Surgery is expected to help the body heal and solve an ailment. In many cases, however, it results in complications and infections that have a negative outcome. A 2020 article published in the International Journal of Surgery estimates a total of 310 million major surgeries are performed globally each year, with rates of readmission within 30 days between 5-15% and morbidity rates between 1-4%.[1]
According to MD Anderson Cancer Center, about 60% of people diagnosed with cancer will undergo surgery as part of their treatment plan. Even a minor surgery to insert a port can result in a variety of infections that can lead to a subsequent hospitalization.
Patient compliance and education are always going to play a critical role in mitigating the risks of infection. Not properly following post-surgical care protocols naturally increases the opportunity for an infection to occur. But with the modern technologies now available in health care, it is clear that surgical site infections (SSI) are a plague on the health care system that need to be addressed with a greater scope of research and solutions.
The Centers for Disease Control (CDC) analyzed healthcare-associated infections (HAI) and published findings attributing 20% of HAIs to SSIs.[2] It also found that SSI is the costliest type of HAI, with estimated annual costs of US $ 3.3 billion.[3] SSIs are responsible for extending hospital stays on average by 9.7 days with reported increased costs of US $ 20,000 per admission.[4]
Hospitals and surgical centers have taken steps to improve infection control practices. Guidelines for surgical preparation on the part of the patient and health care providers have been updated to reflect the findings of recent research, and new protocols and technologies have been introduced to increase operating room ventilation, improve sterilization methods, and advance surgical techniques. Yet the wound coverings used on surgical sites rely on technology that is often over one hundred years old, especially after a patient is discharged.
Adhesive bandage
The first adhesive bandage was introduced to consumers in 1921. The design was created by Earle Dickson (October 10, 1892; Grandview, Tennessee -September 21, 1961; Kitchener, Canada) who worked at a leading pharmaceutical company. His wife Josephine Knight was constantly experiencing knicks and burns in the kitchen and he was inspired to create a better wound covering for her than cotton secured with adhesive tape.
The first commercially available bandages were long strips that consumers cut pieces from to tailor fit their needs. Today, there are a variety of bandages available to treat a variety of wound sizes and scopes. These wound coverings all fall short of indicating for the patient when the bandage may need to be changed.
New technologies
A clinical pilot study published in the September 2022 Journal of Wound Care investigated the potential for new technologies in post-surgical wound dressings to impact SSIs post-discharge. The study compared the current use of transparent films to cover surgical wounds with a novel film dressing with a colorimetric indicator that alerts the patient when the dressing has been compromised.
While transparent films are intended to provide a water-resistant covering to protect surgical sites when a patient is showering or performing other activities that could exposed the surgical site to contamination, the challenge that exists is patients may not be able to tell if the integrity of the film covering has been compromised.
By comparison, a DrySee wound covering also provides water-resistant protection with the added security of color-changing gauze that indicates to patients or caregivers if the integrity of the bandage seal has been compromised or if exudate from the wound has saturated the center gauze pad. In the study, 75% of participants reported preference for the film dressing with a colorimetric indicator, with several citing an improved sense of security.
Cancer patients recovering from surgery, whether it was to insert a port, resection, or a restorative procedure, have been shown to benefit from a sense of normalcy. A study published in Occupational Therapy International observed the correlation between advanced cancer patients’ abilities to execute activities of daily living (ADL) and quality of life, finding high observed ADL motor ability was associated with high quality of life.[5]
Providing cancer patients with wound coverings for surgical sites that enable them to engage in ADLs with confidence and without fear can understandably afford comfort during the healing process. Beyond the mental benefit of an improved wound covering, the potential to reduce occurrences of SSIs by simplifying post-surgical wound care for patients deserves further investigation.
Film dressings with a colorimetric indicator could be the next evolution of the bandage that plays a vital role in reducing the costs associated with SSIs.
Reference
[1] Dobson GP. Trauma of major surgery: A global problem that is not going away. Int J Surg. 2020 Sep;81:47-54. doi: 10.1016/j.ijsu.2020.07.017. Epub 2020 Jul 29. PMID: 32738546; PMCID: PMC7388795.
[2] Ban KA, Minei JP, Laronga C, Harbrecht BG, Jensen EH, Fry DE, Itani KM, Dellinger EP, Ko CY, Duane TM. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2017 Jan;224(1):59-74. doi: 10.1016/j.jamcollsurg.2016.10.029. Epub 2016 Nov 30. PMID: 27915053.
[3] Awad SS. Adherence to surgical care improvement project measures and post-operative surgical site infections. Surg Infect (Larchmt). 2012 Aug;13(4):234-7. doi: 10.1089/sur.2012.131. Epub 2012 Aug 22. PMID: 22913334.
[4] Zimlichman E, Henderson D, Tamir O, Franz C, Song P, Yamin CK, Keohane C, Denham CR, Bates DW. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med. 2013 Dec 9-23;173(22):2039-46. doi: 10.1001/jamainternmed.2013.9763. PMID: 23999949.
[5] Brekke MF, la Cour K, Brandt Å, Peoples H, Wæhrens EE. The Association between ADL Ability and Quality of Life among People with Advanced Cancer. Occup Ther Int. 2019 Sep 2;2019:2629673. doi: 10.1155/2019/2629673. PMID: 31531007; PMCID: PMC6745094.
Featured image: 2020 -2023 © DrySee. Used with permission.
