Plastic wound protector outperforms gauze in lowering infection risk in open GI surgery
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Key takeaways:
- The surgical site infection rate was 10.9% with the wound protector vs. 20.5% with conventional gauze.
- There was no difference between groups in postoperative length of hospital stay or complication rates.
A dual-ring plastic wound protecter reduced the risk for surgical site infection by 46.81% compared with conventional surgical gauze during open abdominal gastrointestinal surgery, according to study results.
“In the intraoperative period, the use of a wound protector device is recommended to reduce the rate of [surgical site infection (SSI)] in clean-contaminated, contaminated and dirty abdominal surgical procedures,” Nina Yoo, MD, PhD, of the department of surgery at Seoul St. Mary’s Hospital at The Catholic University of Korea, and colleagues wrote in JAMA Surgery. “However, the WHO panel suggested its use with conditional recommendation with a very low quality of evidence.”
They added, “The effectiveness of reducing SSI for surgical procedures dealing with contaminated or dirty wounds has not been shown, to our knowledge.”
To investigate the efficacy of a plastic wound protector in reducing the rate of SSIs, Yoo and colleagues conducted a multicenter, randomized clinical trial of 457 adult patients (mean age, 58.4 years; 56% men) who underwent open GI surgery at 13 academic hospitals in South Korea from August 2017 to October 2022. A dual-ring, plastic wound protector (n = 229) or conventional surgical gauze (n = 228) was applied to patients’ incision sites.
Researchers noted 74.6% of patients had a clean-contaminated wound and 25.4% had a contaminated or dirty infected wound. The primary endpoint was SSI rate within 30 days of surgery.
According to analysis, the overall SSI rate was 15.7%, with a 10.9% rate in the wound protector group and a 20.5% rate in the conventional group. The plastic wound protector achieved a statistically significant 46.81% RR reduction for SSI (95% CI, 16.64-66.06), as well as a 43.75% RR reduction for clean-contaminated wounds (95% CI, 3.75-67.13), especially superficial SSIs (RR reduction = 42.5%; 95% CI, 7.16-64.39).
Researchers also reported “no significant difference” in postoperative length of hospital stay between the wound protector and conventional gauze groups (mean, 15.2 vs. 15.3 days) or in postoperative rates of complication (20.1% vs. 18.8%).
“Plastic wound protectors were effective in reducing the incidence of SSIs in open abdominal GI surgeries compared with traditional surgical gauze,” Yoo and colleagues wrote. “Despite the challenges of assessing the cost-effectiveness and environmental impact of wound protectors, the clinical benefits are evident.”
They continued: “Innovative efforts should concentrate on making these devices more environmentally sustainable while maintaining their effectiveness in infection prevention, prioritizing patient safety alongside ecological responsibility.”
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