Raising standards of orthopaedic wound care: a prospective, comparative evaluation of a modern dressing design

Introduction: Prevention of infection in orthopaedics remains a constant challenge. In spite of increasing evidence to support use of modern dressings many units use traditional adhesive dressings, which can cause wound healing problems. Our modern dressing design hydrofibre/hydrocolloid (HF/HC) was highly effective following hip and knee replacements in a national arthroplasty unit. The aim of this study was to evaluate this dressing in a district hospital to see if similar clinical outcomes could be achieved.
Methods: Prospective evaluation of the modern dressing involved 89 consecutive elective and trauma patients from October 2007–January 2008. Outcome measures included blistering, wear time, dressing changes, delayed discharge and SSI rate. Results were compared to a traditional dressing currently used.
Results: 65 patients HF/HC group, 24 Traditional group. CUSUM tool set an upper alert limit of 5% blister rate. Traditional group breached upper alert limit after 8 cases. It was decided unethical to continue after 24 cases. Comparison of HF/HC with Traditional showed blistering 1.5% versus 16.7%, wear time 4.8 versus 1.4 days and dressing changes 0.9 versus 2.8. Delayed discharge 0% compared with 4.2%. SSI rates 0% versus 4.2%. All outcome differences were statistically significant except delayed discharge (p<0.05, Mann Whitney, chi-square tests).
Conclusion: Implementation of evidence-based modern wound care into a district general orthopaedic department achieved improved clinical outcomes with elective and trauma patients, similar to those of a national arthroplasty unit.This supports the use of the dressing and highlights the ongoing concerns of traditional dressings used in orthopaedics.