Effectiveness Not Established

Silver Impregnated Dressing

for Prevention of Infection: General

Dressings containing ionic silver for surgical wounds have been examined in patients with cancer for effects on the incidence of surgical site infections.

Research Evidence Summaries

Biffi, R., Fattori, L., Bertani, E., Radice, D., Rotmensz, N., Misitano, P., . . . Nespoli, A. (2012). Surgical site infections following colorectal cancer surgery: A randomized prospective trial comparing common and advanced antimicrobial dressing containing ionic silver. World Journal of Surgical Oncology, 10, 94.

Study Purpose

To determine if ionic silver surgical dressings could reduce the incidence of surgical site infection in adult patients undergoing elective laparotomy for colorectal cancer

Intervention Characteristics/Basic Study Process

Subjects randomly were assigned to have their surgical wound covered with either an ionic silver dressing (AQUACEL® Ag Hydrofiber®) or a common dressing. To achieve blinding for patients, nurses, and medical staff, both groups had an additional layer of a common dressing applied by scrub nurses over the main dressing. Patients were monitored for surgical site infection for 30 days postoperatively.

Sample Characteristics

  • N = 112          
  • AGE = 18–75 years (mean = 64 years)
  • MALES: 58, FEMALES: 42
  • KEY DISEASE CHARACTERISTICS: Elective laparotomy surgery for colorectal cancer

Setting

  • SITE: Multi-site    
  • SETTING TYPE: Inpatient    
  • LOCATION: Italy

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment

Study Design

  • Randomized, prospective trial (double-blinded)

Measurement Instruments/Methods

  • Surgical site and vital signs evaluated daily during hospitalization, upon discharge, and at 30-day follow-up (surgical wounds remained covered for seven days)

Results

The authors evaluated the primary outcome of surgical wound infection. Patient characteristics were similar across the two study arms. Surgical wound infection rates were lower in the arm receiving the antimicrobial dressing. This was true with respect to grade 1 versus grade 2 and 3, and grade 1 and 2 versus grade 3. However, the difference in infection rates was not great enough to be of statistical significance (p = 0.623).

Conclusions

Infection rates were slightly lower in the experimental group, but not enough to be statistically significant.

Limitations

  • The cover dressing purportedly provided blinding, but blinding would have been removed when the surgical dressing was removed. The article does not state whether surgeons or nurses were present when dressings were removed.
  • Using the second layer of a common dressing over the antimicrobial dressing may have affected its performance, or may have affected the performance of the first layer of the common dressing in those patients randomized to the arm that received a double layer of the common dressing.
  • The presence and severity of necrosis, erythema, edema, rigors, and hematoma are subjective analyses.

 

Nursing Implications

Patients having rectal surgery for cancer are at higher risk for surgical wound infection compared to colon surgery. Novel antimicrobial dressings may help reduce infection rates, but further study is needed.

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