Siah C J, Yatim J
Singapore General Hospital, Singapore.
J Wound Care. 2011 Dec;20(12):561-8. doi: 10.12968/jowc.2011.20.12.561.
To perform a comparative assessment of the efficacy of total occlusive ionic silver-containing dressing (TOISD) combination vs no dressing after colorectal surgery.
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 colonisation. 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.
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.
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.
对结直肠手术后使用含离子银的全封闭敷料（TOISD）组合与不使用敷料的疗效进行比较评估。
两组手术部位在手术室伤口闭合时（浅表切口皮肤表面）进行擦拭并送检培养及药敏试验，作为细菌定植的基线。研究组患者的手术伤口用TOISD组合敷料包扎，对照组患者的手术伤口采用不使用敷料的常规方法处理。在术后第5至7天从浅表切口皮肤表面再次取样进行培养及药敏试验，以比较两组的细菌定植情况。
共招募了166例患者。6例患者在术后第5天前退出，对照组剩余79例患者，研究组剩余81例患者。微生物拭子培养显示两组在细菌定植方面存在显著差异（p<0.001，均值=1.43±0.63）。与使用含离子银封闭敷料覆盖的伤口相比，对照组伤口患者被细菌污染的优势比（OR）为4.1（95%CI为1.884, 8.964）。
与不使用敷料相比，TOISD在减少手术部位细菌定植方面有效。然而，如果手术部位没有细菌感染，其特性就无法发挥作用。虽然在术后初期，TOISD不一定适用于没有细菌感染的手术切口部位，但它有助于防止机会性细菌的进一步转录和分裂，从而可能降低浅表切口手术部位感染（SSI）的风险。与不使用敷料相比，使用TOSID虽然在统计学上不显著，但也有可能降低深部切口SSI的风险和加重程度。
