Optimizing Infection Prevention in Open Abdominal Surgery: The Role of Plastic Wound Protectors
Rethinking Infection Prevention in Gastrointestinal Surgery
Surgical site infections (SSIs) remain a significant challenge in open abdominal gastrointestinal (GI) surgery, particularly in contaminated or clean-contaminated cases. Recent research1 underscores the efficacy of dual-ring plastic wound protectors in dramatically reducing SSI rates compared to conventional surgical gauze. These findings mark a pivotal step forward in enhancing patient safety and surgical outcomes.
Evidence Supporting Plastic Wound Protectors
A multicenter randomized clinical trial conducted across 13 academic hospitals in South Korea between 2017 and 2022 assessed the efficacy of plastic wound protectors in reducing SSIs in open GI surgeries. The trial included 457 adult patients with a mean age of 58.4 years, of whom 56% were male. Participants were randomly assigned to receive either a dual-ring plastic wound protector (n = 229) or conventional surgical gauze (n = 228).
The study's primary endpoint was the rate of SSI within 30 days post-surgery. Researchers observed an overall SSI rate of 15.7%, with 10.9% in the wound protector group and 20.5% in the gauze group.
“Plastic wound protectors were effective in reducing the incidence of SSIs in open abdominal GI surgeries compared with traditional surgical gauze,” noted Yoo et al.
The wound protector group demonstrated a 46.81% relative risk (RR) reduction for SSIs (95% CI, 16.64–66.06) overall. Among patients with clean-contaminated wounds, the reduction reached 43.75% (95% CI, 3.75–67.13), while superficial SSIs saw a 42.5% reduction (95% CI, 7.16–64.39).
Implications for Clinical Practice
The findings strongly support the integration of plastic wound protectors into standard practice for open abdominal GI surgeries.
“In the intraoperative period, the use of a wound protector device is recommended to reduce the rate of [surgical site infection (SSI)] in clean-contaminated, contaminated, and dirty abdominal surgical procedures,” Yoo et al. wrote in JAMA Surgery.
Notably, no significant differences were observed between the two groups in postoperative hospital stay (mean, 15.2 vs. 15.3 days) or complication rates (20.1% vs. 18.8%).
Balancing Effectiveness and Sustainability
Despite their proven clinical benefits, plastic wound protectors pose challenges regarding cost-effectiveness and environmental sustainability.
“Innovative efforts should concentrate on making these devices more environmentally sustainable while maintaining their effectiveness in infection prevention, prioritizing patient safety alongside ecological responsibility,” Yoo et al. emphasized.
This dual focus on clinical outcomes and environmental stewardship represents an evolving priority in modern surgical practice.
Next Steps for Adoption
The World Health Organization (WHO) has conditionally recommended the use of wound protectors in contaminated and dirty surgical procedures, although evidence quality remains low. This study provides robust data supporting their efficacy, especially in high-risk settings. Surgical teams should consider adopting plastic wound protectors in appropriate cases while exploring ways to mitigate their environmental impact.
Yoo, N., Mun, J. Y., Kye, B.-H., Kim, C. W., Lee, J. I., Park, Y. Y., Kang, B. M., Park, B. K., Kwak, H. D., Kang, W.-K., Bae, S. U., Oh, H.-K., Hong, Y., & Kim, H. J. (2024). Plastic wound protector vs surgical gauze for surgical site infection reduction in open GI surgery: A randomized clinical trial. JAMA Surgery, 159(7), 737. https://doi.org/10.1001/jamasurg.2024.0765