perspective of the economic analysis was explicitly stated and a large variability in cost was considered in the analysis. In 82 studies, the authors reported cost-effective intervention. CONCLUSIONS Although economic evaluation of nursing practice has increased, it is still a rather small area. According to the items elucidated in this study, further methodological improvement is needed to evaluate the economics of nursing.
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Affiliation(s)
- K Lämås
- Department of Nursing, Umeå University, Umeå, Sweden.
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Thomas S. Hydrocolloid dressings in the management of acute wounds: a review of the literature. Int Wound J 2009; 5:602-13. [PMID: 19134061 DOI: 10.1111/j.1742-481x.2008.00541.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A review of the literature suggests that the application of self-adhesive hydrocolloid dressings, most commonly associated with the treatment of ulcerative conditions such as pressure ulcers and leg ulcers, may also offer benefits in the management of acute wounds of all types, for example decreasing healing times of donor sites by about 40% compared with traditional treatments. Healing times of superficial traumatic injuries and surgical wounds are similarly enhanced but in the treatment of burns, the principal benefit appears to be a reduction in wound pain, an effect that has also been reported in virtually all other wound types. The impermeable nature of hydrocolloids provides a protective covering to the wound, permitting washing or showering while helping to prevent the spread of pathogenic microorganisms. There also appear to be significant cost-benefits associated with the use of hydrocolloids. In recent years, hydrocolloid dressings have been replaced by other products such as foams for the treatment of more heavily exuding wounds but for more lightly exuding wounds they still offer many practical advantages and as such will undoubtedly continue to meet an important need in wound management practice.
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Abstract
This six-part research series is aimed at clinicians who wish to develop research skills, or who have a particular clinical problem that they think could be addressed through research. The series aims to provide insight into the decisions that researchers make in the course of their work, and to also provide a foundation for decisions that nurses may make in applying the findings of a study to practice in their own Unit or Department. The series emphasises the practical issues encountered when undertaking research in critical care settings; readers are encouraged to source research methodology textbooks for more detailed guidance on specific aspects of the research process.
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Affiliation(s)
- Mari Botti
- Deakin University, Burwood, Victoria 3125, Australia.
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Shinohara T, Yamashita Y, Satoh K, Mikami K, Yamauchi Y, Hoshino S, Noritomi A, Maekawa T. Prospective Evaluation of Occlusive Hydrocolloid Dressing Versus Conventional Gauze Dressing Regarding the Healing Effect After Abdominal Operations: Randomized Controlled Trial. Asian J Surg 2008; 31:1-5. [DOI: 10.1016/s1015-9584(08)60046-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Vogt KC, Uhlyarik M, Schroeder TV. Moist wound healing compared with standard care of treatment of primary closed vascular surgical wounds: A prospective randomized controlled study. Wound Repair Regen 2007; 15:624-7. [DOI: 10.1111/j.1524-475x.2007.00294.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Fleck T, Moidl R, Blacky A, Fleck M, Wolner E, Grabenwoger M, Wisser W. Triclosan-coated sutures for the reduction of sternal wound infections: economic considerations. Ann Thorac Surg 2007; 84:232-6. [PMID: 17588420 DOI: 10.1016/j.athoracsur.2007.03.045] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2006] [Revised: 03/10/2007] [Accepted: 03/19/2007] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sternal wound infections are a major complication after cardiac surgery in terms of morbidity and cost increase. To decrease the incidence of infection, we evaluated triclosan-coated sutures for the closure of the sternal incision, as it is known that most of the surgical site infections are related to the incision site. METHODS From May to December 2005, a total of 479 patients underwent a cardiac surgical procedure. From those, 103 patients were closed with triclosan-coated suture material (cost per patient $30 [in United States dollars]), whereas the remaining 376 patients had their incision closed with noncoated sutures (cost per patient $21). RESULTS During the study period, 24 patients had superficial (n = 10) or deep (n = 14) sternal wound infections (cost per patient $11,200). All those patients were closed with conventional suture material. In the triclosan group, no wound infection or dehiscence was observed during hospital stay and follow-up visits. CONCLUSIONS Triclosan-coated sutures might be valuable in the reduction of sternal wound infections and avoid the suture being a risk factor for surgical site infections. The increased cost of the coated suture material has to be weighed against the enormous cost of sternal wound infections caused directly by the cost of care as well as indirectly through the loss of economic productivity.
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Affiliation(s)
- Tatjana Fleck
- Department of Cardiothoracic Surgery, AKH Vienna, Medical University of Vienna, Vienna, Austria.
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Segers P, de Jong AP, Spanjaard L, Ubbink DT, de Mol BAJM. Randomized clinical trial comparing two options for postoperative incisional care to prevent poststernotomy surgical site infections. Wound Repair Regen 2007; 15:192-6. [PMID: 17352750 DOI: 10.1111/j.1524-475x.2007.00204.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Surgical site infection (SSI) remains an important complication of cardiac surgery. Prevention is important, as SSI is associated with high mortality and morbidity rates. Incisional care is an important daily issue for surgeons. However, there is still scant scientific evidence on which guidelines can be based. A randomized clinical trial was performed to compare two options for postoperative incisional care. Patients undergoing sternotomy for cardiothoracic surgery were eligible. To protect an incision from exogenous contamination or direct inoculation by endogenous pathogens, the study group received an adhesive drape, impermeable to water and air. The control group was treated with a water- and air-permeable absorbent dressing. Primary outcome measure was SSI. Between March 2003 and January 2005, 1,185 patients were included. Both groups were comparable for base-line characteristics. No significant difference was found in the incidence of sternal SSI between groups (2.6 vs. 3.3%). In our study, an incisional-care program using a sterile, impermeable adhesive drape did not perform better than an absorbent dressing in reducing SSI after cardiothoracic surgery. In our view, future studies in the field of prevention of SSI should concentrate on other areas of interest.
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Affiliation(s)
- Patrique Segers
- Department of Cardiothoracic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
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Streeter NB. Considerations in prevention of surgical site infections following cardiac surgery: when your patient is diabetic. J Cardiovasc Nurs 2006; 21:E14-20. [PMID: 16699351 DOI: 10.1097/00005082-200605000-00014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The incidence of surgical site infections among patients with diabetes continues to occur at a greater rate when compared with their nondiabetic counterparts. Preexisting vascular changes, delayed wound healing, and impaired immune factors contribute. Adult patients with diabetes likely possess comorbid coronary artery disease, thus increasing the need for cardiac surgery. The resultant potential for infection can be combated with supplementary interventions above those universally taken. Modifiable risk factors of hyperglycemia and obesity are targeted preoperatively. Glycemic control, adequate tissue perfusion, and adjunct use of nasal mupirocin are addressed intraoperatively. Lastly, focus is placed on nutrition, exercise, and continued glucose control postoperatively and beyond discharge.
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Mansha M, Sharif K, Sharif Z, Kashif FA, Diggory P. The impact of different methods of wound closure and dressing on the rate of wound infection in patients with fracture of the neck of femur. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.joon.2005.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Botti M, Endacott R. Clinical research 5: Quantitative data collection and analysis. Intensive Crit Care Nurs 2005; 21:187-93. [PMID: 15896961 DOI: 10.1016/j.iccn.2005.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Accepted: 02/25/2005] [Indexed: 11/29/2022]
Abstract
This six-part research series is aimed at clinicians who wish to develop research skills, or who have a particular clinical problem that they think could be addressed through research. The series aims to provide insight into the decisions that researchers make in the course of their work, and to also provide a foundation for decisions that nurses may make in applying the findings of a study to practice in their own Unit or Department. The series emphasises the practical issues encountered when undertaking research in critical care settings; readers are encouraged to source research methodology textbooks for more detailed guidance on specific aspects of the research process. A couple of points: 1. It is artificial to describe research as qualitative or quantitative. Studies often include both dimensions. However, for the purposes of this paper/series, this distinction is drawn for clarity of writing. 2. It is common practice for quantitative studies to refer to study 'subjects' and qualitative studies to refer to study 'participants'. For ease of reading, the latter term will be used throughout this series
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Affiliation(s)
- Mari Botti
- Epworth Hospital/Deakin University Clinical Nursing Research Centre, The Epworth Hospital, Melbourne, Australia.
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A randomized clinical trial comparing hydrocolloid, phenytoin and simple dressings for the treatment of pressure ulcers [ISRCTN33429693]. BMC DERMATOLOGY 2004; 4:18. [PMID: 15601464 PMCID: PMC545970 DOI: 10.1186/1471-5945-4-18] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2003] [Accepted: 12/15/2004] [Indexed: 12/11/2022]
Abstract
Background Pressure sores are important and common complications of spinal cord injury. Many preventive and therapeutic approaches have been tried and new trials are evolving. One relatively recent method is application of a hydrocolloid dressing (HD). In this study we compared the therapeutic effects of HD on pressure ulcer healing with two other topical applications, phenytoin cream (PC) and simple dressing (SD). Methods Ninety-one stage I and stage II pressure ulcers of 83 paraplegic male victims of the Iran-Iraq war were randomly allocated to three treatment groups. Mean age and weight of the participants were 36.64 ± 6.04 years and 61.12 ± 5.08 kg, respectively. All the patients were managed in long term care units or in their homes for 8 weeks by a team of general practitioners and nurses, and the ulcer status was recorded as "Complete healing", "Partial healing", "Without improvement" and "Worsening". Results Complete healing of ulcers, regardless of location and stage, was better in the HD group than the PC [23/31(74.19%) vs 12/30(40%); difference: 34.19%, 95% CI = 10.85–57.52, (P < 0.01)] or the SD [23/31(74.19%) vs 8/30(26.66%); difference: 47.53%, 95% CI = 25.45–69.61, (P < 0.005)] groups. Complete healing of stage I ulcers in the HD group [11/13(85%)] was better than in the SD [5/11(45%); difference: 40%, 95% CI = 4.7–75.22, (P < 0.05)] or PC [2/9 (22%); difference: 63%, 95% CI = 29.69–96.3, (P < 0.005)] groups. Complete healing of stage II ulcer in the HD group [12/18 (67%)] was better than in the SD group [3/19(16%); difference: 51%, 95% CI = 23.73–78.26, (P < 0.005)], but not significantly different from the PC group [10/21 (48%); difference: 19%, 95% CI = -11.47–49.47, (P > 0.05)]. We performed a second analysis considering only one ulcer per patient (i.e. 83 ulcers in 83 patients). This "per patient" analysis showed that complete ulcer healing in the HD group was better than in the PC [20/28(71.4%) vs 11/28 (39.3%); difference: 32.1%, 95% CI = 7.4–56.7, (P < 0.01)] or SD [20/28(71.4%) vs 8/27 (29.6%); difference: 41.8%, 95% CI = 17.7–65.8, (P < 0.005)] groups. Conclusion We deduced that HD is the most effective method investigated for treating stage I and II pressure ulcers in young paraplegic men.
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