Authors (including presenting author) :
Cheung CY(1), Lee HY (2), Law SMS (3), Chan MY (4)
Affiliation :
(1) Surgery, Princess Margaret Hospital, (2) Surgery, Princess Margaret Hospital, (3) Stoma and Wound Nurses Clinic, Princess Margaret Hospital, (4) Stoma and Wound Nurses Clinic, Princess Margaret Hospital.
Introduction :
According to a Clean Care is safer programme by World Health Organization(WHO), the second most frequent and surveyed health care-associated infections in high-income countries is surgical site infections (SSI). The highest SSI is the colorectal surgery with 9.5% interlude per operations. SSI develop negative influence on patient outcome, such as burden the morbidity, mortality and extra expenses to health care system. The length of stay increased 9.7 days due to SSI in 2005 in USA, and more expenses spend on the antibiotics and the advanced dressing materials. Patient suffered from SSI will double the mortality rate in USA with increased cost and readmission for the treatment.
There are many different treatment and dressing options for health care providers for wound care. The dressings with advanced technology become more popular in recent days. Many studies show the importance of moist wound dressing to enhance the wound healing process. A recommendation from the UK’s National Institution for Health and Clinical Excellence (NICE) suggest that all surgical incision wound should be dressed with low-adhesive dressing for at least 3-5 days after operation. And a journal published in CINAHL Information System stated that the use of dressing with moist wound healing effects can help to reduce the SSI rate by 50% that the conventional gauze. On the other hand, there are studies commended that there are no significant different in prevention of SSI with the use of moist wound dressing. Therefore, it is a controversial issue on the effectiveness of preventing SSI by using moist wound dressing versus conventional gauze dressing.
In Hong Kong, colorectal cancer is the commonest cancer, there were around 5000 new cases in 2014. And it is the second leading cause of cancer deaths, in 2015, around colorectal cancer caused 2000 deaths. An unpublished internal audit carried out in surgical department in Princess Margaret Hospital (PMH) in 2015 found that the day 30 post-operation SSI incidence among patients with colorectal surgery using occlusive ionic silver-containing dressing (20%; 19/95) was statistically lower than those using conventional gauze dressing (52.9%; 9/17) with p=0.012. Although the effect of using silver dressing to reduce SSI rate is controversial, there are no formal study has been published locally. Therefore, it is meaningful to carry out a randomized controlled trial (RCT) to prove the significance of silver dressing in reduce SSI rate.
Objectives :
To compare the SSI incidence among patients with abdominal colorectal surgery patients using prophylactic occlusive ionic silver-containing dressing and conventional gauze dressing.
Methodology :
This is a single-blind two-arm parallel randomized controlled trial on occlusive ionic silver-containing dressing conducted in Princess Margaret Hospital (PMH). PMH is a major acute general hospital in Kowloon West Cluster in Hong Kong, providing 1,542 beds to maintain a wide range of specialist care. There are around 150 abdominal colorectal surgery provided every year in our department. Both the subjects, data collectors and outcome assessors will be blinded to the type of dressing being used. Eligible inpatients receiving colorectal surgery from the department of surgery will be consecutively recruited in each surgical ward.
Patient aged 18 years or above will be included if they undergo abdominal colorectal operation including colorectal cancer case and non-colorectal cancer case such as perforated diverticulitis, trauma, and so on. Patients with cognitive impairment and/or with known allergic reactions to silver, hydrofibre or hydrocolloid and/or with non-closed wound immediate after operation will be excluded.
Subjects will be randomly assigned to use occlusive ionic silver-containing dressing (experimental group) or conventional gauze dressing (control group) with equal probability. Blocked randomization will be carried out by an independent party.
On the day of admission, or an emergency operation is offered, written informed consent will be obtained from all eligible patients. Patients will be arranged by an independent primary nurse in two groups, the experimental and control group, according to the designed block randomized sequence.
Patient’s case doctor will be responsible to document in date collection form, if there are surgical site infection occur. A research team is responsible for the data collection. Data obtained includes age, gender, pre-operative albumin level, pre- and post-operative sepsis status, operation class (elective or emergency), operation duration, number of operation, wound classification (clean, clean-contaminated, contaminated, and dirty), types of stoma raised (colostomy or ileostomy), the use and length of duration of antibiotics (pre op and post op). Subjects will be assessed for SSI on Day 3, 15 and 30 after operation in clinical area and followed by phone interviews. After patient discharge, patient will be provide the information of SSI status. Data will be collection by research team via phone contact, patient will be blind to the study as well. Carers of the patient, who are blind to the study, will be interviewed if the patient is unable to describe their surgical site condition.
Result & Outcome :
There are not statistically significance of using prophylactic Occlusive Ionic Silver-containing Dressing in Abdominal Colorectal Surgery Patients to prevent Surgical Site Infection. Therefore, we are going to modify the current practice of choosing post-operation wound dressing materials. We can foresee there will be a decrease of expenditure on purchasing those advanced wound dressing materials.
