Investigating the effectiveness of dialkylcarbamoylchloride-coated wound dressings in the prevention of surgical site infection

Totty, Joshua Philip

Abstract

Background: Surgical site infection (SSI) is the second most common healthcare acquired infection and may complicate between 5 and 30% of all surgical procedures. Avoidance of antibiotic or antimicrobial agents is important to future prevention strategies due to increasing levels of microbial resistance. When impregnated into post-operative dressings, dialkylcarbamoylchloride (DACC) non-selectively binds bacteria at the wound surface which may prevent ingress into the wound thus reducing SSI rates.

Methods: Following a systematic review of the evidence, two studies were undertaken; the first a non-randomised before-and-after study in which 100 consecutive patients received a control dressing and the following 100 patients received a DACC-coated dressing; and the second a pilot feasibility randomised controlled trial in which 144 patients were recruited and randomised to receive either a DACC-coated dressing or a control dressing.

Results: In the first study, the rate of SSI at 5-7 days was significantly lower in the DACC group compared to standard dressings (1% Vs 10%, p < 0.05). There was no difference in the rates of SSI at 30 days (10% vs 19%, p = 0.11). In the second study, at 30 days, there was a 36.9% Relative risk reduction in SSI associated with the DACCcoated dressing (16.22% vs 25.71%, odds ratio 0.559, p = 0.161). In patients who had a prosthetic implant, there was a reduction of SSI from 24% to 7.7% at 30 days (OR 0.264, p = 0.109). In terms of feasibility, 43.5% of screened patients were successfully randomised in the study, with a retention rate of 76.4% across the trial.

Conclusions: The work in this thesis has shown that DACC-coated dressings show a promising effect in the reduction of SSI, and that a large randomised study is both feasible and justifiable. This pilot data justifies the completion of a wider multicentre study to further assess the clinical and cost effectiveness of this dressing technology.

Citation

Totty, J. P. Investigating the effectiveness of dialkylcarbamoylchloride-coated wound dressings in the prevention of surgical site infection. (Thesis). Hull York Medical School, the University of Hull and the University of York. https://hull-repository.worktribe.com/output/4222026

• Thesis Type: Thesis
• Deposit Date: Dec 6, 2019
• Publicly Available Date: Feb 23, 2023
• Keywords: Medicine
• Public URL: https://hull-repository.worktribe.com/output/4222026
• Additional Information: Hull York Medical School, The University of Hull and The University of York
• Award Date: Jun 1, 2019