NO Evidence to Suggest that Dressing of Wounds is Better than NO Dressing in Preventing Infection

The verdict is out!

no evidence to suggest either that one dressing type was better than any other, or that covering these wounds with dressings at all was better, at preventing surgical site infection, or that any dressing type improves scarring, pain control, patient acceptability or ease of removal.

Dumville JC, Walter CJ, Sharp CA, Page T. Dressings for the prevention of surgical site infection. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD003091. DOI: 10.1002/14651858.CD003091.pub2

http://summaries.cochrane.org/CD003091/no-recommendations-regarding-type-of-wound-dressing-for-the-prevention-of-surgical-site-infection

Millions of surgical procedures are conducted globally each year. The majority of procedures result in wounds in which the edges are brought together to heal using stitches, staples, clips or glue – this is called ‘healing by primary intention’. Afterwards, wounds are often covered with a dressing that acts as a barrier between them and the outside environment. One advantage of this may be to protect the wound from micro-organisms, and thus infection. Many different dressing types are available for use on surgical wounds, however, it is not clear whether one type of dressing is better than any other at preventing surgical site infection, or, indeed, whether it is better not to use a dressing at all. We conducted a review of all available, relevant, evidence regarding the impact of dressings on the prevention of surgical site infections in surgical wounds healing by primary intention. The review examined data from 16 randomised controlled trials and found no evidence to suggest either that one dressing type was better than any other, or that covering these wounds with dressings at all was better, at preventing surgical site infection, or that any dressing type improves scarring, pain control, patient acceptability or ease of removal. It is important to note that many trials in this review were small and of poor quality, at high or unclear risk of bias. Decisions on wound dressing should be based on dressing costs and the need for management of specific symptoms e.g., absorption of exudate.

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.

This record should be cited as:

Dumville JC, Walter CJ, Sharp CA, Page T. Dressings for the prevention of surgical site infection. Cochrane Database of Systematic Reviews 2011, Issue 7. Art. No.: CD003091. DOI: 10.1002/14651858.CD003091.pub2

Published Online:  July 6, 2011

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ROJoson’s Recommendations (I have been practicing these for more than 30 years now):

  1. NO need for dressing of surgical wounds when the latter are dry already.   Just keep them clean with regular and frequent cleaning with soap and water and wearing clean clothes.  Note: Wounds can be wet.
  2. Place dressing only when the wounds are not dry and with discharges or exudates.
  3. Beware of the potential complications of plasters, namely, allergy and blister formation.
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