Preventing caesarean section wound complications: use of a silver-impregnated antimicrobial occlusive dressing

Objective: To investigate the role of an adherent soft silicone antimicrobial occlusive foam silver-impregnated dressing for reduction of surgical site infections (SSI) in primary low-transverse caesarean section (1 degrees LTCS) delivery. Method: Women aged 18-45 years admitted to the labour and delivery or the antepartum unit undergoing a 1 degrees LTCS were recruited. Exclusion criteria included repeat caesarean, vertical skin incision, intrapartum fever and closure with staples. Consented participants delivered by scheduled or unscheduled 1 degrees LTCS received the silver-impregnated dressing. Those who declined to participate and were delivered by scheduled or unscheduled caesarean received a standard gauze with tape dressing (controls). Surgical preparation and preoperative antibiotics were administered as per hospital policy. Results: A total of 362 participants were consented for use of the silver-impregnated dressing, with 190 participants undergoing 1 degrees LTCS, of whom 185 were included in the final analysis. Of those who declined to participate, 190 ultimately underwent 1 degrees LTCS during the same time period. Cases and controls were similar in demographics, body mass index, diabetes status, labour and procedure length, and tobacco use. The overall incidence of SSI was 3.7%. A 50% reduction in incidence of SSI was observed in the silver-impregnated dressing group compared with control group (2.7% versus 4.7%, respectively), but this was not statistically significant (p=0.08; odds ratio 0.55; 95% confidence interval: 0.18-1.67). Conclusion: Among women undergoing 1 degrees LTCS with subcuticular closure of a transverse incision, use of a silver-impregnated dressing reduced the rate of SSI by >50% but was not statistically significant.