Jessica Honeycutt, RN, Katie Huff, RN,

1
When to remove a surgical dressing?

• Jessica Honeycutt, RN, Katie Huff, RN,
• Arlene Williams, RN and Meagan Ward, RN
• OU-Tulsa College of Nursing Career Mobility

2
PICO Question

• For adult surgical patients who have a
  non-draining surgical incision, what is the best
  practice for incision dressing removal to prevent
  surgical site infection?

3
Current Practice

• According to literature, there are many differing
  practices. At this time the current practice is
  not evidence-based and is mostly driven by
  physician preference.
• According to the 1999 National Guideline for
  Prevention of Surgical Site Infection, the
  incision is covered for the first 24-48 hours
  (Category 1B), but there is no recommendation to
  cover an incision beyond 48 hours due to this
  being considered an unresolved issue.

4
Why is this a valid question?

• Cost
• Single dressing change costs 3.34. This cost
  does not include the sterile gloves or nursing
  time.
• Surgical site infection
• According to the CDC, hospital infection rate for
  surgical incisions was 40.

5
Review of the Literature

• Studies are few, far between, and prevalently
  older.
• Five applicable studies could be found.
• Three of the studies were conducted in Europe.
• Four studies (Sticha, Cruse, Dosseh-Ekoue and
  Chrintz) all found that removing the dressing
  after 48 hours had no increase in infection rate.
• All four also stated more research is needed
  before there can be a practice change.

6
Review of the Literature

• Pros
• No major increase in infection
• Decreased cost, fewer nursing hours
• Wound can be examined easier
• Easier personal hygiene for the patient.
• Sticha study found there is no increase in
  infection after 48 hour dressing removal.
• Chrinzt study found that with early dressing
  removal, wounds are easily examined, patients are
  more able to carry out personal hygiene, and
  nursing hours are reduced by eliminating further
  dressing changes.

7
Review of the Literature

• Cons to removing dressing after 48 hours include
  
• Pain or discomfort to patient
• Emotional discomfort due to patient being able to
  visualize scar.
• The Holm study stated that patients seemed more
  physically comfortable and emotionally happy
  with the dressing staying on for 10 days when
  compared with the 48 hour group.

8
Review of the Literature

• Three studies stated no infection difference with
  early dressing removal
• One stated a minor increase in infection with
  early removal.
• Three of the studies were older performed 1998
  and earlier.
• No clear cut practice change can be suggested at
  this time.

9
Recommended Intervention

• Additional research is needed before a practice
  change can be recommended.
• Studies with the specific question of
  appropriate dressing removal time are needed.
• This recommendation was made due to
• lack of studies with the stated specific topic
• date of the studies
• national guidelines stating the specific time
  removal as an unresolved issue

10
Questions for further study

• What is the cost of care related to incision site
  dressing care beyond 48 hours?
• What is the patient perspective on early dressing
  removal?
• What is the impact of late dressing removal on
  patient quality of life and functional level?
• What is the physician perspective on early
  dressing removal?

11
References

• Chrintz, H., Vibitz, H., Cordtz, T., Harreby, J.,
  Waaddegaard, P. (1989). Need for surgical
  dressing change. British Journal of Surgery,
  76(2), 204-205.
• Cruse, P. J., Foord, R. (1980). The
  epidemiology of wound infection A 10 year
  prospective study of 62, 939 wounds. Surgical
  Clinics of North America, 60(1), 27-40.
• Dosseh, E. D., Doleaglenou, A., Fortey, Y. K.,
  Ayite, A. E. (2008). Randomized trial comparing
  dressing to no dressing of surgical wounds in a
  tropical setting. Journal of Chirugie, 145(2),
  143-146.
• Holm, C., Petersen, J. S., Groenboek, F.,
  Gottrup, F. (1998). Effects of occlusive and
  conventional gauze dressings in incisional
  healing after abdominal operations. Eur J Surg,
  164, 179-183.

12
References

• Mangram, A. J., Horan, T. C., Pearson, M. C.,
  Silver, L. C., Jarvis , W. K. (1999). Guideline
  for prevention of surgical site infection.
  Infection Control and Hospital Epidemiology, ,
  268.
• National Guideline Clearinghouse. (2008).
  Prevention of surgical site infections
  Prevention and control of healthcare-associated
  infections in Massachusetts. Retrieved February
  25, 2009, from http//www.guideline.gov/summary/su
  mmary.aspx?doc_id12921nbr006635stringp...
• Sticha, R. S., Swiriduk, D., Wertheimer, S. J.
  (1998). Prospective analysis of postoperative
  wound infections using an early exposure method
  of wound care. Journal of Foot and Ankle Surgery,
  37(4), 286-291.