Silver-Impregnated Dressings for Sternotomy Incisions to Prevent Surgical Site Infections in Children

Abstract

BackgroundThe consequences of surgical site infections can be severe and range from short-term delays in discharge from the hospital to life-threatening infections such as mediastinitis. Objectives To evaluate the effectiveness of silverimpregnated dressings in decreasing surgical site infections in children after cardiac surgery. Methods A randomized, controlled trial was used to compare silver-impregnated dressings (59 participants) with standard dressings (58 participants). The study team supervised all dressing changes after a sternotomy and ensured adherence with the hospital's bundle for reduction of surgical site infections. The ASEPSIS tool was used to evaluate sternal wounds for evidence of infection. Results The 2 groups had comparable Risk Adjustment for Congenital Heart Surgery scores, age, sex, weight, height, operating room characteristics, and number of chest tubes and/or pacemaker wires. No surgical site infections occurred in any study participant. Infections did occur, however, during the same period, in cardiac surgical patients who were not enrolled in the study. Conclusions The evidence did not support the superiority of silver-impregnated dressings for prevention of surgical site infections in children after cardiac surgery. Adherence to a bundle for prevention of surgical site infections may have decreased the incidence of such infections in the study population during the study period.

Understanding the Hawthorne effect in wound research—A scoping review

“…Almost a third of the reviewed studies pointed out that research participation raised awareness (of being studied) among health care teams, leading to improved quality of care, which resultantly improved participants' health outcomes. For example, Staveski et al studied 117 children undergoing sternotomy to explore if silver‐impregnated dressings were more effective than standard dressings in the prevention of infection at the surgical incision. No infection eventuated in either group, although there were records of infection among non‐participants in the hospital during the study period.…”

“…HE in the reviewed articles was present as a passing mention and related to three purposes: justifying an aspect of the research design, 23,24,[26][27][28][29][30]53 defending unexpected findings, [32][33][34][35][36][38][39][40]44,46,54,55 and acknowledging a deficit of conducting an open-label study. 37,42,47,56,57 Regardless of the purpose, the term HE was referred to briefly and lacked definition in most of the reviewed articles.…”

Median sternotomy - gold standard incision for cardiac surgeons

“…The patient is positioned in supine position with the arms secured alongside him and a roll between the scapulae. The upper torso is shaved, antibiotic prophylaxis is given within one hour of the incision and the patient is draped with sterile film (2,3).…”

“…This limited incision is used for surgery of the mediastinal goiters, surgery of the trachea and minimally invasive aortic and mitral valve repair. From here The sternum is usually divided from top to bottom by using a sternal saw ( Figure 3) but it can also be performed from the bottom to the top (2,3).…”

“…In thoracic surgery the incision is used for tumor resections of the anterior mediastinum, lower trachea and main stem bronchus surgery as well as retrosternal goiters or for the management of vascular lesions (2,3).…”