Introduction to be about 0.5-8%. In cases of

Introduction

Wound is an injury to living
tissue caused by a cut, blow, or other impact, typically one in which the skin
is cut or broken. There are a lot of different products used to treat different
types of wounds. However, the efficacy of products used in reducing the rates
of infection has yet to confirm. Povidone Iodine(PVI) is an antiseptic that was
used to help to reduce infection on simple suture and superficial wounds and
Gentamicin collagen sponge will help reduce any surgical site wounds internally
as a topical appendage. Studies have shown that wound infection occurs roughly
3-5% of traumatic wounds that are repaired in EDs however varies on some
factors such mechanism of injury, wound location and patient health status (Ghafouri
et al, 2016). Postoperative sternal wound infections were also reported to be
about 0.5-8%. In cases of deep sternal wound infections, it was associated with
high death rates of 14% to 47% (Schimmer et al, 2012). There is also a wide range
in the incidence of sternal wound infection in transplant patients around
4%-40% (Urbanowicz et al, 2015). The purpose of the review is to compare what products
are effective in reducing wound infections. In relevance to nursing, nurses who
are in the research sector, they are able to take into account the product that
were mentioned and implement the products in acute setting.

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Products
used in reducing wound infections

Ghafouri, Zare, Bazrafshan, Abazarian and Ramim (2016)
conducted a randomized controlled trial study to determine the effect of PVI as
a skin disinfectant in preventing simple traumatic wound infection after repair
in emergency departments. However in Schimmer, Özkur, Sinha, Hain and Gorski et
al (2012) research, they did first controlled, prospective, randomized, double-blind,
single-center study to investigate the efficacy of a retrosternal
gentamicin-collagen sponge in reducing sternal wound complications after heart
surgery. In Ghafouri et al (2016) study, a total of 443 patients were screened
but 37 patients were excluded as they did not meet the inclusion criteria hence
only 406 patients were part of the study. They were randomly assigned into
either experiment or control groups and were given adequate local anaesthesia
by injecting lidocaine 1% in wound edges at the beginning of wound management.
Wounds were irrigated with normal saline solution in the control group whereas
in the experiment group, wounds were primarily irrigated with normal saline
solution and then PVI 10% was rubbed on the intact skin 5cm apart from the wounds
and was covered with sterile cotton gauzes. In Schimmer et al (2012) study, a
total of 720 patients were enrolled and 353 of them were assigned to the
intervention group and the 367 patients were assigned to control group. 400
pure collagen sponges and 400 identical gentamicin-collagen sponges were used. After
complete adaptation of the pericardium and preliminary placement of the sternal
wiring, the study sponge was implanted retrosternally without premoistening.
Sternal wiring was then performed. The closure techniques used were
trans-/peristernal, figure of 8 or band cerclages. The wound was then closed in
layers of sutures and covered with a sterile dressing. Each patient was regularly
given perioperative prophylaxis with intravenous cefuroxime (1.5g twice a day)
starting 30 minutes before the operation for up to 48 hours postoperatively. The
results for Ghafouri et al (2016) study, observed infection rate was 8.7% (19
patients, odds ratio= 1.5, 95% confidence interval 0.76-2.97) in the experiment
group and 5.8% (13 patients, odds ratio= 0.96. 95% confidence interval 0.92-1.02)
in the control group. The rates were not statistically significant between
these two groups (odds ratio=1.5, 95% confidence interval 0.74-3.23, P=0.236).
On the other hand about the results for Schimmer et al (2012) study, the
incidence of SSWI and DSWI was 11 patients (3%) and 13 patients (3.52%)
respectively in the control group. 7 patients (1.98%) and 2 patients (0.56%)
respectively in the intervention group. The non-infection probability in the
follow-up period was significantly higher in the intervention group than in the
control group. From the two studies, it is shown that Gentamicin collagen
sponges are more efficient in reducing the infection rates unlike PVI. The
group that had PVI on had a higher percentage of infections which in my
opinion, already showing a bad sign to using it as an antiseptic agent to reduce
the rate of infection. Thus, Gentamicin collagen sponges had significantly DSWI.

 

Efficacy
of Gentamicin collagen sponge in reduction of wound infection

Urbanowicz, Straburzy?ska-Migaj, Buczkowski, Grajek and Jemielity
(2015) conducted a retrospective, single-center study to investigate Gentamicin
collagen sponge application as a means of mitigating infection in patients
going through heart transplantation procedures. A total of 75 patients was
enrolled in the study. The intervention group consists of 25 patients who
underwent orthotopic heart transplantation. Gentamicin collagen sponge was
inserted intraoperatively between the sternal borders before chest closure in
all patients. The control group that did not receive any sponge application was
composed of 50 patients who underwent cardiac surgery. The results in Urbanwicz
et al (2015) study showed that there were no bacterial sternal wound infections
or sternal disability in the heart transplant group. None of the patients had
wound healing problems. However, two patients (4%) in the cardiac surgery group
had deep sternal wound infections requiring surgical intervention. One patient
underwent sternal wound debridement and retrosternal drainage administration
for 7 days and 1 patient underwent vacuum application for 10 days. Similarly,
results in Schimmer et al (2012) study showed that the intervention group that
has Gentamicin collagen sponge application had a lower rate of SSWI AND DSWI
infections (1.98%) and (0.56%) respectively than the control group which only
had pure collagen sponge applications having the infection rates at 3% for SSWI
and 3.52% for DSWI. This shows that gentamicin collagen sponge application is
effective in mitigating infections.

 

Conclusion

It was interesting knowing that there are such products
that are able to significantly reduce the rate of infections by physically
putting it in the body before doing a surgical closure. I am also sure that
hospitals are not using PVI as an antiseptic for wound care since during my
clinical attachments, normal saline solutions are constantly used for wound care.
I was suggesting in future research, gentamicin collagen sponges can be made in
another way where it can be used for superficial wounds, not only for surgical
procedures. There were definitely some gaps as far as what exactly is contained
in the Gentamicin collagen sponge, what are some cardiac surgeries did the
patients specifically went through, and some words that were not properly
defined. But all in all, Gentamicin collagen sponge is definitely an effective
prophylaxis.