A Randomized Controlled Trial: Comparison of Three Dressings Following Surgery

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Primary Author:</td>
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Rebecca C. Clark, PhD, RN</td>
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Co-Principal Investigators/Collaborators:</td>
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N/A</td>
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Organization:</td>
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Carilion Clinic</td>
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Abstract</h2>
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Purpose</h3>
<p>To determine which dressing: a dry sterile dressing, a metallic silver dressing, or an ionic silver dressing provided better outcomes (wound healing, comfort, incidence of infection) for post-sternotomy surgery patients.</p>
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Background</h3>
<p align="left">New silver-based dressings are being used in care of patients following cardiac surgery, but there is limited research to support selection of specific products. It is important to evaluate the impact of these dressings on patient outcomes and provide evidence to support best practice. </p>
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Materials & Methods</h3>
<p>A convenience sample of 351 patients undergoing cardiac surgery were enrolled in a randomized trial that compared outcomes of wound healing, patient comfort, and infection associated with three different dressings. Factors of adherence, time for application, and ease of use were evaluated. Patients were randomly assigned to one of three groups; dressings were applied in the Operating Room. Study nurses assessed outcomes according to defined protocols. Data were analyzed using Fisher’s exact and chi square tests. </p>
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Results</h3>
<p>The final sample was 315 subjects. There were no statistically significant differences among dressings in wound healing, prevention of infection and comfort with dressing in place. There was a statistically significant difference between silver dressings with dressing removal: the metallic silver dressing resulted in least patient-reported pain (p=.01). There were statistically significant differences in: ease of application (p<.0001); ease of incision assessment (p<.0001); ease of removal (p =.0472); dressing integrity (p=.0162); and time to apply (p<.0001). The ionic silver dressing was more difficult to apply but facilitated incision assessment. The metallic dressing was rated ‘very easy’ to remove more often than the ionic dressing (70% vs 50%), but was more often ‘poorly sealed’ at time of removal (23% vs 9%). </p>
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Conclusion</h3>
<p>Dressings are an important aspect of wound management. In our study, silver dressings were not superior for wound healing or infection control for post-operative patients, but did provide advantages for patient comfort, ease of removal and visualization. </p>
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Bibliography</h3>
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Haycock, C., Laser, C., Keuth, J., Montefour, K., Wilson, M., Austin, K., et al. (2005). Implementing evidence-based practice findings to decrease postoperative sternal wound infections following open heart surgery. Journal of Cardiovascular Nursing, 20(5), 299-305.</li>
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Storm-Versloot, M., Vos, C., Ubbink, D., and Vermeulen, H. (2010).Topical silver for preventing wound infection (review). Cochrane Database of Systematic Reviews 2010, 3, Art No CD006478. Doi:10.1002/14651859. CD0066478. Pub2.</li>
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<p>© Improvement Science Research Network, 2012</p>
<p>The ISRN published this as received and with permission from the author(s).</p>