title: A prospective, randomized controlled trial comparing 3 dressing types following sternotomy.
abstract: Dressings are an important aspect of post-sternotomy care. A prospective, randomized, controlled trial was conducted between July 2010 and August 2012 to compare wound and patient outcomes among 3 marketed postoperative dressings. Using convenience sampling methods, 315 patients requiring a sternotomy incision followed by hospitalization were randomly assigned to postoperative care with a dry sterile (n = 106), metallic silver-containing (n = 105), or ionic silver-containing (n = 104) dressing. Application time and ease of dressing application were assessed. The dry dressings remained in place for 24 to 48 hours. On postoperative day 5 or at time of discharge, the silver dressings were removed and wound outcomes (degree of wound approximation, skin integrity, wound exudate, presence/absence of necrotic tissue), presence/absence of surgical site infection, patient comfort, and dressing factors (ease of removal, dressing integrity) were evaluated. All participants received the same preoperative skin preparation and intravenous antibiotics. Data were analyzed using Fisher's exact chi-squares and 1-way ANOVA. No statistically significant differences were found among the dressings in terms of wound healing or infection rate, but statistically significant differences were noted in patient comfort and certain dressing factors. When comparing all 3 dressings, the dry sterile dressing took less time to apply (P = 0.000) and was easiest to apply (P = 0.000). Use of the metallic silver dressing resulted in the least patient-reported pain upon removal (P = 0.015), and incision assessment was easiest with the ionic silver dressing (P = 0.000). When comparing the 2 silver dressings, the metallic silver dressing was easiest to remove (P = 0.003) but had less integrity at the time of removal (P = 0.007). None of the patients in the ionic silver and 1 patient (1%) in the metallic silver dressing group developed a deep infection. Additional research is warranted to determine best practice in postoperative, clean surgical incision management, including sternotomy wounds.
authors.affiliation: Carilion Clinic, Roanoke, VA; email: cdjennings@carilionclinic.org.
authors.forename: Cathy
authors.initials: C
authors.lastname: Dickinson Jennings
authors.affiliation: Carilion Clinic, Roanoke, VA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Culver Clark
authors.affiliation: Carilion Clinic, Roanoke, VA.
authors.forename: Joseph W
authors.initials: JW
authors.lastname: Baker
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001458:Bandages / Q000009:adverse effects*; D006801:Humans; D059408:Pain Management / Q000379:methods; D011182:Postoperative Care / Q000379:methods / Q000592:standards*; D011446:Prospective Studies; D012834:Silver / Q000627:therapeutic use; D056346:Sternotomy / Q000009:adverse effects* / Q000451:nursing*; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D000900:Anti-Bacterial Agents; D012834:Silver