Use of an antimicrobial barrier foam dressing for the management of surgical incisions

INTRODUCTION

A surgical site infection is defined as an infection within 30 days of a surgical procedure or within one year if there is an implant.  An infection contributes to increased length of stay, readmission and increased cost of healthcare.   It is also associated with increased morbidity and mortality.  The risk of an infection may continue after the patient is discharged.  Facilities in California are required to report HAI to the National Healthcare Safety Network (NHSN).

 METHOD

A study was initiated to identify if outcome measures currently in place to manage surgical incisions were adequate.  Orthopedic, hip and knee implants and general surgery cases were monitored by wound class, ASA score, and cut time.  The wound was closed by primary intention with sutures or staples.  

The surgical bundle to minimize or eliminate a surgical site infection, included appropriate antibiotic with timely administration, staff hand hygiene, and adequate patient skin cleansing to reduce microbe colonization. 

To manage the surgical incision post operatively, a silver impregnated foam centered on a transparent film dressing was placed over the incision by the surgeon.   The silver antimicrobial foam dressing was left in place for up to 7 days, depending on the amount of drainage.  The clear film dressing allowed visualization and monitoring for erythema, edema and drainage without contaminating the surgical site. 

RESULTS

Initial dressing change was 7 days post op.  Six surgical sites were monitored for 30 days.  Five orthopedic cases received a second dressing for 7 additional days.  Primary outcome was infection free post-op course.  Secondary outcome permitted the patient to shower without affecting the dressing.  No patients required prolonged hospital stay or readmission. 

CONCLUSIONS

All steps in the surgical bundle were in place.  The addition of the silver antimicrobial barrier dressing provided protection for the wound.  No infections reported to NHSN.