title: Significant reduction of wound infections with daily probing of contaminated wounds: a prospective randomized clinical trial.
abstract: OBJECTIVE
  Local wound management using a simple wound-probing protocol (WPP) reduces surgical site infection (SSI) in contaminated wounds, with less postoperative pain, shorter hospital stay, and improved patient satisfaction.
  
  
  METHODS
  Prospective randomized clinical trial.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Adult patients undergoing open appendectomy for perforated appendicitis were enrolled from January 1, 2007, through December 31, 2009.
  
  
  METHODS
  Study patients were randomized to the control arm (loose wound closure with staples every 2 cm) or the WPP arm (loosely stapled closure with daily probing between staples with a cotton-tipped applicator until the wound is impenetrable). Intravenous antibiotic therapy was initiated preoperatively and continued until resolution of fever and normalization of the white blood cell count. Follow-up was at 2 weeks and at 3 months.
  
  
  METHODS
  Wound pain, SSI, length of hospital stay, other complications, and patient satisfaction.
  
  
  RESULTS
  Seventy-six patients were enrolled (38 in the WPP arm and 38 in the control arm), and 49 (64%) completed the 3-month follow-up. The patients in the WPP arm had a significantly lower SSI rate (3% vs 19%; P = .03) and shorter hospital stays (5 vs 7 days; P = .049) with no increase in pain (P = .63). Other complications were similar (P = .63). On regression analysis, only WPP significantly affected SSI rates (P = .02). Age, wound length, body mass index, abdominal circumference, and diabetes mellitus had no effect on SSI. Patient satisfaction at 3 months was similar (P = .69).
  
  
  CONCLUSIONS
  Surgical site infection in contaminated wounds can be dramatically reduced by a simple daily WPP. This technique is not painful and can shorten the hospital stay. Its positive effect is independent of age, diabetes, body mass index, abdominal girth, and wound length. We recommend wound probing for management of contaminated abdominal wounds.
authors.affiliation: Department of Surgery, Cedars-Sinai Medical Center, 8635 W Third St, 650W, Los Angeles, CA 90048, USA. shirin.towfigh@cshs.org
authors.forename: Shirin
authors.initials: S
authors.lastname: Towfigh
authors.forename: Tatyan
authors.initials: T
authors.lastname: Clarke
authors.forename: Wael
authors.initials: W
authors.lastname: Yacoub
authors.forename: Aydin H
authors.initials: AH
authors.lastname: Pooli
authors.forename: Rodney J
authors.initials: RJ
authors.lastname: Mason
authors.forename: Namir
authors.initials: N
authors.lastname: Katkhouda
authors.forename: Thomas V
authors.initials: TV
authors.lastname: Berne
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001062:Appendectomy / Q000009:adverse effects; D001064:Appendicitis / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D017060:Patient Satisfaction; D011446:Prospective Studies; D016037:Single-Blind Method; D017792:Surgical Stapling / Q000379:methods; D013530:Surgical Wound Infection / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents