COVERING UP

Everyday across the world nurses care for wounds in a variety of settings.

Nurses care for wounds that occur because of surgery or trauma.

Wounds are often covered with a dressing.

The role of the dressing is to act as a barrier between the wound and the external environment.

The wound will have been bought together by

1. staples

2. stitches

3. clips, and

4. glue.

This process is called healing by primary intention.

The Cochrane Collaboration, using all available relevant evidence, has reviewed and assessed whether using a dressing prevents surgical site infections in surgical wounds that are healed by primary intention.

The long standing practice of placing a dressing on a wound provides physical support, protection and absorbs exudate.

As Cochrane says

“… it is not clear whether one type of dressing is better than any other in preventing surgical site infection, or, indeed, whether it is better not to use a dressing at all.”

The review looked at 29 randomised controlled trials that investigated wounds that had a low risk of surgical site infection (clean surgery) or a higher risk rate of infection with potentially contaminated surgery.

There are four types of surgical procedures identified by Cochrane:

Clean: non-infective operative wounds in which no inflammation is encountered, and neither the respiratory, alimentary, genitourinary tract nor the oro-pharyngeal cavity is entered. In addition these cases are elective, primarily closed, and drained with closed drainage system when required.

Clean/contaminated: operative wounds in which the respiratory, alimentary, genital or urinary tract is entered under controlled conditions and without unusual contamination. Specifically, operations involving the biliary tract, appendix, vagina and oropharynx are included in this category, provided no evidence of infection or a major break in sterile technique is encountered.

Contaminated: fresh, accidental wounds, operations with major breaks in sterile technique or gross spillage from the gastrointestinal tract, and incisions in which acute, non-purulent inflammation is encountered.

Dirty: old traumatic wounds with retained devitalised tissue and those that involve existing clinical infection or perforated viscera. This definition suggests that organisms causing postoperative infection were present in the operative field before the operation.

There was no clear evidence that one dressing type was better than any other at reducing the risk of surgical site infection.

Also there was no clear evidence that any dressing type

1. improves scarring,

2. pain control,

3. patient acceptability or

4. ease of removal.

The reviews were small in size and a high risk of bias and imprecision was reported.

Clearly there is a need for further larger studies to verify these findings.

Cochrane concludes that the decision to dress a wound would be dependent upon the cost of the dressing as well as patient preference.

To learn more about dressings for the prevention of surgical infections:

Dumville, Jo C., et al. “Dressings for the prevention of surgical site infection.” The Cochrane Library (2016).  http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD003091.pub4/full

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