Silver Impregnated Dressing Does Not Decrease Incidence of Surgical Site Infection After Sternotomy Incision for Adult Cardiac Surgery
Vignesh Raman1, Kelly Thompson-Brazill2, Kathy Kane2, Charles D. Harr2, Abdul G. Chaudhry2, Robert M. Hunter2, Bryon B. Boulton2, William A. Killinger2, Judson B. Williams2 , 1Duke University Health System, Durham, NC, 2WakeMed Health and Hospitals, Raleigh, NC
OBJECTIVE: Sternal wound infections (SWI) complicate 1-8% of cardiac surgeries and carry significant morbidity. We investigated the utility of silver impregnated dressing in decreasing SWIs after coronary artery bypass graft (CABG).
METHODS: A single-institution retrospective cohort study was performed as part of a trial of a new sternal dressing. 557 sternotomy cases were performed in 2015 with application of a traditional gauze (TG) dressing. In 2016, 682 sternotomy cases were performed with use of a commercially-available silver-impregnated dressing (SD). Prospectively identified metrics were analyzed for each patient population along with structured questionnaires of patients in the SD group.
RESULTS: Baseline characteristics of patients in TG and SD groups were similar. Morbidity and mortality were similar. Nine (1.6%) and 12 (1.8%) SWIs were reported in TG and SD groups, respectively. The number of organ space infections (3) and deep sternal wound infections (3) were the same; however, the number of superficial infections was greater in the SD year (3 vs. 6). There was no difference in the rate of SWIs (p=0.80). Amongst patients in either group with SWI, there were no differences in the proportion of superficial infections (44% vs. 50%; p=0.8) or the microbiological organism cultured (67% vs. 50% staphylococcus; p=0.45). 22% of patients reported not satisfied with SD after median dressing duration of 5 days. Pain and erythema upon removal were the most frequent complaints.
CONCLUSIONS: Silver dressings did not mitigate risk of SWI after sternotomy for cardiac surgery. Traditional gauze represents an equally effective and more economical choice in dressing sternotomies.