Experiences implementing hydrocolloid dressings after caesarean section
Despite increasing interest in reduction of surgical site infection (SSI) after caesarean section, there is limited evidence around optimal dressing choice. We report the experience of a secondary hospital in regional New Zealand changing from a basic contact dressing to a hydrocolloid dressing over a three-month period, reporting SSI rates, midwifery and nursing experience, and cost.
A retrospective cohort study of hydrocolloid dressings for caesarean sections over three months, compared with basic contact dressings in caesarean sections in the same period one year previously. We report wound swabs with significant growth; results from a survey sent to midwifery and nursing staff; and cost per dressing, as well as the number of dressing changes before discharge.
In the hydrocolloid group (n=94) four patients had significant growth on wound swabs (4.3%, 95% confidence interval (CI): 0–10.6%) compared with six patients in the basic contact group (n=117) (5.1%, 95% CI: 1.0–7.1%). Only 9/20 (45%) midwives reported that they liked the hydrocolloid dressings, compared with 19/21 (90%) liking the basic contact dressings, primarily due to difficulty removing the dressings. When accounting for the number of dressing changes on the ward, the cost per caesarean section was $5.11 NZD for hydrocolloid dressings, compared with $5.72 NZD for basic contact dressings.
Our initial experience with a change to hydrocolloid dressings showed promising results with regard to SSI rates, as well as a cost reduction. This, however, is to be balanced with dressings that are potentially more difficult to remove, resulting in reduced midwifery and nursing satisfaction.
There is increasing interest in reducing the rate of surgical site infection (SSI) after caesarean section, with increasing evidence for holistic care bundles to improve outcomes.1,2 These bundles can generally be divided into antenatal, peri-operative and postnatal components, with varying amounts of evidence for each individual component. One peri-operative component which has limited evidence and conflicting guidance is choice of surgical site dressing.3
There are multiple factors to consider when identifying the optimal dressing, including: cost; availability (at both regional and hospital level); SSI prevention; obstetrician preference; midwifery and nursing preference; acceptability to the patient; and stratification by patient risk factors (the most important factor being obesity4). Compared with non-obstetric laparotomies, caesarean section presents a unique scenario, where the patient is typically caring for a neonate (and potentially other children) as well as undergoing the physiological changes of the puerperium. The patient, therefore, is likely to be less well rested, and may have greater priorities than their own recovery, nutrition and care of the surgical wound.
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