Can sutures get wet? Prospective randomised controlled trial of wound management in general practice

Abstract

Objective To compare standard management of keeping wounds dry and covered with allowing wounds to be uncovered and wet in the first 48 hours after minor skin excision. Design Prospective, randomised controlled, multicentre trial testing for equivalence of infection rates. Setting Primary care in regional centre, Queensland, Australia. Participants 857 patients randomised to either keep their wound dry and covered (n = 442) or remove the dressing and wet the wound (n = 415). Results The incidence of infection in the intervention group (8.4%) was not inferior to the incidence in the control group (8.9%) (P < 0.05). The one sided 95% confidence interval for the difference of infection rates was ∞ to 0.028. Conclusion These results indicate that wounds can be uncovered and allowed to get wet in the first 48 hours after minor skin excision without increasing the incidence of infection.

Does Bathing of a Surgical Site Increase the Incidence of Infection After Cesarean Section?

“…Bu çalışmada minör cerrahi sonrası, 48 saat sonra banyo yapmasına izin verilen hastalar, geleneksel yöntemler uygulanan ve insizyon hattı kapalı ve kuru tutulması önerilen hastalar ile karşılaştırılmış, YYE oranları arasında anlamlı farklılık saptanmamıştır. 20 Hastaların ayakta duş alabilmesi ya da banyo yapabilmesi muhtemelen hastane kö-kenli patojen bakterilerin, kapalı alanda ısı ve neme bağlı değişen, zararlı floranın kolonizasyonunu engelliyor olabilir. Ancak, açık kesi hattının daha fazla travmaya maruz kalabileceği akılda tutulmalı ve doku bütünlüğünün ve iyileşme sürecindeki epitel bariyerinin bozulmaması için daha fazla dikkat edilmelidir.…”

Alcoholic versus aqueous chlorhexidine for skin antisepsis: the AVALANCHE trial

“…The baseline infection rate was lower than we predicted on the basis of previous studies. [7][8][9][10] Our sample size calculation was based on a 5% absolute reduc tion in surgical site infection (from a 10% baseline rate) being clinically relevant. It is possible that general practitioners might have reconsidered the margin for superiority if the baseline rate were 7%.…”

“…[7][8][9]15 Excision loca tion was recorded on a body site map. Clinicians at each practice site examined patient records to complete missing data.…”

“…4,7,9,10,15,22 The antiseptic solution was applied using sterile forceps and gauze over an area 1 cm beyond the surgical field. Drapes, gloves, sutures, local anesthetic and dressings were the same in the 2 study arms.…”

“…Previous research in the Mackay region 7,[9][10][11]15 and recent interviews (unpublished data) showed that most general practi tioners in Mackay use chlorhexidine in preference to povidone iodine, partly because of the perceived "messiness" and skin staining associated with povidone iodine. Therefore, in the cur rent study, we examined the difference between alcoholic and aqueous chlorhexidine, rather than comparing chlorhexidine with povidone iodine.…”