rapping up a surgical case
usually concludes with wrapping up an incision site. Increased attention
awarded to the impact that infection can have on the healing of a surgical
wound, and patient morbidity and mortality, has brought about interesting
developments in the engineering of postsurgical bandages and dressings. The
traditional gauze and adhesive tape does create something of a barrier to a
fresh surgical wound, but it’s just not enough for some patients whose
pre-operative condition may require something more sophisticated. Industry
has answered the challenge with advanced surgical bandages and dressings.
The Acticoat family of
bactericidal barrier dressings,
Smith-Nephew Wound Management
Certainly the environment poses risk of infection after
surgery, but the risk of infection actually begins before surgery. The
patient’s condition, particularly conditions that affect the immune system,
prior to surgery poses a risk factor. In such high-risk cases, an advanced
dressing can perform as an infection control measure to protect
postoperative wounds from becoming infected.
Antimicrobial dressings as a preventive measure to infection
is a relatively new trend, according to Carl Liebert, group product
Smith-Nephew Wound Management, Largo, FL.
"Antimicrobial barrier dressings can act as an infection-management device.
For surgical wounds, they can prevent bacteria in the hospital environment
from migrating to the wound. Likewise, they can prevent transfer of bacteria
from the wound to the hospital staff and from the staff to the environment."
An enormous advantage, averred Liebert, is that "use of advanced dressings
can potentially reduce the use of systemic antibiotics." Who doesn’t like
the sound of that?
"Realization of infection risk due to the patient’s
co-morbidities, such as diabetes, cancer, or poor vascularization, creates
the need for a barrier from the broader environment," stated Liebert. "It’s
important to realize that risk exists in the hospital and elsewhere, so a
potent antimicrobial barrier dressing is needed to minimize risk of
infection occurring in postoperative wounds."
Earmarks of an effective bandage or dressing
Certain components or properties should be present in the
antimicrobial bandage or dressing to present an effective barrier to
exogenous bacteria and to manage endogenous bacteria present at the incision
site. What’s important, contended Liebert, is that the antimicrobial be
potent and fast-acting and that the bandage have the capability of being
left in place for several days. Leaving a dressing in place for several days
reduces trauma to the wound, creates less discomfort for the patient, and
saves money by consuming less nursing time and reducing costs on dressings.
Smith-Nephew’s Acticoat Antimicrobial Barrier contains
silver. Silver has long been known for its inherent antimicrobial
properties. It’s being used increasingly by the healthcare industry because,
when used in potent dose amounts (>60 ppm), it doesn’t present the danger of
resistance. Acticoat employs nanocrystalline ionic silver, delivered in
atomic-sized "clusters" on the bandage. To be effective, ionic silver must
be present in concentrations of >60 ppm or greater. Acticoat is
potent, releasing 70 to 100 ppm of ionic silver. Its potency renders it
effective on multiple types and species of bacteria.
Liebert explained the importance of using a fast-acting
antimicrobial: "Incisions start to heal within 24 hours, so activation time
is important. Acticoat is fast-acting because it’s highly soluble. Silver
activates quickly to create a barrier, with a log3 reduction in bacterial
load within 30 minutes.
Kristen Comstock, skin health marketing manager,
Paul, MN, offered further advice on qualities to look for in an effective
advanced bandage or dressing. "Different features make bandages or dressings
suitable for different types of surgical wounds. Look for ease of
application and removal; conformability to the wound site; extended wear
time; the capability for the patient to shower without harming the bandage; nonadherence to the wound bed; compatibility with sutures, staples, and
Steri-Strip skin closures; and the ability to monitor the wound without
removing the dressing."
DUKAL Non-Adherent Pad
3M’s Tegaderm Absorbent clear acrylic dressing is
transparent. "It’s novel because you can visualize the wound while it
absorbs exudate," proclaimed Comstock. "Wear time is not cut short because
the dressing has to be removed so that the healthcare worker can see what’s
going on. You can see whether the wound is healing properly without removing
the dressing, which is a great advantage, because removing the dressing can
damage the skin and be really uncomfortable for the patient."
If what is seen through the dressing is not good news, 3M
has a solution. "If the wound is not healing properly," noted Comstock, "a
dressing with an antimicrobial could be used." 3M released Tegaderm Ag Mesh
last year, a silver product with a cotton-gauze substrate.
Gerry LoDuca, president,
Dukal Corporation, Hauppauge, NY,
also offered advice to purchasers seeking postsurgical wound-care products,
highlighting the importance of balancing good quality with reasonable
prices: "Look for a high-quality product by a reputable company at
Dukal’s mission is to offer alternatives to all traditional
wound-care products at a price advantage. "Dukal’s goal is to build good
products that perform as well or better than the national leaders, with an
advantage in purchase price," said LoDuca.
One of Dukal’s postsurgical wound-care products is a
nonadhering pad. "The outer facing is covered by a material that allows
wicking, and, while it’s very absorbent, it doesn’t stick to the wound. It’s
held in place with a nonconforming-type bandage, presenting a clean cover to
minimize contamination. Removal is nontraumatic. It stacks up well against
Often pre- or postsurgical care involves insertion of a
catheter for one reason or another. Sought-after qualities in catheter-care
dressings are similar to those important in postsurgical bandages and
dressings. Mike Goro, vice president, sales and marketing,
Hospital Supply Corporation, Howell, MI, talked to Healthcare Purchasing
News about what’s needed in catheter dressings: "Tri-State manufactures
several specialty dressings designed specifically for care at the catheter
insertion site. Dressings for the care and maintenance of catheter sites
should be transparent, to allow clear observation of the site; they should
be easy to apply; provide security to the site; be non-irritating to the
tissue; provide an occlusive barrier against bacteria or other contaminants;
and provide a high level of moisture transmission away from the insertion
"Tri-State’s Centurion dressings use a three-part
construction. First is the transparent material, the bottom of which is
coated with a special hypoallergenic adhesive that has been applied in a
specific pattern to ensure excellent adhesion, while providing the optimum
vapor-moisture transmission away from the insertion site. Next, a frame made
of a porous material is placed along the outer boundary to give the dressing
some rigidity for ease of application but also to wick away excess moisture
that may form near the insertion site. The next step involves placing a
tough netting material over the frame that expands the ‘lock down’ surface
of the dressing and strengthens it against any pulls or tugs that would
otherwise jeopardize the integrity of the dressing. These steps, along with
the materials used, work to provide a dressing that resists the breakdowns
associated with other dressings. That means fewer changes, easier technique
for application, greatly reduced chance for infection, and significantly
improved comfort for the patient."
3M Tegaderm Absorbent clear acrylic dressing,
used over a surgical wound with sutures.
"Every dressing and every component Tri-State manufactures
to support our dressings has been designed using extensive input from nurses
in the field," said Goro. "Hundreds of hours of talking with nurses go into
the design and development of every dressing. From nurses we learned the
importance of cost outcomes, and we set out to develop dressings around that
concept. Most dressings today last any where from 1 to 3 days. Our dressings
have been designed to last up to 7 days with no deterioration or failure."
Tri-State isn’t just trying to go for an adhesion-time
record; there are significant reasons for using dressings that can stay in
place for an extended length of time, Goro explained.
"Every time a dressing has to be changed or replaced, there
is a cost associated with the dressing and any supplemental components
needed for the procedure. There also are additional costs in nursing time,
patient anxiety, and the potential for infection. At the very least, an
infection can cost an institution thousands of dollars. Extending the length
of time, as well as the performance, of the dressing can greatly reduce the
overall cost outcome for the using institutions. Clinical studies performed
by Robert Garcia, Brookdale University, have shown significant
catheter-related bloodstream-infection reductions in patients using
SorbaView dressings over extended time. Numerous major institutions have
switched to SorbaView during the past few years. The reason is clear: fewer
dressings and dressing procedures mean fewer infections and less cost."
What’s in store?
What’s in store for the future of bandages and dressings?
Mandatory reporting of healthcare-acquired infections, the trend toward less
invasive surgeries, and earlier hospital discharges are a few factors
shaping the future of postsurgical wound care.
Liebert believes that, as hospitals are held more
accountable for infection rates, these types of infection prevention
measures will receive more consideration, leading to a product trend toward
more advanced dressings in postoperative wound care. An example of new
product development at Smith-Nephew is their new Acticoat Site, designed to
work with postoperative external fixation devices used in orthopedic trauma
surgery. "At Smith-Nephew, we’re constantly looking at how new products can
be applied or developed to meet evolving wound-care needs."
Ultimate PICC Line Dressing
3M’s Comstock observed that, because patients are being
discharged from the hospital earlier and earlier, more wound care will be
performed at home by the patient or the patient’s family. "Out-patient
surgery and home care are influencing product development," stated Comstock.
"Easy application and removal are good elements of wound care that will
become even more important."
Dukal’s LoDuca added: "The demand for heavier dressings, for
more absorption, probably will not increase. Surgeries are moving to
minimally invasive procedures, away from large, open incisions to smaller
wounds that heal faster and are less traumatic for the patient."
Catheter security will continue to garner attention as well.
"At Tri-State," said Goro, "we have taken our dressing technology and
applied it to developing new catheter security systems that utilize the
strength and adherence properties for which we’ve come to be known. Security
systems will support dressings and help to reduce infections, thrombosis,
and accidental ‘tear’ or ‘pull outs’ of catheters. We are working to develop
dressings that have the security built right into them. We also are
investigating the potential and cost benefits of dressings that have
antibacterial properties built directly into them." As for their strength in
product development, said Goro, "We continue to meet with nurses to discuss
their ideas and needs."