Changing wound care protocols to reduce post-operative Caesarean section complications

Objectives:  To evaluate a single use negative pressure wound therapy (SUNPWT) system and a post-op visible (POV) dressing for use on at risk (BMI = 30-53) patients for C-section SSIs.

Methodology: SUNPWT was applied in theatre immediately following the operation and was left in situ for one week only. Midwives had undergone wound management training and education on the application and management of the SUNPWT system. A total of 50 patients were recruited for the evaluation, 25 elective and 25 emergency surgery patients. The evaluation was over a twelve month period. The age range was 18-42 years, mean age of 31. Post-discharge surveillance was completed and patients were monitored for 30 days post-operatively. Infections were confirmed with both clinical observation and microbiological investigation.

 

Key results:  The infection rate prior to the evaluation of the SUNPWT system and the POV dressing was 12% for six months. Following the change in practice and the introduction SUNPWT and the POV dressing, the infection rate was 6%. This would suggest an average reduction of 50%, which could result in significant cost savings and improve wellbeing for a number of patients.

Conclusion: This study demonstrates that using negative pressure on closed incisions in high risk

patients can potentially reduce wound complications, readmission rates and may reduce the overall incidence of wound breakdown in this vulnerable patient group. In addition, the positive impact on the patient and families’ wellbeing during a very important time in their lives cannot be ignored. Based on this evidence and to aid optimal wound healing, POV dressings are now left in situ for a minimum of seven days on all uncomplicated cases. For patients with BMI >35, SUNPWT is used as the standard post-operative dressing, and is left in situ for one week.