Advanced dressings for the prevention of surgical site infection in women post-caesarean section: A systematic review and meta-analysis
•Surgical site infection prevention post-caesarean is of the utmost importance.•Surgical site infection incidence poses clinical and economic implications.•Dialkylcarbamoyl chloride dressings prevent surgical site infection post-caesarean.•Silver dressings do not effectively prevent surgical site in...
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| Published in: | European journal of obstetrics & gynecology and reproductive biology Vol. 267; pp. 226 - 233 |
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| Main Authors: | , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
Ireland
Elsevier B.V
01-12-2021
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| Subjects: | |
| Online Access: | Get full text |
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| Summary: | •Surgical site infection prevention post-caesarean is of the utmost importance.•Surgical site infection incidence poses clinical and economic implications.•Dialkylcarbamoyl chloride dressings prevent surgical site infection post-caesarean.•Silver dressings do not effectively prevent surgical site infection post-caesarean.•Further trials of advanced dressings post-caesarean section are required.
Surgical site infections (SSIs) are a common complication post-caesarean section. Advanced dressings aim to provide an optimal wound environment, primarily by physically or chemically controlling moisture, in order to promote timely healing. A systematic review and meta-analysis was conducted to evaluate the effectiveness of advanced dressings in SSI prevention post-caesarean section. Secondary effectiveness outcomes included superficial SSI, endometritis, wound dehiscence, rehospitalisation and length of rehospitalisation.
We conducted a systematic review and meta-analysis according to PRISMA guidelines. A protocol was registered a priori. MEDLINE, EMBASE, CENTRAL and CINAHL databases were searched from inception to May 2021, without date or language restrictions. Keywords included: caesarean section; bandages; dressing and surgical wound infection. Randomised controlled trials (RCTs) were included if they investigated any advanced dressing in women post-caesarean section compared to simple dressings and assessed SSI incidence. Relative risks (RR), with 95% confidence intervals (CIs) and p-values, were calculated using Review Manager software (RevMan version 5.0, The Cochrane Collaboration). I2 percentages were reported to assess heterogeneity and a funnel plot was produced to assess publication bias. Quality assessment was performed using the Cochrane Risk of Bias Assessment Tool. All data were double-extracted and discrepancies were finalised by a third reviewer.
From 253 citations identified, six RCTs were included in the systematic review and meta-analysis. Two studies investigated dialkylcarbamoyl chloride (DACC)-impregnated dressings; two investigated silver-impregnated dressings; one investigated copper-impregnated dressings and one investigated chlorhexidine gluconate dressings. The overall meta-analysis showed that advanced dressings did not reduce SSI risk (RR 0.81 [95% CI 0.52–1.24; p = 0.32]). However, subgroup analysis revealed that DACC-impregnated dressings reduced SSI risk (RR 0.33 [95% CI 0.14–0.77; p = 0.01]). Silver-impregnated dressings caused a nonsignificant increase in SSI risk (RR 1.20 [95% CI 0.77–1.88; p = 0.41]). All studies showed a high risk of bias.
This systematic review and meta-analysis suggests DACC dressings potentially reduce SSI. However we have shown no benefit of silver dressings. Further high-quality RCTs are required to recommend a change in clinical practice. |
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| Bibliography: | ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Undefined-3 |
| ISSN: | 0301-2115 1872-7654 |
| DOI: | 10.1016/j.ejogrb.2021.11.014 |