Dermacyn® Irrigation in Reducing Infection of a Median Sternotomy Wound

Mohd, Abdul Ramzisham Rahman; Ghani, Mohd Khairulasri; Awang, Raflis Ruzairee; Min, Joanna Ooi Su; Dimon, Mohd Zamrin

doi:10.1532/hsf98.20091162

Cited by 9 publications

(8 citation statements)

References 15 publications

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“…There may be more infections in wounds irrigated with povidone iodine compared with Dermacyn. The RR for Mohd 2010 was 2.80 (95% CI 1.05 to 7.47; 190 participants). This would represent an absolute difference of 95 more SSIs per 1000 people treated with povidone iodine than with superoxidised water (95% CI 3 more to 341 more).…”

Section: Resultsmentioning

confidence: 99%

“…Different antibacterial irrigants compared (six studies) ( Dashow 1986 ; Mohd 2010 ; Oller 2015 ; Peterson 1990 ; Tighe 1982 ; Vallance 1985 )…”

Section: Resultsmentioning

confidence: 99%

“…One study compared povidone iodine with superoxidised water irrigation (Dermacyn) in 190 participants undergoing coronary artery bypass graft (CABG) (classed as clean) ( Mohd 2010 ).…”

Section: Resultsmentioning

confidence: 99%

“… Mohd 2010 reported deaths together with the need for reopening of the chest due to bleeding. There were four deaths in total but it was not clear in which group they occurred.…”

Section: Resultsmentioning

confidence: 99%

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Intracavity lavage and wound irrigation for prevention of surgical site infection

Norman

Atkinson

Smith

et al. 2017

Cochrane Database of Systematic Reviews

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BackgroundSurgical site infections (SSIs) are wound infections that occur after an operative procedure. A preventable complication, they are costly and associated with poorer patient outcomes, increased mortality, morbidity and reoperation rates. Surgical wound irrigation is an intraoperative technique, which may reduce the rate of SSIs through removal of dead or damaged tissue, metabolic waste, and wound exudate. Irrigation can be undertaken prior to wound closure or postoperatively. Intracavity lavage is a similar technique used in operations that expose a bodily cavity; such as procedures on the abdominal cavity and during joint replacement surgery.ObjectivesTo assess the effects of wound irrigation and intracavity lavage on the prevention of surgical site infection (SSI).Search methodsIn February 2017 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase and EBSCO CINAHL Plus. We also searched three clinical trials registries and references of included studies and relevant systematic reviews. There were no restrictions on language, date of publication or study setting.Selection criteriaWe included all randomised controlled trials (RCTs) of participants undergoing surgical procedures in which the use of a particular type of intraoperative washout (irrigation or lavage) was the only systematic difference between groups, and in which wounds underwent primary closure. The primary outcomes were SSI and wound dehiscence. Secondary outcomes were mortality, use of systemic antibiotics, antibiotic resistance, adverse events, re-intervention, length of hospital stay, and readmissions.Data collection and analysisTwo review authors independently assessed studies for inclusion at each stage. Two review authors also undertook data extraction, assessment of risk of bias and GRADE assessment. We calculated risk ratios or differences in means with 95% confidence intervals where possible.Main resultsWe included 59 RCTs with 14,738 participants. Studies assessed comparisons between irrigation and no irrigation, between antibacterial and non-antibacterial irrigation, between different antibiotics, different antiseptics or different non-antibacterial agents, or between different methods of irrigation delivery. No studies compared antiseptic with antibiotic irrigation.Surgical site infectionIrrigation compared with no irrigation (20 studies; 7192 participants): there is no clear difference in risk of SSI between irrigation and no irrigation (RR 0.87, 95% CI 0.68 to 1.11; I2 = 28%; 14 studies, 6106 participants). This would represent an absolute difference of 13 fewer SSIs per 1000 people treated with irrigation compared with no irrigation; the 95% CI spanned from 31 fewer to 10 more SSIs. This was low-certainty evidence downgraded for risk of bias and imprecision.Antibacterial irrigation compared with non-antibacterial irrigation (36 studies, 6163 participants): there may be a lower incidence of SSI in participants treated with antibacterial ir...

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Section: Resultsmentioning

confidence: 99%

“…Different antibacterial irrigants compared (six studies) ( Dashow 1986 ; Mohd 2010 ; Oller 2015 ; Peterson 1990 ; Tighe 1982 ; Vallance 1985 )…”

Section: Resultsmentioning

confidence: 99%

“…One study compared povidone iodine with superoxidised water irrigation (Dermacyn) in 190 participants undergoing coronary artery bypass graft (CABG) (classed as clean) ( Mohd 2010 ).…”

Section: Resultsmentioning

confidence: 99%

“… Mohd 2010 reported deaths together with the need for reopening of the chest due to bleeding. There were four deaths in total but it was not clear in which group they occurred.…”

Section: Resultsmentioning

confidence: 99%

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Intracavity lavage and wound irrigation for prevention of surgical site infection

Norman

Atkinson

Smith

et al. 2017

Cochrane Database of Systematic Reviews

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“…However, there are also a few studies supporting the prophylactic use of antiseptic substances (e.g. polyhexanide, povidone‐iodine, betadine solution and superoxidised water) to lower the rate of surgical site infections (Table ). Despite the paucity of evidence from further well‐designed studies, the recommendation for the prophylactic use of antiseptic agents in critically contaminated wounds is justified.…”

Section: Npwti: Prophylaxis In Contaminated Surgical Extremity Woundsmentioning

confidence: 99%

Recommendations on negative pressure wound therapy with instillation and antimicrobial solutions – when, where and how to use: what does the evidence show?

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Scheuermann-Poley

Willy

2013

International Wound Journal

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Infections of contaminated or colonised acute or chronic wounds remain a grave risk for patients even today. Despite modern surgical debridement concepts and antibiotics, a great need exists for new therapies in wound management. Since the late 1990s, advantageous effects of negative pressure wound therapy (NPWT) have been combined with local antiseptic wound cleansing in the development of NPWT with instillation (NPWTi). This article summarises the current scientific knowledge on this topic. MEDLINE literature searches were performed on the subject of negative pressure wound and instillation therapy covering publications from the years 1990 to 2013 (36 peer-reviewed citations) and regarding randomised controlled trials (RCTs) covering wound care with bone involvement (27 publications) or soft-tissue wounds without bone participation (11 publications) from 2005 to 2012. The use of NPWTi in the therapy of infected wounds appears to be not yet widespread, and literature is poor and inhomogeneous. However, some reports indicate an outstanding benefit of NPWTi for patients, using antiseptics such as polyhexanide (concentration 0·005-0·04%) and acetic acid (concentration 0·25-1%) in acute and chronic infected wounds and povidone-iodine (10% solution) as prophylaxis in contaminated wounds with potential viral infection. Soaking times are recommended to be 20 minutes each, using cycle frequencies of four to eight cycles per day. Additionally, the prophylactic use of NPWTi with these substances can be recommended in contaminated wounds that cannot be closed primarily with surgical means. Although first recommendations may be given currently, there is a great need for RCTs and multicentre studies to define evidence-based guidelines for an easier approach to reach the decision on how to use NPWTi.

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Akute Maßnahmen beim „limb salvage“-Prozedere Teil 2

Willy

Stichling

Müller³

et al. 2016

Unfallchirurg

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The quality of the primary care of Gustilo-Anderson (GA) type IIIB and IIIC extremity injuries is crucial to the success of the limb salvage procedure. This article provides a compilation of consistent, but often controversially discussed aspects of initial debridement, modern techniques of lavage and wound closure, in addition to current issues on the application of antibiotics and antiseptics, based on our own experiences and the latest literature. The following points should be stressed. Severe extremity injuries with gross contamination (GA IIIA, B, and C) will still be associated with an infection rate of up to 60 %. The initial debridement should be performed as soon as an experienced trauma surgeon is available. Tissue that is definitely avital will have to be removed, whereas traumatized but potentially surviving tissue will have to be re-evaluated during a second-look operation after 36-48 h. Given a high enough level of contamination, biofilms will form after as few as 6 h. The perioperative antibiotic prophylaxis has to be initiated early and should be continued for at least 24 h (GA I/II) or up to 5 days (GA III). In cases of bacterial contamination, wound irrigation will be useful with additives such as polyhexanide, octenidine or superoxidized water. Rinsing of the wound should be performed with 3-9 L and only slight manual pressure (no jet lavage). The definitive primary closure of a wound should be achieved in the initial operation, but only in the case of certain "decontamination" and overall vitality of the wound (GA I and II). In the presence of high-grade injuries, a temporary vacuum sealing technique can be used until the earliest possible definitive plastic surgical wound closure.

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Dermacyn® Irrigation in Reducing Infection of a Median Sternotomy Wound

Abstract: We found Dermacyn to be safe and more effective as a wound-irrigation agent than povidone-iodine for preventing sternotomy wound infection.

Cited by 9 publications

References 15 publications

Intracavity lavage and wound irrigation for prevention of surgical site infection

Intracavity lavage and wound irrigation for prevention of surgical site infection

Recommendations on negative pressure wound therapy with instillation and antimicrobial solutions – when, where and how to use: what does the evidence show?

Akute Maßnahmen beim „limb salvage“-Prozedere Teil 2

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