Dressings used to prevent surgical site infection in the postoperative period of cardiac surgery: integrative review

Vieira, Ana Laura Gomide; Stocco, Janislei Giseli Dorociaki; Ribeiro, Anna Carolina Gaspar; Frantz, Cristina Valéria

Acessibilidade / Reportar erro

Brasil

Revista da Escola de Enfermagem da USP

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Review Article • Rev. esc. enferm. USP 52 • 2018 • https://doi.org/10.1590/S1980-220X2017011803393 copy

Dressings used to prevent surgical site infection in the postoperative period of cardiac surgery: integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To identify and describe which dressings are recommended to prevent surgical site infection in hospitalized adult patients after cardiac surgeries.

Method:

Integrative review carried out in the databases MEDLINE, LILACS, CINAHL, Web of Science, Cochrane and Scopus. Studies related to dressing in the postoperative period of cardiac surgery were selected.

Results:

Seven articles were included, with the following dressings: negative pressure wound therapy, silver nylon dressing, transdermal delivery of continuous oxygen and impermeable adhesive drape. The dressings that led to reduction of infection were negative pressure and silver nylon dressings.

Conclusion:

It was not possible to identify which dressing is most recommended, however, some studies show that certain types of dressings were related to the reduction of infection. Clinical trials with a rigorous methodological design and representative samples able to minimize the risk of bias should be conducted to evaluate the effectiveness of dressings in the prevention of surgical site infection.

DESCRIPTORS
Cardiovascular Nursing; Thoracic Surgery; Surgical Wound Infection; Review

ID	Title	Country/Year	Design	Intervention	Outcomes	Evaluation Instrument
A1⁽¹⁷17. Grauhan O, Navasardyan A, Hofmann M, Müller P, Stein J, Hetzer R. Prevention of poststernotomy wound infections in obese patients by negative pressure wound therapy. J Thorac Cardiovasc Surg. 2013;145(5):1387-92. DOI: http://dx.doi.org/10.1016/j.jtcvs.2012.09.040 http://dx.doi.org/10.1016/j.jtcvs.2012.0... ⁾	Prevention of post sternotomy wound infections in obese patients by negative pressure wound therapy	Germany 2013	Prospective case-control observational	Case – negative pressure wound therapy (Prevena™ – Incision Management System) Control – conventional sterile dressings	Infection Case – Three of 75 (4%) patients presented infection Control – 12 of 75 (16%) (OR= 4.57; CI95%= 1.23-16.94, p = 0.026)	NOS^* * NOS – Newcastle-Ottawa Scale. The NOS score ranges from zero to nine. A study can receive one star (*) for each item numbered within the “Selection” and “Outcome” categories. A maximum of two stars can be assigned for each item in the “Comparability” category(16). The maximum number of stars that each study can receive is nine. 6
A2⁽¹⁸18. Bakri M, Nagem H, Sessler D, Mahboobi R, Dalton J, Akça O, et al. Transdermal oxygen does not improve sternal wound oxygenation in patients recovering from cardiac surgery. Anesth Analg. 2008;106(6):1619-26.⁾	Transdermal Oxygen Does Not Improve Sternal Wound Oxygenation in Patients Recovering from Cardiac Surgery	United States, 2008	Randomized	Intervention – transdermal continuous oxygen therapy (EpiFLO^® oxygen generators) Control – transdermal continuous oxygen therapy (innactive EpiFLO^® oxygen generators)	Reduction of infection Increasing FiO₂ from 30% to 50% increased arterial oxygen from 99 (84 –116) to 149 (128 –174) mmHg (p < 0.001)and sternal wound tissue oxygen tension from 23 (16 –33) to 27 (19 –38) mmHg (p < 0.001) Local oxygen delivery did not improve tissue oxygenation: 24 (14-41) vs. 25 (16-41) mmHg (p=0.88)	JADAD^ The final score of the Jadad Scale ranges from 0 to 5 points: studies that receive scores <3 are classified as low quality and studies with scores ≥ 3 have high methodological quality(15). 5
A3⁽¹⁹19. Huckfeldt R, Redmond C, Mikkelson D, Finley P, Lowe C, Robertson J. A clinical trial to investigate the effect of silver nylon dressings on mediastinitis rates in postoperative cardiac sternotomy. Ostomy Wound Manage. 2008;54(10):36-41.⁾	A Clinical Trial to Investigate the Effect of Silver Nylon Dressings on Mediastinitis Rates in Postoperative Cardiac Sternotomy	United States, 2008	Retrospective/prospective study, observational	Case – silver nylon dressing (Silverlon^® Island Dressing) Control – standard gauze dressings	Mediastinitis Case – no patient (0%) developed mediastinitis Control – 13 patients (1.1%) developed mediastinitis (χ2 = 3.88, p<0.05).	NOS^* * NOS – Newcastle-Ottawa Scale. The NOS score ranges from zero to nine. A study can receive one star (*) for each item numbered within the “Selection” and “Outcome” categories. A maximum of two stars can be assigned for each item in the “Comparability” category(16). The maximum number of stars that each study can receive is nine. 6
A4⁽²⁰20. Segers P, de Jong AP, Spanjaard L, Ubbink DT, de Mol BA. Randomized clinical trial comparing two options for postoperative incisional care to prevent poststernotomy surgical site infections. Wound Repair Regen. 2007;15(2):192-6.⁾	Randomized clinical trial comparing two options for postoperative incisional care to prevent poststernotomy surgical site infections	The Netherlands, 2007	Randomized trial	Intervention – water and air impermeable adhesive drape (Opsite™). Control – water- and air-permeable absorbent dressing (Hansapor™).	Surgical site infection There was no significant difference in the incidence of sternal surgical site infection between groups (2.6 vs. 3.3%)	JADAD^ The final score of the Jadad Scale ranges from 0 to 5 points: studies that receive scores <3 are classified as low quality and studies with scores ≥ 3 have high methodological quality(15). 3
A5⁽²¹21. Colli A, Camara ML. First experience with a new negative pressure incision management system on surgical incisions after cardiac surgery in high risk patients. J Cardiothorac Surg [Internet]. 2011 [cited 2017 Jan 21];6:160. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3305521 https://www.ncbi.nlm.nih.gov/pmc/article... ⁾	First experience with a new negative pressure incision management system on surgical incisions after cardiac surgery in high risk patients	Spain, 2011	Prospective cohort, observational	Negative pressure wound therapy (Prevena™ – Incision Management System) The dressing contains ionic silver (0.019%)	Complete wound healing Wounds and surrounding skin showed complete wound healing with the absence of skin lesions due to the negative pressure after removal of the Prevena™ dressing.	NOS^* * NOS – Newcastle-Ottawa Scale. The NOS score ranges from zero to nine. A study can receive one star (*) for each item numbered within the “Selection” and “Outcome” categories. A maximum of two stars can be assigned for each item in the “Comparability” category(16). The maximum number of stars that each study can receive is nine. 3
A6⁽²²22. Grauhan O, Navasardyan A, Tutkun B, Hennig F, Müller P, Hummel M, et al. Effect of surgical incision management on wound infections in a poststernotomy patient population. Int Wound J. 2014;11 Suppl 1:6-9.⁾	Effect of surgical incision management on wound infections in a post sternotomy patient population	Germany, 2014	Prospective cohort, observational	Control – conventional sterile wound tape dressings Intervention – negative pressure wound therapy (Prevena™ – Incision Management System)	Wound infection within 30 days. Significantly lower infection rate than control group: 1.3% (3 patients) vs. 3,4% (119 patients), respectively (OR = 2.74; p<0.05)	NOS^* * NOS – Newcastle-Ottawa Scale. The NOS score ranges from zero to nine. A study can receive one star (*) for each item numbered within the “Selection” and “Outcome” categories. A maximum of two stars can be assigned for each item in the “Comparability” category(16). The maximum number of stars that each study can receive is nine. 7
A7⁽²³23. Atkins B, Wooten M, Kistler J, Hurley K, Hughes G, Wolfe W. Does negative pressure wound therapy have a role in preventing poststernotomy wound complications? Surg Innov. 2009;16(2):140-6.⁾	Does Negative Pressure Wound Therapy Have a Role in Preventing Post sternotomy Wound Complications?	United States, 2009	Retrospective cohort, observational	Negative pressure wound therapy	Infection No cases of sternal wound infection were found	NOS^* * NOS – Newcastle-Ottawa Scale. The NOS score ranges from zero to nine. A study can receive one star (*) for each item numbered within the “Selection” and “Outcome” categories. A maximum of two stars can be assigned for each item in the “Comparability” category(16). The maximum number of stars that each study can receive is nine. 4

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author: Ana Laura Gomide Vieira, Rua General Carneiro, 181 – Bairro Alto da Glória, CEP 80060-900 – Curitiba, PR, Brazil analaura.gov@gmail.com