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

Totty, Joshua Philip

Medicine
June 2019

Thesis or dissertation


Rights
© 2019 Joshua Philip Totty. All rights reserved. No part of this publication may be reproduced without the written permission of the copyright holder.
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.

Publisher
Hull York Medical School, The University of Hull and The University of York
Supervisor
Chetter, Ian; Smith, George E., MD
Qualification level
Doctoral
Qualification name
MD
Language
English
Extent
4 MB
Identifier
hull:17719
QR Code