SSIs and Post-Op Dressings: What’s Missing?

You might remember from our previous blogs that certain measures, like surgical site infections (SSIs) are penalized in multiple programs of the Affordable Care Act—in the Value-Based Purchasing Program as well as the Hospital-Acquired Conditions Reduction Program. View Blog #2 and Blog #3 here.

SSIs are the most common and costly of all hospital-acquired infections in the US.1 Approximately 160,000-300,000 SSIs occur each year in the US and each SSI is associated with approximately 7–11 additional postoperative hospital-days per infection.2 SSIs are believed to total $3.5 billion to $10 billion annually in healthcare expenditures.2

Morbidity rates of SSIs are also concerning. Seventy-seven percent of deaths in patients with an SSI are directly attributable to the SSI.2 And did you know that patients with an SSI have a 2- to 11-times higher risk of death compared with operative patients without an SSI?2

Post-operative dressings have become a critical component of wound management and prevention of SSIs. A number of dressings are currently available that offer variable levels of desirable features:

Basic wound contact dressings3

  • Absorbent dressings: applied directly to the wound
  • Surgical absorbents: used as secondary absorbent layers in the management of heavily-exuding wound

Advanced dressings3

  • Vapor-permeable films: permeable to water vapor and oxygen, but not to water or micro-organisms; normally transparent
  • Hydrocolloid dressings: occlusive dressings composed of a hydrocolloid matrix attached to a base (possibly film or foam); fluid absorbed from the wound causes the hydrocolloid to liquify
  • Fibrous hydrocolloid dressings: composed of sodium carboxymethyl cellulose, which forms a gel when it comes into contact with fluid
  • Polyurethane matrix hydrocolloid dressings: consist of 2 layers—a polyurethane gel matrix and a waterproof polyurethane film designed to act as a bacterial barrier

Antimicrobial dressings3

  • Polyhexamethylene biguanide (PHMB) dressings: impregnated with the antimicrobial agent polyhexanide
  • Topical skin adhesives (glue-as-dressing): for closure of minor skin wounds and additional suture support; also used on an already closed wound as a dressing without an additional covering
  • Silver dressings4: release silver ions to bind to the DNA structures to affect cell function and respiration, effecting the cessation of bacterial replication
  • Chlorhexidine Gluconate (CHG) dressings: effective against a broad spectrum of gram-positive and gram-negative bacteria, yeasts, and some viruses; chlorhexidine is the active antimicrobial agent, and chlorhexidine gluconate is a commonly used form of chlorhexidine because it is colorless, odorless, and easily dissolves in water.5
  • Iodine dressings4: thought to disrupt microbial enzymes, proteins, and cell membranes through reacting with cell amino acids
  • Honey dressings4: used for centuries for its broad spectrum antimicrobial activity and ability to reduce the potential for wound infection and accelerate wound healing

Differentiations in dressings include varying degrees and combinations of transparency, absorbency, antimicrobial agent, adherence, conformability and water-resistance. What we have yet to see in a post-op dressing is one that integrates absorbency, transparency and antimicrobial. Perhaps soon?

Join us next time for our blog, “Antimicrobial Dressings: The Silver Mystique.”

References:

  • Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: surgical site infection guidelines, 2016 update. J Am Coll Surg. 2017;224(1):59-74.
  • Anderson DJ, Podgorny K, Berrior-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35:605-27.
  • Dumville JC, Gray TA, Walter CJ, et al. Dressings for the prevention of surgical site infection (review). Cochrane Database of Systematic Reviews 2016, Issue 12. Art. No.: CD003091. DOI: 10.1002/14651858.CD003091.pub4.
  • Hewish J. Understanding the role of antimicrobial dressings. Wounds Essentials 2012;1:84-90. http://www.wounds-uk.com/pdf/content_10457.pdf. Accessed February 13, 2017.
  • ChlorhexidineFacts.com website. http://www.chlorhexidinefacts.com/the-molecule.html. Accessed June 1, 2017.