Reducing Surgical Site Infections in C-Section Using a Novel Silver-Plated Dressing

Author(s):
Sue Grant; Amanda Budak

Background:

Surgical Site Infections (SSI) after caesarean section have been reported from 3-15 percent in the published literature.  There are multiple ramifications to a SSI in an early post-partum mother, including but not limited to: extended pain, additional cost of managing the infection, and the potential for re-hospitalizations to treat the infection.

Hypothesis:

Changing the clinical protocol for managing wounds from a silver chloride dressing to a silver plated nylon dressing will decrease the incidence of post c-section wound infections.

Methods:

The study was performed at a community-based hospital in Pennsylvania that performs approximately 750 deliveries annually with a 31.3% C-Section rate.  The hospital has reported a monthly SSI rate of 3-10% on an ongoing basis.  When plotted and analyzed over time, there appeared to be a trend toward sustained higher infection rates.  This led the facility to evaluate current post-surgical wound dressing and infection prevention protocols.  The hospital followed a standardized SSI prevention bundle which included the use of a silver chloride impregnated dressing (Aquacel AG) over the surgical incision.

Due to increasing infection rates, and patient reports of discomfort and difficulty removing the silver chloride impregnated dressing (Aquacel AG), and based on the body of published evidence, the hospital elected to switch to a silver-plated nylon dressing.  Retrospective data were gathered to confirm the specific protocol used for skin prep during the baseline period in which the silver chloride impregnated dressings were used, and additional patient data were gathered including age, BMI, type of c-section procedure (elective versus emergent), size of delivered infant, and the presence of co-morbidities, and pre-eclampsia. Upon switching to the silver-plated nylon dressing, all other aspects of the SSI prevention protocol were unchanged.

Results:

After the change in protocol to the silver-plated dressing, and over the course of twelve consecutive months, the department of labor and delivery reported zero surgical site infections.

The findings of this retrospective analysis demonstrate the effectiveness of a silver-plated nylon dressing as part of a bundle to help prevent SSI in c-section patients.  While small in scope, these findings suggest use of Silverlon silver-plated nylon dressings has a positive impact on SSI rates associated with c-section, and the need for a larger study to demonstrate statistically significant results.

Conclusions:

Switching to a silver plated nylon dressing decreased the overall incidence of post operative surgical site infections.