Here - EWMA 2013

E-POSTER PRESENTATIONS
EP 488
IN VITRO ASSESSMENT OF ABSORBENCY AND RETENTION OF
MICROORGANISMS
E-Poster: Dressings
Valerie Edwards-Jones 1 , Pam Spruce 2
1 Manchester Metropolitan University (Manchester, United Kingdom);
2 TVRE Consulting (Stoke-On-Trent, United Kingdom).
Chronic wound exudate contains harmful microorganisms which can delay healing.
Absorbent dressings are used to manage exudate and retain microorganisms.
Aim: To determine the absorbency and retention of microorganisms by 4 dressings.
Methods: Phosphate buffered saline containing a known number of microorganisms
was absorbed into 4 different wound dressings under 60mm Hg pressure. The amount
of fluid and numbers of microorganisms absorbed into the dressings was determined at
4 and 24hrs. Four microorganisms were used, Escherichia coli, Pseudomonas
aeruginosa, methicillin resistant Staphylococcus aureus and Candida albicans:
Results: A similar amount of fluid was absorbed by all four dressings at 4hrs, but
dressing 2** absorbed the highest volume over the 24hr period.
The sequestration and retention of microorganisms into the dressings varied depending
upon microorganism and the time period.
At 4hrs, Dressing 3*** retained more E.coli, Dressing 4**** retained more P.aeruginosa
and Candida albicans, and Dressing 2** retained more MRSA.
At 24hrs, Dressing 3*** retained more Gram negative bacteria, than the other dressings
and Dressing 2** retained more MRSA and Candida albicans than the other dressings.
Conclusions: The absorbency of the dressings varied over the two different time
periods. Retention of microorganisms in the dressing varied depending upon their Gram
type. This may have been due to an electrostatic interaction between the microorganism
and the dressing.
* Advadraw (Advencis), ** Drawtex (Beier), *** Aquacel Extra (Convatec), *****Urgoclean (UrgoMedical)
E-POSTER: DRESSINGS
EP 489
E-Poster: Dressings
Guidelines for the use of an incision management system after
median sternotomy
Ammar Mustafa 1 , Shady Ashraf 1 , Nasser Mughal 1 , Cornelia Carr 1 , Abdulaziz Alkhulaifi 1
1 Heart Hospital, Hamad Medical Corporation (Doha, Qatar).
Guidelines for the use of Negative Pressure Wound Therapy (NPWT) after Cardiac
Surgery
Postoperative wound complications following cardiac surgery, deep sternal infections in
particular, are associated with increased morbidity and mortality. Negative Pressure
Wound Therapy (NPWT) is well established in the management of infected sternal
wounds. However, it is a relatively new modality of treatment for clean and surgical
incisions. We have been utilizing NPWT for the last 6 months in the treatment of
sternotomy incisions in patients considered high risk for complications such as surgical
site infection and wound dehiscence.
There are no specific clinical indications in the literature for the use of NPWT following
cardiac surgery. We have looked at our 6 months experience with this type of dressing to
check if we can define some indications.
We propose the following clinical guidelines for the use of NPWT post cardiac surgery: 1.
Obese patients with Body Mass Index >30. 2. Uncontrolled diabetes (HbA1c>8%). 3.
Bilateral internal mammary artery harvesting. 4. Heavy smoking and COPD. 5. Fragile
sternum and fractured sternum during sternotomy. 6. Delayed primary closure of sternal
wound. 7. Further meian sternotomies after first time (for “redo” operations).
We applied NPWT to 47 patients with one or more of these criteria immediately after
closure of the sternotomy wound. The dressing was removed after 6-7 days. The primary
end point was the development of wound complications within 30 days. 1 patient
developed a sternal wound infection (2.1%) compared to 5 patients (10.6%) from a
similar control group of 47 patients (no NPWT).
We have also used NPWT after secondary closure of 3 thigh wounds that had to have
haematomas evacuated at the sites of long saphenous vein harvesting for Coronary
Artery Bypass Grafting (CABG) with good results. In conclusion, NPWT may have
additional benefits in preventing complications in high risk patients as a primary or a
secondary dressing. We are currently planning for further studies regarding the use of
NPWT for clean surgical incisions.
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