Study shows no benefits in use of sterile dressings

Less expensive dressings fared well

A pilot study conducted at the University of San Francisco indicates that sterile dressing changes offer no wound healing advantage over clean dressing changes for patients recovering from open surgical wounds.1 

The purpose of the study was to determine if there was a difference in the rate of wound healing and the cost of supplies between sterile and clean postoperative dressing change techniques. According to the authors, "Recent work examining the effect of bioburden on healing suggests that clean technique may not substantially decrease healing, nor increase the rate of infection." 

Thirty subjects (15 men and 15 women, mean age of 40.6 years) participated in the investigation. All underwent abdominal surgical procedures with wounds healing by secondary intention. Subjects were randomly assigned to receive either clean or sterile dressings. A basin with either sterile or clean supplies was placed at the bedside of each subject and was used by the nursing staff to care for the wound. Intervention was begun on the first postoperative day and repeated three times a day until discharge from the hospital. 

Wound volume at the beginning of the study ranged from 1.4 to 34.6 cm3, and from 0.9 to 46.0 cm3 at the end of the study. No significant differences in wound volume were found between the two groups. In each study group, about half of the wounds increased in size and half decreased. 

Statistical analysis showed that sterile technique was significantly more expensive. The average cost of a single dressing change using sterile supplies was $21.97, compared with $12.38 using clean supplies. 

Data from this study showed no difference in the rate of wound healing with the use of clean vs. sterile technique. The investigators added several cautionary notes to their work, including the following: 

• The scope of their work was limited. 

• Follow-up lasted for less than a week, which "does not capture the period of rapid proliferation of granulation tissue." 

• The sample size was small. 

• The study addressed wound bioburden only through gross examination for the presence of pus. 

• The time differential between techniques was not evaluated (nursing time is one of the most expensive aspects of wound care). 

They note that their findings need to be confirmed through a larger sample and longer-term follow-up.

1. Stotts, NA, Barbour S, Griggs K, et al. Sterile versus clean technique in postoperative wound care of patients with open surgical wounds: A pilot study. J Wound Ost Cont Nurs 1997; 24:10-18.