dressing changes for OH patients

Specialties CCU

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Specializes in Cardiac surgery.

I have a question for you guys. I am doing a project on sternal dressings. I work on a step down unit, where I receive OH patients POD 1. We are using Silverlon dressings on the sternal incisions, and these dressings are to be worn for 7 days post op. We wash the incisions daily with hibiclens, and the silverlon dressing is to be wet with sterile water twice a day. One of the surgeons did research on this product and it showed to cut the infection rate by 50%. The silverlon dressing to me are interesting. I posted a message on the general nursing forum, and got some replies saying that after the first day post op, the incisions are kept OTA. What dressings (if any) are being used on your OH patients?

Thanks for your input,

Francesca

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Specializes in SICU, Peds CVICU.

We leave them OTA POD1-2, sometimes we betadine them after taking the dressing down, but usually we don't do a lot with them. If they get infected or don't heal well for whatever reason we may use some sort of packing, but that's pretty uncommon.

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Open to air starting POD#2; the incision is epithelialized by then.

Postop wound infection is directly related to intraop technique and good closure, nutrition, adherent sternal prec etc.

Do you have data on these dressings?

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Specializes in Cardiac surgery.

One of the surgeons I know did research on these types of dressings that we use. I am doing a project, and thought it would be interesting to see what others are using with the OH patients. If you would like, I could find the research he did and post it.

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Specializes in CTICU.

You take the silverlon down to wash the incision with CHG? Why?? The silverlon itself is bactericidal. You really only need to re-wet when it dries out. Secondary dressing depends on how much the wound is exudating.

I am not a huge fan of silver dressings as they have been proven to be keratinotoxic and can impair healing and macrophage function.

The dressing I don't think has a huge impact on sternal wound infections - as mentioned, it's generally an issue of excessive bleeding, surgical technique, nutrition state, etc. I would want to focus on those things instead of the sternal dressing if you have high infection rates.

We did a comparative study between plain primapore and other dressings at my last hospital - really didn't make enough of a difference to justify the cost of the silver dressings.

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Specializes in Cardiac surgery.

Thank you all for your input. I am doing a project for one of my classes and you all have been a great help!

Thanks,

Francesca

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Specializes in CTICU.

PS: If you want a great antibacterial dressing that also has excellent healing properties, try MediHoney!

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ghillbert,

I would like to comment on your reply - "I am not a huge fan of silver dressings as they have been proven to be keratinotoxic and can impair healing and macrophage function."

You are right here. But not all "silver dressings" are the same. Hospitals that have experienced what you are referring to are using a silver product called Acticoat. When Acticoat is moistened and applied to the wound, the metallic silver on the dressing actually falls off and gets dumped into the wound. If any of you have used Acticoat, you'll notice the the dressing turns the wound black or grey. This is called staining or tattooing due to the metallic silver falling into the wound. Metallic silver is toxic in itself and will slow down the healing process as well as impair macrophage function. This is considered to be a "dirty" delivery system. We NEVER want to deposit metallic silver into the wound because of this reason.

Silverlon is 99.99% pure metallic silver PERMANENTLY BOUND onto nylon and will NOT shed any metallic silver into the wound. All you get is the silver ions which is what actually kills the bacteria. It'll kill MRSA in 30 minutes to an hour - all without dumping metallic silver into the wound and speeding up the healing. It also has been shown to reduce inflammation and act as a topical anesthetic due to the conductive value of the dressing. If any of you have any experience with TENS units, you'll know exactly how the pain is decreased by delivering a low current to the affected area. Silverlon will absolutely reduce infections by a minimum 50%.

There is a reason why the US military (Marines, Army, Navy) is all exclusively using Silverlon Dressings for all personnel in Afghanistan, Iraq, and all military hospitals throughout the world as well as some of the most prestigious teaching hospitals in the US. It has been proven to significantly reduce infections in the most austere settings. The best part is that it can be re-used on the same patient because the silver is permanently bound to the dressing. Simply rinse it in sterile/distilled/tap water to remove excess exudates and apply back on patient. When Silverlon Negative Pressure Dressings are used with any wound VAC, the dressings are no longer changed out 3X per week. It's only done once per week. Still the wounds are healing 40% faster than Wound VAC alone being changed out 3X per week.

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