Preventing infections in surgical wounds

Up to one in 20 patients undergoing surgery will develop a surgical site infection (SSI)¹, so it’s vital to protect surgical wounds post-operatively.

SSI and other skin complications can interfere with the normal healing process – leading to prolonged hospitalisation and even the need for further surgery ^{2 3} – as well as pain and discomfort for patients ⁴.

Dressing-related risk factors for SSI

Surgical wounds, like other wounds, are an ideal breeding ground for pathogens. Once the patient has left the operating room, a number of factors relating to the use of wound dressings may increase the risk of wound infection.

Dressing changes are associated with a risk of infection: the more often a dressing is changed, the more the wound is exposed to contamination ³.

Poor exudate management is also a risk factor. Wound exudates contain material derived from contaminating microorganisms ⁵. When they aren’t managed effectively, there’s a greater risk of moisture-related damage (i.e. maceration) and bacterial contamination of the wound, particularly if there is leakage outside the dressing ³.

Damage to the skin around the wound is also associated with infection. For example, the adhesive tapes that are used to hold traditional dressings in place are associated with the development of wound blisters ⁵. When blisters burst, there’s an increased risk of infection ⁵.

Preventing infection in surgical wounds

We provide healthcare professionals with best practice knowledge and expert support to help them reduce the risk of SSIs.

Minimising the frequency of dressing changes

Experts agree that initial wound dressings should ideally be left on as long as possible – at least seven days after surgery – provided there are no signs of excessive wound secretion or infection ⁶. We believe that the risk of wound contamination from the external environment can be reduced by keeping the number of dressing changes to a minimum.

Changing dressings less often may also help to reduce the risk of wound and peri-wound trauma and skin blistering ³.

Choosing wound dressings

The ideal wound dressing should maintain a warm, moist healing environment – and manage exudate effectively so that the dressing can be left on the wound for as long as possible ⁵.

To protect the periwound area and prevent skin blistering, a dressing should not adhere to the wound and gently to the surrounding skin. It should be easy to apply, easy to remove and flexible ⁶.

'References'

1. Anderson DJ, et al. Strategies to prevent surgical site infections in acute care hospitals. Infect Control Hosp Epidemiol. 2014 update [cited14 Sep 2017];35(6):605-627. URL: doi: 10.1086/676022.

2. Urban JA. Cost analysis of surgical site infections. Surg Infect. (Larchmt) 2006;7(Supplement 1):S19-S22.

3. Zarghooni K, et al. Is the use of modern versus conventional wound dressings warranted after primary knee and hip arthroplasty? Acta Orthop Belg. 2015;81(4):768-775.

4. Eastburn S, et al. A review of blisters caused by wound dressing components: can they impede post-operative rehabilitation and discharge? Int J Orthop Trauma Nurs. 2016 [cited 14 Sep 2017];21:3-10. URL: doi: 10.1016/j.ijotn.2015.08.001.

5. Ravenscroft MJ, et al. A prospective, randomised, controlled trial comparing wound dressings used in hip and knee surgery: Aquacel and Tegaderm versus Cutiplast. Ann R Coll Surg Engl. 2006 [cited 14 Sep 2017];88(1):18-22. URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1963649/.

6. Ousey K, et al. Understanding and preventing wound blistering. Wounds UK 2011;7(4):50-56.