Practice development Innovations Surveillance (NNIS)[9] records, the hospital’s


SSI rates were lower than the NNIS mean SSI rate of 3.4% for gastrointestinal and hernia operations. (The NNIS is a collaborative surveillance system that collects data on nosocomial infections. The data is reported voluntarily by participating hospitals to estimate the magnitude of the nosocomial infection problem in the US and to monitor trends in infections and risk factors.)


GENERAL POSTOPERATIVE WOUND MANAGEMENT The postoperative care bundle is part of the comprehensive wound management programme that has the aim of reducing SSI in the hospital. The following routine practices are also employed by the surgery


department: n


The routine laparotomy wound closure involves mass closure of the wound with PDS™


II (polydioxanone) suture


(Ethicon), a monofilament absorbable suture. Subcuticular skin closure is applied where aesthetics is an overriding consideration


n


For clean and clean contaminated wounds, the skin is apposed with either metal staples (Proximate® or Appose™


staples (Insorb®


[Covidien]) or absorbable [Incisive Surgical]).


Absorbable staples are preferred to metal staples for skin apposition because of their superior aesthetic outcome. Additionally, they obviate the risk of suture track infection and inflammation. More studies are needed to investigate the impact of absorbable staples in SSI reduction


n References


11. Rozzelle CJ, Leonardo J, Li V. Antimicrobial suture wound


closure for cerebrospinal fluid shunt surgery: a prospective, double- blinded, randomized controlled


References 4. ?????????????3.


trial. J Neurosurg Pediatr 2008; 2(2): 111–17.


12. Fleck T, Moidl R, Blacky A,


Fleck M, Wolner E, Grabenwoger M, Wisser W. Triclosan-coated


sutures for the reduction of sternal wound infections: economic


considerations. Ann Thorac Surg 2007; 84(1): 232–6.


n


Early suture removal is preferred for interrupted wound closure. Sutures and staples are removed on the eighth day postoperatively


Dressing using chlorhexidine and normal saline for wound cleansing is advised. In the authors’ hospital all laparotomy wounds are covered with Opsite® Post-Op (Smith & Nephew) before the reversal of anaesthesia. The dressing is left on for 48–72 hours postoperatively unless it becomes soiled or soaked with blood. Thereafter, the dressing is removed for wound inspection and the wound is exposed. If the wound is clean, any further cleaning is performed


13 Wounds International Vol 2 | Issue 1 | ©Wounds International 2011 Plus [Ethicon] n with normal saline


If a deep SSI is suspected, Kaltostat® (ConvaTec) or hydrogel dressings are recommended. Clinicians in the authors’ hospital are not currently using antimicrobial dressings as antimicrobial products are being progressively introduced. However, the hospital is in the midst of converting from the PDS II suture (mentioned above) to the PDS™


II


Plus antibacterial suture (Ethicon), which is impregnated with triclosan. The use of antimicrobial dressings will probably be the next phase.


THE FUTURE The main focus for future implementation is to produce a guideline for the use of antibiotic- impregnated sutures. Preliminary data demonstrates a reduction in SSI rates with the use of antibacterial-coated sutures for surgical wound closure. For instance, in vitro studies using triclosan-coated sutures demonstrate a considerable reduction in bacterial adherence to the sutures[10] The triclosan-coated suture was


.


also reported to be effective in reducing cerebrospinal fluid shunt infection[11] well as sternal wound infection[12]


as . The


authors remain to be convinced of the use of the antibacterial-coated suture in abdominal wound closure as there is limited data in the current studies. In light of this, the authors’ team is planning to conduct a randomised controlled trial to answer this question before full implementation.


AUTHOR DETAILS Dr Liau, Kui-Hin, FRCS, FAMS, is Director and Senior Consultant Surgeon, Nexus Surgical Associates, Mount Elizabeth Medical Centre and Hospital, Singapore (position when article was written — Deputy Head of Department of Surgery and Senior Consultant and Chief of Hepatobiliary and Pancreatic Surgery Unit, Tan Tock Seng Hospital, Singapore)


Khin Thanda Aung, is Research Assistant, Department of Surgery, Tan Tock Seng Hospital, Singapore.


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