Silver-Impregnated Dressing Does Not Decrease Incidence of Surgical Site Infection after Adult Cardiac Surgery

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Sternal wound infections complicate 1% to 8% of cardiac surgeries and carry significant morbidity. We investigated the utility of silver-impregnated dressing in decreasing sternal wound infections after sternotomy cases. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A single-institution cohort study was performed as part of a quality improvement trial of a new sternal dressing. Five hundred fifty-seven sternotomy cases were performed in 2015 with application of a traditional gauze dressing. In 2016, 682 sternotomy cases were performed with the use of a commercially available silver-impregnated dressing. Prospectively identified metrics were analyzed for each patient population along with nursing assessments and structured questionnaires. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Baseline characteristics of patients in traditional gauze and silver-impregnated dressing groups were similar. Morbidity and mortality were similar. Nine (1.6%) and 12 (1.8%) sternal wound infections were reported in traditional gauze and silver-impregnated dressing groups, respectively. There was no difference in the rate of sternal wound infections ( P = 0.80). The number of organ space infections (3) and deep sternal wound infections (3) was the same; however, the number of superficial infections was greater in the silver-impregnated dressing cohort (3 vs. 6). Among patients in either group with sternal wound infection, there were no differences in the proportion of superficial infections (44% vs. 50%, P = 0.8) or the organism cultured (67% vs. 50% staphylococcus, P = 0.45). A total of 22% of patients reported “not satisfied” with silver-impregnated dressing. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> Silver dressings did not reduce sternal wound infection after sternotomy for cardiac surgery in a large-cohort study. We discontinued the routine use of silver dressings for adult cardiac surgery based on these results because traditional gauze likely represents an equally effective and less costly alternative. </jats:p></jats:sec>

Treatment of Cardiac Surgical Wounds with Silver Dressings

“…Our study did not indicate benefit with the use of SD to prevent mediastinitis or even superficial sternal infections. The incidence of infection in our study population was similar to what was reported in the literature, and like Raman, 22 we were not able to reproduce the promising results reported by Huckfeldt 25 in 2004. This may suggest institutional-specific bias present in Huckfeldt's study.…”

“…23 More recently, Raman also reported no difference between silver and gauze in a single center retrospective study of adult cardiac patients. 22 The findings reported in the literature were variable, making the clinical significance of SD unclear.…”

“…But the reproducibility of these findings was variable, and the pursuit of high-quality data slowed down. [22][23][24][25] However uncertain, the potential to save one patient from suffering this complication instituted a department wide change to use silver dressings in all cardiothoracic surgical patients.…”