title: Dressings for the prevention of surgical site infection.
abstract: Surgical wounds (incisions) heal by primary intention when the wound edges are brought together and secured, often with sutures, staples, or clips. Wound dressings applied after wound closure may provide physical support, protection and absorb exudate. There are many different types of wound dressings available and wounds can also be left uncovered (exposed). Surgical site infection (SSI) is a common complication of wounds and this may be associated with using (or not using) dressings, or different types of dressing.
  
  
  
  To assess the effects of wound dressings compared with no wound dressings, and the effects of alternative wound dressings, in preventing SSIs in surgical wounds healing by primary intention.
  
  
  
  We searched the following databases: the Cochrane Wounds Specialised Register (searched 19 September 2016); the Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library 2016, Issue 8); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations, MEDLINE Daily and Epub Ahead of Print; 1946 to 19 September 2016); Ovid Embase (1974 to 19 September 2016); EBSCO CINAHL Plus (1937 to 19 September 2016).There were no restrictions based on language, date of publication or study setting.
  
  
  
  Randomised controlled trials (RCTs) comparing wound dressings with wound exposure (no dressing) or alternative wound dressings for the postoperative management of surgical wounds healing by primary intention.
  
  
  
  Two review authors performed study selection, 'Risk of bias' assessment and data extraction independently.
  
  
  
  We included 29 trials (5718 participants). All studies except one were at an unclear or high risk of bias. Studies were small, reported low numbers of SSI events and were often not clearly reported. There were 16 trials that included people with wounds resulting from surgical procedures with a 'clean' classification, five trials that included people undergoing what was considered 'clean/contaminated' surgery, with the remaining studies including people undergoing a variety of surgical procedures with different contamination classifications. Four trials compared wound dressings with no wound dressing (wound exposure); the remaining 25 studies compared alternative dressing types, with the majority comparing a basic wound contact dressing with film dressings, silver dressings or hydrocolloid dressings. The review contains 11 comparisons in total.
  
  
  
  SSIIt is uncertain whether wound exposure or any dressing reduces or increases the risk of SSI compared with alternative options investigated: we assessed the certainty of evidence as very low for most comparisons (and low for others), with downgrading (according to GRADE criteria) largely due to risk of bias and imprecision. We summarise the results of comparisons with meta-analysed data below:- film dressings compared with basic wound contact dressings following clean surgery (RR 1.34, 95% CI 0.70 to 2.55), very low certainty evidence downgraded once for risk of bias and twice for imprecision.- hydrocolloid dressings compared with basic wound contact dressings following clean surgery (RR 0.91, 95% CI 0.30 to 2.78), very low certainty evidence downgraded once for risk of bias and twice for imprecision.- hydrocolloid dressings compared with basic wound contact dressings following potentially contaminated surgery (RR 0.57, 95% CI 0.22 to 1.51), very low certainty evidence downgraded twice for risk of bias and twice for imprecision.- silver-containing dressings compared with basic wound contact dressings following clean surgery (RR 1.11, 95% CI 0.47 to 2.62), very low certainty evidence downgraded once for risk of bias and twice for imprecision.- silver-containing dressings compared with basic wound contact dressings following potentially contaminated surgery (RR 0.83, 95% CI 0.51 to 1.37), very low certainty evidence downgraded twice for risk of bias and twice for imprecision. Secondary outcomesThere was limited and low or very low certainty evidence on secondary outcomes such as scarring, acceptability of dressing and ease of removal, and uncertainty whether wound dressings influenced these outcomes.
  
  
  
  It is uncertain whether covering surgical wounds healing by primary intention with wound dressings reduces the risk of SSI, or whether any particular wound dressing is more effective than others in reducing the risk of SSI, improving scarring, reducing pain, improving acceptability to patients, or is easier to remove. Most studies in this review were small and at a high or unclear risk of bias. Based on the current evidence, decision makers may wish to base decisions about how to dress a wound following surgery on dressing costs as well as patient preference.
authors.affiliation: Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK, M13 9PL.
authors.forename: Jo C
authors.initials: JC
authors.lastname: Dumville
authors.affiliation: Division of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Manchester, UK, M13 9PL.
authors.forename: Trish A
authors.initials: TA
authors.lastname: Gray
authors.affiliation: Colorectal Surgery, Gloucestershire NHS Foundation Trust, Cheltenham General, Sandford Road, Cheltenham, UK, GL53 7AN.
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Walter
authors.affiliation: The Wound Centre, PO Box 3207, Blakehurst, Sydney, New South Wales, Australia, 2221.
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Sharp
authors.affiliation: Royal Adelaide Hospital, Level 4, Margaret Graham Building, North Terrace, Adelaide, Australia, SA5000.|University of Adelaide, Level 3, Eleanor Harrald Building, North Terrace, Adelaide, Australia, SA 5000.
authors.forename: Tamara
authors.initials: T
authors.lastname: Page
authors.affiliation: University of Bristol, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, UK, BS28 2PS.
authors.forename: Rhiannon
authors.initials: R
authors.lastname: Macefield
authors.affiliation: University of Bristol, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, UK, BS28 2PS.
authors.forename: Natalie
authors.initials: N
authors.lastname: Blencowe
authors.affiliation: University of Bristol, School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, UK, BS28 2PS.
authors.forename: Thomas Kg
authors.initials: TK
authors.lastname: Milne
authors.affiliation: School of Clinical Sciences, University of Bristol, Level 7, Bristol Royal Infirmary, Marlborough Street, Bristol, UK, BS2 8HW.
authors.forename: Barnaby C
authors.initials: BC
authors.lastname: Reeves
authors.affiliation: Bristol Centre for Surgical Research, School of Social & Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, UK, BS8 2PS.
authors.forename: Jane
authors.initials: J
authors.lastname: Blazeby
mesh_terms: D000464:Alginates / Q000008:administration & dosage; D001458:Bandages; D047070:Bandages, Hydrocolloid; D001645:Biguanides; D004202:Disinfectants; D006801:Humans; D016032:Randomized Controlled Trials as Topic; D012834:Silver / Q000008:administration & dosage; D013530:Surgical Wound Infection / Q000145:classification / Q000517:prevention & control*; D014945:Wound Healing
chemical_list: D000464:Alginates; D001645:Biguanides; D004202:Disinfectants; C031233:polihexanide; D012834:Silver