Summary of Clinical Issue Assignment | Essay Help Services

Permalink: https://www.arthroplastyjournal.org/article/S0883-5403(16)30648-9/fulltext

Abstract

Background: Commercial silver-impregnated occlusive dressings (such as AQUACEL® Ag SURGICAL Cover

Dressing) have been touted as antimicrobial dressings to be used following total joint arthroplasty. Given

the increased cost of an AQUACEL® Ag SURGICAL Cover Dressing over a standard dressing for total joint

arthroplasty, the objective of this study was to determine whether AQUACEL® Ag SURGICAL Cover

Dressing is effective in reducing the rates of acute periprosthetic joint infection (PJI) compared to

standard sterile dressing.

Methods: We retrospectively reviewed the charts of 1173 consecutive patients who underwent a total

knee or total hip arthroplasty between 2007 and 2015 by 1 surgeon. The surgeon switched from using a

standard xeroform/gauze dressing to an AQUACEL® Ag SURGICAL Cover Dressing in June 2011, with no

other major changes in antimicrobial management. Charts were reviewed for evidence of acute PJI

(within 3 months of surgery).

Results: There were a total of 11 cases of acute PJI in this patient cohort (0.94%). The incidence of acute PJI

for patients managed with a sterile xeroform dressing was 1.58% (9 of 568 patients), compared to 0.33%

(2 of 605 patients) with the use of AQUACEL® Ag SURGICAL Cover Dressing. Univariate analysis showed

this to be statistically significant (P ¼.03), and a multiple logistic regression model supported AQUACEL®

Ag SURGICAL Cover Dressing as a protective factor with an odds ratio of 0.092 (95% confidence interval,

0.017-0.490; P ¼ .005).

Conclusion: This 4-fold decrease in acute PJI with the use of AQUACEL® Ag SURGICAL Cover Dressing

supports the use of silver-impregnated occlusive dressings for the reduction of acute PJI.

Permalink: https://www.journalacs.org/article/S1072-7515(15)00334-8/fulltext

Abstract

BACKGROUND: Several pre- and intraoperative factors have been associated with incisional surgical site infection

(SSI), but little is known about the influence of postoperative wound care and especially,

the use of different dressings on incisional SSI. The aim of this study was to compare 3

methods of wound dressings (conventional dressing, silver-containing dressing, and mupirocin

ointment dressing) for their ability to prevent SSI, as measured by SSI rates, in patients

with colorectal cancer undergoing elective open surgery.

STUDY DESIGN: A prospective, randomized study was performed. Inclusion criteria were diagnosis of colorectal

neoplasms and plans to undergo elective surgery with curative aims. Patients were randomized

using a 1:1:1 allocation into 3 groups: patients receiving an ionic silver-containing

dressing (ISD) (group 1), a mupirocin ointment application (MOA) (group 2), and a conventional

dressing (group 3 or standard dressing). The primary outcomes variable was

occurrence of incisional SSI. Follow-up was 30 days postoperatively.

RESULTS: A total of 147 patients were included, 49 in each group. Incisional SSI occurred in 9 patients

(18.4%) in the ISD group, 2 (4.1%) in the MOA group, and 10 (20.4%) in the standard

dressing group (p ¼ 0.028). Adjusting for multiple comparisons, there were no significant

differences between ISD and standard dressing groups; a significant difference was observed

between ISD and MOA (relative risk [RR] 4.5; 95% CI (1.1 to 19.8); p ¼ 0.046) and between

the standard group and the MOA group (RR 5; 95% CI (1.2 to 21.7); p ¼ 0.031).

CONCLUSIONS: Topical application of mupirocin ointment achieves better results for the prevention of SSI than

ionic silver-containing dressing or standard dressing in patients undergoing elective open colorectal

surgery. (JAmColl Surg 2015;221:424e429.2015 by the American College of Surgeons)

Permalink: https://www.ncbi.nlm.nih.gov/pubmed/23448590

Abstract

Background: The use of silver for the treatment of various maladies or to prevent the transmission of infection

dates back to at least 4000 b.c.e. Medical applications are documented in the literature throughout the 17th and

18th centuries. The bactericidal activity of silver is well established. Silver nitrate was used topically throughout

the 1800s for the treatment of burns, ulcerations, and infected wounds, and although its use declined after World

War II and the advent of antibiotics, Fox revitalized its use in the form of silver sulfadiazine in 1968.

Method: Review of the pertinent English-language literature.

Results: Since Fox’s work, the use of topical silver to reduce bacterial burden and promote healing has been

investigated in the setting of chronic wounds and ulcers, post-operative incision dressings, blood and urinary

catheter designs, endotracheal tubes, orthopedic devices, vascular prostheses, and the sewing ring of prosthetic

heart valves. The beneficial effects of silver in reducing or preventing infection have been seen in the topical

treatment of burns and chronic wounds and in its use as a coating for many medical devices. However, silver has

been unsuccessful in certain applications, such as the Silzone heart valve. In other settings, such as orthopedic

hardware coatings, its benefit remains unproved.

Conclusion: Silver remains a reasonable addition to the armamentarium against infection and has relatively few

side effects. However, one should weigh the benefits of silver-containing products against the known side effects

and the other options available for the intended purpose when selecting the most appropriate therapy.

Periprosthetic joint infection (PJI)

dressings (conventional dressing, silver-containing dressing,

and mupirocin ointment dressing) for their ability to prevent

SSI, as measured by SSI rates, in patients with colorectal cancer

undergoing elective open surgery.”

(AQUACEL® Ag SURGICAL Cover Dressing) when compared to standard sterile surgical dressings more effective in

reducing the rates of acute PJI?

and mupirocin ointment dressing, which is the most effective at preventing SSIs after elective open colorectal surgery?

supports the use of silver-impregnated occlusive dressings for the reduction of acute PJI.”

dressing or standard dressing in patients undergoing elective open colorectal surgery.”

(Where did the study take place?)

study evaluated post-operative application of silver nylon dressings following colorectal surgery and found a significantly lower rate of surgical site infection in the silver-treated group. A before-and-after cohort trial

demonstrated similar significant results after lower-extremity

vascular reconstruction.”

the use of this silver-impregnated occlusive dressing compared to a

sterile xeroform dressing,” as well as a greatly increased cost difference. “In the United States, these dressings cost approximately $40 each, compared to $2-3 for a standard gauze and xeroform dressing, which can lead to significant increased costs given the ~1,000,000 TJA procedures performed annually.”

not helpful on surgical incisional sites not infested with bacteria. Because a povidone-iodine application over the

wound, just after the staple  placement, has become a

routine procedure, bacterial colonization would be

reduced with this procedure, maybe justifying the absence of clinical relevance of this device.”

colorectal, or lower extremity

revascularizations and shorter time to re-epithelialization of skin

graft donor sites.”

routine use of silver for this

application.”

Permalink: https://www.sciencedirect.com/science/article/abs/pii/S0305417914002526?via%3Dihub

Abstract

Background: Non-extensive superficial partial thickness burns constitute a major proportion of burns. Conventional treatment involves regular changing of absorptive dressings including the application of a topical antimicrobial, commonly silver sulfadiazine. A systematic review has found insufficient evidence to support or refute such antimicrobial prophylaxis. Another review compared silver sulfadiazine dressings with other occlusive and non-antimicrobial dressings and found insufficient evidence to guide practice. Other research has suggested that dressings with petrolatum gel are as effective as silver sulfadiazine.

Methods: Single-center, randomized, controlled parallel group trial comparing conventional silver sulfadiazine dressings with treatment with petrolatum gel alone. Consenting adults 18–45 years old with superficial partial thickness burns 10% total body surface area seen within 24 h of the injury were randomized to daily dressing either with petrolatum gel without top dressings or conventional silver sulfadiazine treatment with gauze dressings. Primary outcomes were blinded assessment of time to complete re-epithelialization, wound infection or allergic contact dermatitis. Secondary outcomes included assessment of ease, time and pain of dressing changes.

Results: 26 patients were randomized to petrolatum and 24 to silver sulfadiazine dressings. Follow up data available for 19 in each group. Mean time to re-epithelialization was 6.2 days (SD 2.8) in the petrolatum group and 7.8 days (SD 2.1) in the silver sulfadiazine group.

Permalink: https://www.sciencedirect.com/science/article/abs/pii/S0305417918303991?via%3Dihub

Abstract

The aim of this systematic review with meta-analysis was to compare the effect of Silver

Sulfadiazine (SSD) with other new dressings, with or without silver, on healing and infection prevention in burns. The electronic search was carried out in the electronic databases of Pubmed,ScienceDirect, Lilacs and BVS. The articles included were randomized clinical trials about burn treatment with SSD, which evaluated the healing and infection of burn wounds in humans. The exclusion criteria included articles, editorials and letters published in the form of abstracts, unpublished reports and case series, cross-sectional, observational experimental studies, and the use of sulfadiazine for other types of wounds. The search identified

873 references, and 24 studies were included in accordance with the eligibility criteria. The results showed a statistically favorable difference related to the time of healing for silver dressings (p<0.0001; MD 3.83; 95% CI 2.03–5.62) and dressings without silver (p<0.007; MD 2.9; 95% CI 0.81–5.00) in comparison with SSD. The rate of infection showed no difference in the group treated with SSD compared with the group treated with dressings containing silver (p>0.05). The rate of infection was significantly higher in the SSD group compared with the group treated with dressings without silver (p<0.005; MD 25.29% and MD 12.97%). Considering the clinical trials conducted up to the present time, the authors concluded that new dressings with and without silver show better results than SSD for wound healing, and burns treated with dressings without silver are less likely to become infected than burns with SSD. No differences between SSD and new silver materials were observed in relation to infection prevention.

silver-containing          dressing             combination in            decreasing risk             of surgical site             infection: an             RCT. Journal of          Wound Care             20(12): 561-568.         DOI:10.12968/jo            wc.2011.20.12.5         61

Permalink: https://www.ncbi.nlm.nih.gov/pubmed/22240882

Abstract

Objective: To perform a comparative assessment of the efficacy of total occlusive ionic silver containing dressing (TOISD) combination vs no dressing after colorectal surgery.

Method: The surgical sites from both groups were swabbed and sent for culture and sensitivity upon wound closure (superficial incisional skin surface) in the operating theatre, as a baseline for bacterial colonization. The patients’ surgical wounds in the study group were dressed with TOISD combination and the patient’s surgical wounds in the control group received the conventional method

of no dressing. A second swab was taken from the superficial incisional skin surface for culture and sensitivity investigation between the fifth to seventh postoperative day for comparison of the bacterial colonisation in the two groups.

Results: One-hundred and sixty-six patients were recruited. Six patients dropped out before the fifth

postoperative day, leaving 79 patients in the control group and 81 patients in the study group. Microbial swab cultures revealed significant differences between the two groups (p < 0.001, mean=1.43 ± 0.63) in bacterial colonisation. The odds ratio (OR) of patients with wounds in the control group was 4.1 (95%CI is 1.884, 8.964) more likely to be contaminated with bacteria compared with wounds covered with

occlusive ionic silver-containing dressing.

Conclusion: TOISD was found to be effective in reducing bacterial colonisation on the surgical site compared with no dressing. However, it properties were unable to be put into use if there were the

surgical sites were not infested with bacterial. Although TOISD might not be necessarily on surgical incisional site not infested with bacteria for the initial post-operation days, it is helpful in preventing

further transcription and division for opportunistic bacteria, thus might reduce the risk of superficial

incisional SSI. The use of TOSID though statistically insignificant compared to no dressing, could also be possible in reducing the risk and exaceration of deep incisional SSI.

sulfadiazine with standard gauze dressings for the

treatment of superficial partial thickness burns in

adults.”

treatment of superficial partial thickness burns in

adults” increase the healing time?

(SD 2.8) in the petrolatum group and 7.8 days (SD 2.1) in the silver sulfadiazine group.”

With and without silver show better results than SSD for wound healing, and burns treated with dressings without silver are less likely to become infected than burns with SSD. No differences between SSD and new silver materials were observed in relation to infection prevention.”

(Where did the study take place?)

Hospital acute setting ward, Bukit Merah, Singapore

infection or allergic contact dermatitis. Secondary outcomes included assessment of ease,

time and pain of dressing changes.

Results: 26 patients were randomized to petrolatum and 24 to silver sulfadiazine dressings.

Follow up data available for 19 in each group.”

investigating the treatment of burns with SSD which evaluated the healing and infection of wounds in humans; full articles

published in national and international periodicals; indexed in the Lilacs, ScienceDirect, BVS, and Pubmed electronic databases from 2000 to 2016; and published in Portuguese, English, or Spanish. The following exclusion criteria were established: articles, editorials, and letters published in the form of abstracts, unpublished studies, case reports, case series, cross-sectional, observational, and experimental studies, and those in animals. In addition we excluded studies which

used SSD for any other type of wound, or evaluated outcomes other than those established in our objective.”

surgery between May 2010 and April 2011. Potential participants were identified from the daily inpatient elective list for colorectal surgery.”

incidence of wound infection and incidence of adverse

reactions including allergic contact dermatitis (ACD).” Also, “Secondary outcomes included dressing adherence, ease of dressing removal, time taken to change dressing, number of dressing changes and reapplications during the day, and pain during dressing changes and removal of dressings.”

study period.” In relation to the results of the study, it states “ TOISD

properties are only exploited when the sites are infested with bacteria, although the results also indicate that it may help to prevent further transcription

and division of opportunistic bacteria,

and thus reduce the risk of superficial incisional SSI.”

an effective, affordable and widely available alternative to the

standard silver sulfadiazine gauze dressings.”

restore burn lesions. There is immediate need for conducting RCTs with adequate methodological quality and high statistical

power to investigate the effectiveness of SSD and silver dressings for preventing infection in patients with burns.”