Quality improvement evaluation of postoperative wound dressings in orthopaedic patients

Dressings play a key role in postoperative wound care, as clinicians aim to optimise the wound healing environment (including optimal exudate management) and prevent complications such as infection and blistering. Excess exudate can lead to wound breakdown, increased bacterial burden and delaying healing, causing an increased risk of wound infection (superficial) and ultimately increasing the risk of surgical site infection (SSI) (deep infection at the site of the prosthesis). This article describes the evaluation of different postoperative dressings in use within the orthopaedic department of a tertiary hospital, as part of a quality improvement program aimed at evaluating the performance of postoperative dressings and ensuring that the most appropriate dressing is used in the management of postoperative wounds in orthopaedic patients. Seven postoperative dressing types were assessed in 307 orthopaedic patients who had undergone surgery. Post-operative dressings were assessed in terms of their ability to handle exudate (in terms of both 'wet' exudate and 'dry' exudate). User satisfaction of the postoperative dressings was also captured. Dressing change frequency was also recorded. Dressing wear was captured in terms of whether the post-operative dressing under evaluation was still in place at the time the patient was discharged (if the primary dressing required changing, it was replaced with Tegderm™ +Pad, as per current hospital practice.) Most healthcare professionals were satisfied, very satisfied or extremely satisfied with the ease of application of the dressings: Mepore® non-occlusive fabric dressing (96%) (current practice), Opsite® Post-Op Visible (95%), Leukomed® Control (94%), Sorbact® (green) surgical dressing (90%), Mepilex® Border Post-Op (87%), Tegaderm®+Pad (76%) and Aquacel® Ag Surgical (73%). The high satisfaction rates for Mepore® may have been influenced by the familiarity with this dressing which, at the time, was the standard current practice dressing. This dressing was ruled out for future use due to it being non-occlusive. Opsite® Post-Op Visible (second highest rating) was associated with three adverse events. Sorbact® surgical dressing was rated fourth in terms of healthcare professional satisfaction with regards to ease of application but was associated with the highest amount (24%) of wet exudate. Mepilex® Border Post-Op (rated fifth for ease of application; 5% wet exudate) was preferred overall because of its flexibility and small amount of wet exudate, ahead of Leukomed® Control (rated third for ease of application; 12% wet exudate), which had more frequent dressing changes than recommended by the manufacturer. A contributory factor to this may have been the dressing's transparency and the ability to observe the small amount of exudate and the nurse feeling the need to change it. In response to the findings of the quality improvement program, a new protocol of care at the major metropolitan teaching hospital has been implemented; for patients undergoing orthopaedic surgery, Mepilex® Border Post-Op (Mölnlycke) is now routinely applied in theatre and is left intact for 7 days as per the manufacturer's recommendations. Since this change in practice and the introduction of Mepilex® Border Post-Op, the incidence of SSIs at this hospital has reduced.