The Coming of Age of the Antimicrobial Post-Op Dressing?

Authors:  Gerald L. Klein, MD & Peter C. Johnson, MD

Post-operative home care has become more important than ever.  The use of an antimicrobial dressing in this setting is often essential to an uncomplicated recovery.  Previously, tape and gauze may have sufficed for most incisions and antimicrobial dressings were reserved for those incisions at the highest risk of infection.  However, the earlier discharge of surgical patients puts them at increased risk of acquiring a post-op surgical infection, which is most likely to occur 24-48 hours after surgery.  Increasingly, proper home management of wounds is critical to prevent infections.

As patients become more responsible for their wound care and adherence to follow up instructions becomes more critical, the following questions pertain: “What best post-operative practices reduce the risk of an infection?”  Furthermore, what options exist that empower the patient to be a good partner in their post-op care and recovery?

Dressing Features That Enable the Patient: Non-Invasive, Observational Wound Management

Educated patients with the resources to follow their discharge instructions are more likely to experience a positive outcome than those without.  Once home, the onus is on them to manage the care of their own surgery site.  So, what should the dressing provide to help them be a good partner in their care?

·       The dressing should contain an appropriate concentration of a broad-spectrum antimicrobial to prevent microbial growth at the patient-dressing interface.

·       The dressing should be thin and be attached with an adhesive that can withstand at least a week of wear time without being irritating. 

  • This obviates the need for dressing changes, saves time, cost, decreases skin irritation and reduces the potential for the new introduction of microbes.

·       The filmic portion of the dressing should allow for gas transfer without allowing microbial or fluid entry.

·       The dressing adhesive and film should be sufficiently pliant to conform to irregular wound shapes to form a seal with the skin.

·       The dressing should be transparent to enable both patient and physician to observe the incision for signs of inflammation and/or drainage.

If these criteria are met, the patient is provided with convenient and comfortable post-operative wound care.  Moreover, the ability to readily observe the status of the wound makes the patient a better partner to the physician in the early post-operative period when the potential for Surgical Site Infection is at its highest.

Commonly used antimicrobial dressings typically include one of the following:

·       PHMB (Polyhexanide)

·       Silver

·       CHG (Chlorhexidine gluconate)

·       Silver + CHG

 Lack of Guidelines to Prevent Surgical Site Infections (SSIs)

It is unfortunate that the current guidelines do not yet recommend antibiotic dressings but state that the issue is unresolved.  The earlier surgical hospital discharge should help necessitate this change. 

 Current Guidelines

Guideline & Conclusion

1.     CDC Guideline for Prevention of SSI, 2017 No recommendation/unresolved issue

2.     WHO Global Guidelines on the Prevention of SSI, 2016 Conditional recommendation

3.     American College of Surgeons and Surgical Infection Society Guidelines for Prevention and Treatment of SSI, 2016 No recommendations regarding choice of post-operative dressings.

4.     Society for Healthcare Epidemiology of America/Infectious Disease Society of America: Strategies to Prevent Surgical Site Infection in Acute Care Hospitals: 2014 Update Post-operative wound dressings not addressed

 References:

1.     CDC Guideline for Prevention of SSI, 2017. https://jamanetwork.com/journals/jamasurgery/fullarticle/2623725 

2.     WHO Global Guidelines on the Prevention of SSI, 2016. http://apps.who.int/iris/bitstream/handle/10665/250680/9789241549882-eng.pdf;jsessionid=9AAB8F406232C1294A363043D58CAF6F?sequence=1

3.     American College of Surgeons and Surgical Infection Society Guidelines for Prevention and Treatment of SSI, 2016 https://www.journalacs.org/article/S1072-7515(16)31563-0/fulltext

4.     Society for Healthcare Epidemiology of America/Infectious Disease Society of America: Strategies to Prevent Surgical Site Infections in Acute Care Hospitals: 2014 Update

https://www.jstor.org/stable/10.1086/676022

 One such post-operative wound dressing that fulfills these requirements is Eloquest’s ReliaTect™.  A description can be found here: http://www2.eloquesthealthcare.com/blog