Search Strategy

There are always millions of surgical procedures conducted around the world every year that majority resulted in surgical wounds. Following the surgical wound closures, the wounds always leak fluids within the first 24 hours as they are frequently covered with different types of dressings such as glue-as- a-dressing aimed at providing the protection to the wound(Rodriguez-Merchan 2012). Studies show that many surgical wounds receive poor dressing procedures exposing the wounds to surgical sites infections that results in more complications and even to deaths. Studies indicate that about seventy-seven per cent of the surgical patient deaths always resulted from the infractions that are directly correlated to the open surgical wounds (Vasconcelos & Cavaco-Paulo 2011). The Centers for Disease Control in the USA reported that considerable advances have been made in the infection control practices such as sterilization methods, using of advanced surgical techniques and antimicrobial prophylaxis, SSI is still a significant cause of morbidity and prolonged hospitalization even deaths. Thus the recognition of the best surgical dressing is the most important issues to address the issue.

The evidence of the study will be retrieved from various databases such as MEDLINE, CIN NL, and Scopus databases systems.  Other sources of the evidence search will be Google Scholars that will be used to receive the literature on the topic under the study. Therefore, using the search terminologies such as ‘surgical wound’ and ‘wound dressing techniques’, the researcher came across 30 peer-reviewed journals and research papers that were between 2011 and 2018.  Applying the search criteria, the researcher found 20 that met the criteria for the literature review and the pilot study.

Surgical wound refers to the cut made at the skin by the surgeon during the operation and at the end, the cut is always joined back together through the use of stitches, strips or adhesive dressings to allow the skin edges to come together and heal (Percival, Mayer & Salisbury 2017). There are 2 major types of wounds following surgery: incisional wounds and excisional wounds. , therefore, after every surgery, the choices of dressing facilitate the healing process of the wound. The incisional wounds are made when the cutting goes through the skin, muscles and fat so that the body part can be repaired or removed. On the other hand, the excisional wounds are made when the surgeon wants to remove a cyst or any other types of tissues.

The dressing is a sterile pad applied on the wound majorly to absorb any leakage from the wound, provide ideal conditions for healing, protect the wound until it is healed and prevent the stitches from catching on cloth. The dressings are designed to be in contact with the wound thus needs to be effective to prevent further infection and facilitate healing (Green 2013). When the wounds are closed with appropriate dressing, they are continuously exposed to the protease, complement, chemotactic and growth factors.

Historically, people used wet-to-dry dressing methods that required debridement. During the 1600 BC, Linen strips were soaked in either oil or grease and then covered with plasters and used to occlude the wounds. In other societies, the wounds were cleaned using milk and water prior to dressing with honey (Arslan, Murat, Aldemir, Kazaro & Gümü-derelio 2014).  In the 19th century, there was a breakthrough when the antiseptic technique was discovered that was used to control infections. In the 20 the century, there was the invention of the occlusive dressing, that provided a moist environment to the wound, facilitating the re-epithelialization process, collagen synthesis and production of the angiogenesis. Among the techniques used was the woven absorbent cotton gauze.

Literature Review

Some of the attributes of an ideal wound dressing include: the ability of the dressing to absorb and contain the exudate without strike through and leakage; the ability of the dressing not to leave any particulate contaminants in the wounds; the ability of the dressing to insulate the wound from thermal ; the ability of the dressing to block the water and bacteria accessing the wound; the ability of dressing to be used in different skin closures; ability of the dressing not to cause wound trauma during the dressing process and ability of the dressing to aid visualization of the wound(Broussard & Powers 2013). The surgical wound dressing is categorized under tow major groups: clean and sterile techniques:

The clean techniques refer to free of dirt, stains or marks and involve all strategies that are used to prevent any microorganism or reduce the transmission risk from one patient to another (Xiao-ling Huang, Jing-qi Zhang, Shu-ting Guan, & Wu-jin Liang 2016). The clean techniques include: hand washing, use of clean gloves and sterile instruments and is always preferred for long-term home care and some clinic setting; for patients with low-risk infections; and for patients receiving continuous dressing for chronic wounds such as venous ulcers.

Sterile techniques refer to strategies that reduce the exposure of the wound to microorganism through the use of sterile gloves, sterile dressing, and sterile surgical instruments. The rule here is that anything used must be sterile in cleaning and dressing the wound and is always considered the most appropriate in acute care hospital setting among high-risk infections patients(Marston, Tang, Kirsner & Ennis 2016). Aseptic technique refers to free from pathogenic microring nazism. The aseptic technique aims at preventing the transfer of organisms from one person to another by reducing the microbe counts to a minimum. No touch techniques refer to the process of changing the dressing surface without directly coming into contact with his wound. In these techniques, clean gloves and sterile solutions are used to maintain the wound and dress it.

The traditional wound dressing products include gauze, plaster, lint, bandages and cotton wool that all aim at keeping the wound dry and protect from the contamination. The gauze dressing is always made out of the woven and nonwoven fibers of cotton, polyester, and rayon that have some sort of protection against bacteria. The sterilized gauze pads with the help of the fibers have the ability to absorb the exudates and fluids in an open wound; however, the dressing type requires frequent changing to protect maceration of the healthy tissues (Shimizu, Ishida, Yamamoto, Kuroyanagi & Kuroyanagi 2014). Due to the wound leakage immediately after the surgical process, the dressing becomes moistened thus becomes adherent to the wound resulting into wound trauma. The gaze dressing is cost-effective since they are cheap, readily available and easy to use.

The bandages are made out of natural cotton wool, cellulose and polyamide materials that have various functions. For example, the cotton wool bandages are used majorly to retain the light dressing, while high and short compression bandages provide sustained compression in venous ulcers (Cirillo, Spizzirri, Curcio, Spataro, Picci, Nicoletta, & Iemma 2016). The Tulle dressing such as rage Batigras, Paratulle, and Jelonet are commonly referred to as the impregnated dressing; since they contain paraffin that suitable for the superficial wounds.  

History of the Wound Dressing

In general, all the traditional wound dressing is designed for clean and dry wounds that have mild exudate. Since most of the traditional dressing fail to provide a moist environment to the fresh wounds, low ability to absorb more exudate, and difficulty in changing among many others disadvantages, they have been replaced by the modern dressing that has advanced formulations.

The first modern wound dressing technique was discovered in the 1980s that aimed at providing moisture and absorbing the fluids from the wound the modern wound dressing is based on the synthetic polymers and is categorized either as passive or non-occlusive. The modern dressings include:

The semi-permeable dressing is composed of transparent and adherent polyurethane that allows the transmission of water vapour, oxygen and carbon (IV) dioxide from the wound as well as provision of autolytic debridement of eschar and preamble bacteria. The first film was made from the nylon derivatives that had an adhesive polyethylene frame for support (Okoye & Okolie 2015).  the nylon derived film dressing are highly elastic and flexible making them conform to any shape and do not require any tapping, secondly, due to the transparent nature the nylon derived film dressing provided easy wound inspection without the removal of the wound dressing. However, the nylon derived film was not used for highly exudating wounds due to their inability to make maximum absorption, thus in most cases resulted into maceration of the healthy tissues thus they are mostly recommended for the epithelializing, superficial and shallow wounds.

The semi-preamble foam dressing is made up from the hydrophobic and hydrophilic foam that contains adhesive borders. The hydrophobic property protects the wound from the liquid while the allowing gaseous exchange between the wound and atmosphere (Wibaux, Thota, Mastej, Prince, Carty & Johnson 2015). The foam has the capability of absorbing various wounds drainage depending on the wound thickness, thus are suitable fi leg ulcers and moderately exudating wounds. However, the foam dressing is limitedly used because they require frequent dressing.

Hydrogels are insoluble hydrophilic materials that are made from the polymers. These materials have high water content about 70-90% thus helps the granulation tissues to have a moist environment, thus facilitate the healing and removal of the dressing without further wound damages (Choi, Kim, Kim, Kim, Yong, Cho & Choi 2016). The hydrogels have the ability to decrease the cutaneous wounds temperature by providing a soothing and cooling effect thus is suitable for the burns wounds, ulcer wounds. The major advantages of this type of dressing are: nonirritant, nonreactive and are a preamble to metabolites. Some of the hydrogels dressings are Initiate, Nu-gel, and Aquaform.

Alginate dressing is made from the sodium and calcium salts that contain mannuronic and guluronic acid salts.  Alginate dressing has the absorption capacity that is derived from the seaweed thus provide strong hydrophilic gel formation limiting the wound exudates and bacterial contamination (Aderibigbe & Buyana 2018). The healing process of the wound is facilitated by the ability of the alginates ability to activate the macrophages that initiate the inflammatory signal. The ions from the alginate dressing are always exchanged with the blood to form a protective film

Attributes of an Ideal Wound Dressing

The bioactive wound dressing is produced from the biomaterials that are significant in the healing process of the wound (Quirós, Boltes & Rosal 2016). The dressings have biodegradable, biocompatible and non-toxic since they are generally derived from the natural tissues (Mohseni, Shamloo, Aghababaei, Vossoughi, & Moravvej 2016). The bioactive dressing included collagen, hyaluronic acid, chitosan, alginate, and elastin.

The literature review aimed at making the researcher understand the background of the surgical wound dressing. Findings from the systematic review and similar documents targeted the researchers on the clinical field. The identified journals provided enough foundation for the researcher to understand the history of the wound dressing, the traditional and modern techniques, and factors considered for selecting an ideal wound dressing method.

The pilot study refers to the research study conducted before the actual intended study. The pilot study will use both the qualitative and quantitative research methods to collect the data regarding the new dressing.

The aim of this pilot study is to collect the experiences and perceptions of both the wound patients and the clinical officers regarding the new wound dressing techniques, this will enable the researcher to make a decision whether to adopt the new technique in the hospital or to discard it (Pettus, Dunnigan, Veeh, Howard, Scheyett & Roberts 2017). The results of the pilot study will also work as a foundation for future research on the wound dressing techniques.

To collect reliable and accurate data, the researcher used the following research questions during the study:

• Research Question 1: How best does the new wound dressing facilitate the healing process?
• Research Question 2: How best does the new dressing protect the wound from contamination?
• Research Question 3: How frequent does the new dressing requires change?
• Research Question 4:What is the reliability of the new wound dressing in terms to nurses?

According to Wulfmeyer, et al., 2018), the research approach aids in collecting the most accurate and relevant information that contain either experimented or observed data. The approach entails all the procedures of data collection, analysis, and interaction based on the nature of the research problem, therefore, in this study, the researcher aims at determining the superiority of the new surgical wound dressing. To accomplish the study, the researcher will employ both the qualitative and quantitative rescue methods

The qualitative research approach is associated with the social constructivist paradigm that emphasizes the socially constructed nature of reality. The process entails recording analyzing and attempting to uncover the experience of the participants with the reality. The qualitative research app-arch is integrated into the pilot study to help the researcher with accurate insights into the feasibility and potential design of the trial (Farghaly 2018). The study will use a semi-structured questionnaire that will help in exploring the participant experience on the acceptability of the new wound dressing technique, staffs experiences on using the new wound dressing techniques and the perceptions of the stakeholders.

The quantitative research approach generally focuses on collecting and converting data into a numerical form to allow statistical calculation for a general conclusion (Kipanyula & Sife 2018). Based on the study questions the quantitative data concerning the percentage of the best experiences, quick healing process among others will be investigated through the quantitative research approach.

The setting of the research will be in this hospital and will be based on secondary care that entails acute and maternity.  The selection of our hospital is based on the capability to handle wound patients, maternal health programs, critical care, and adequate staff and daily patients that will successfully facilitate the data collection process. The population of the study will be majorly the patients aged 18 years and above that are undergoing abdominal general surgery such as small and large bowel resection, hepatic resection, and abdominal hernia surgery.

Clean Techniques

Sample size refers to the subset of the population under the study that helps in making a general conclusion.  The participants of the study will be randomly selected based on the word dressing groups. The wound dressing groups will be based on the available dressing technique and the newly proposed technique.

The participants of the study entail patients and the clinical officers that attend to the wounds. The participants were recruited from various tertiary wound care clinics that carry approximately 50 consultations per week. Prior to the recruitment, all the participants were informed of the study purposes and given chance to decide whether they are free to participate. The participants of the pilot test study were recruited directly from the hospital while others were recruited through an email account (Mauro, Haxtema & Temesgen 2017). The convenient sampling strategy was used to recruit the participants thus only those patients that had the wounds or undergoing the superficial surgical process and that clinical officer with knowledge about the wound dressing was approached.

Inclusion

• All surgical patients that are above the age of 18 of both gender majorly the abdominal and chest surgery.
• Nurses who had performed wound dressing using more than four techniques both the traditional and modern techniques.

Exclusion

• Patients were excluded if they were younger than 18 years
• Patients with abdominal or major surgery that are less than three months before the index operations will be ineligible
• patients that have inadequate consent capacity will be ineligible
• Patients that show an inability to complete a patient-reported questionnaire
• Nurses who have never performed any surgical wound dressing

According to Sade (2017), the voluntary participation of the participants will be considered to accomplish the pilot study. No participants will be coerced to participate and all will be given the opportunity to quit whenever they feel. The participants will be told the need and importance of the study and their consent received before the commencement of the study. Furthermore, the researcher will acquire the approval from the relevant authorities before proceeding and the ethical procedure will be approved by the Hospital Ethical Committee.

In every study, data collection forms the most important aspect of the study as it aids in quantifying the data that will be used to confirm the assumptions and the hypothesis. For the purpose of this study, the stretcher adopts primary data collection so as to get the first-hand information regarding the new wound dressing technique (Bowen Zhang 2017). The researcher will use experimental on the selected patient by dressing them with the conventional wound dressing methods and the new wound dressing method. Thereafter, the participants will participate in a questionnaire process to capture their experiences regarding the new wound dressing technique. The questionnaire will capture various issues such as the applicability, reliability, nature of fluid absorption, the frequency of dressing, and healing process of the wound when the new wound dressing techniques are used as compared to the conventional wound dressing techniques. The results collected will be analyzed to ascertain the research questions.

Data analysis helps the researcher in understating and interpreting the data collected to draw a conclusion regarding the topic under the study. The two common data analysis methods used by researchers are descriptive and inferential. According to Heeringa and  Berglund (2017), descriptive data analysis deals with the recording from the group members and summarizes the data in terms of the properties and reports are mean, median, mode, standard deviation, and some graphs. On the other hand, the inferential data analysis involves that analysis from a specific group of the sample from the entire population and involves the hypothesis test, regression analysis, and confidence intervals.

Sterile Techniques

For the purpose of this pilot study, the researcher chose the descriptive statistical data analysis method since it will be able to provide the percentage of the participants who participated, their experiences on the new wound dressing techniques and the ability to compare the outcome of the new wound dressing technique as compared to the conventional techniques. The difference between the dressing techniques will be analyzed through the use of student’s t-test to predict the healing process of the wound depending on the dressing. 

The purpose of this pilot study is to determine the feasibility, reliability, and applicability of the new wound dressing techniques, thus the audience for the research will be patents and the public, clinical officers, external statutory organizations such as the department of health and academia. To ensure that the results of the pilot study reach all the stakeholders, the following dissemination plan will be followed to translate the knowledge into practice. The results from this pilot study will be reported through:

• The use of peer-reviewed journals and newsletters that will be distributed among the stakeholders to read.
• Use of electronic media such as social media to enlighten the stakeholders of the benefits of the new wound dressing techniques.
• Use of the electronic databases such as MEDLINE, Embase, and CINAHL
• Development of a workshop in various hospitals to implement the practice

The dedication plan will be facilitated by the researchers’ communication capability. The researcher will communicate with the various stakeholders: surgical patients, clinical staffs, government agencies and hospitals to make them understand and accept the new wound dressing technique.

The most possible hindrance of the dissemination of the pilot results will be the inadequacy of funds to carry out all the strategies. The organization of the workshops in various hospitals will require some funds and time, which might be inadequate. Secondly, the creation of websites and loading of the results into the relevant databases also will require some approval from the relevant authorities, and some cash to carry the same thus limiting the ability of the researcher in reaching the targeted audience. Additionally, the responsibility is most likely to be upon me, thus carrying out the process might be too hectic and tiresome.

References

Aderibigbe, B. A., & Buyana, B. (2018). Alginate in Wound Dressings. Pharmaceutics, 10(2), N.PAG. https://doi.org/10.3390/pharmaceutics10020042

Arslan, A., Murat, Aldemir, S. D., Kazaro, Lu, N. M., & Gümü, develop?lu, M. (2014). Honey-based PET or PET/chitosan fibrous wound dressings: effect of honey on the electrospinning process. Journal of Biomaterials Science — Polymer Edition, 25(10), 999–1012. https://doi.org/10.1080/09205063.2014.918455

Bowen Zhang. (2017). Plant Root Research Methods and Trends. Agricultural Science & Technology, 18(12), 2295–2302. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=127713318&site=ehost-live

Broussard, K. C., & Powers, J. G. (2013). Wound Dressings: Selecting the Most Appropriate Type. American Journal of Clinical Dermatology, 14(6), 449–459. https://doi.org/10.1007/s40257-013-0046-4

Choi, J. S., Kim, D. W., Kim, D. S., Kim, J. O., Yong, C. S., Cho, K. H., Choi, H.-G. (2016). Novel neomycin sulphate-loaded hydrogel dressing with enhanced physical dressing properties and wound-curing effect. Drug Delivery, 23(8), 2806–2812. https://doi.org/10.3109/10717544.2015.1089958

Cirillo, G., Spizzirri, U. G., Curcio, M., Spataro, T., Picci, N., Nicoletta, F. P., & Iemma, F. (2016). Cotton gauze-hydrogel composites: Valuable tools for electrically modulated drug delivery. International Journal of Polymeric Materials, 65(9), 442–450. https://doi.org/10.1080/00914037.2015.1129956

Farghaly, A. (2018). Comparing and Contrasting Quantitative and Qualitative Research Approaches in Education: The Peculiar Situation of Medical Education. Education in Medicine Journal, 10(1), 3–11. https://doi.org/10.21315/eimj2018.10.1.2

Green, B. (2013). Making an informed decision: how to choose the correct wound dressing. Wound Healing Southern Africa, 6(1), 12–20. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=89084476&site=ehost-live

Heeringa, S.G., West, B.T. & Berglund, P.A. (2017). Applied survey data analysis. Chapman and Hall/CRC. A Cross-sectional Study. Ethiopian Journal of Health Sciences, 27(3), 283–290. https://doi.org/10.4314/ejhs.v27i3.10

Izquierdo-Blasco, J., Campins-Martí, M., Soler-Palacín, P., Balcells, J., Abella, R., Gran, F., … Sanchez-de-Toledo, J. (2015). Impact of the implementation of an interdisciplinary infection control program to prevent surgical wound infection in pediatric heart surgery. European Journal of Pediatrics, 174(7), 957–963. https://doi.org/10.1007/s00431-015-2493-9

Kipanyula, M. J., & Sife, A. S. (2018). Global Trends in Application of Stereology as a Quantitative Tool in Biomedical Research. BioMed Research International, 2018, 1–9. https://doi.org/10.1155/2018/1825697

Marston, W., Tang, J., Kirsner, R. S., & Ennis, W. (2016). Wound healing society 2015 update on guidelines for venous ulcers. Wound Repair & Regeneration, 24(1), 136–144. https://doi.org/10.1111/wrr.12394

Mauro, F., Haxtema, Z., & Temesgen, H. (2017). Comparison of sampling methods for the estimation of nearest-neighbour index values. Canadian Journal of Forest Research, 47(6), 703–715. https://doi.org/10.1139/cjfr-2016-0239

Mohseni, M., Shamloo, A., Aghababaei, Z., Vossoughi, M., & Moravvej, H. (2016). Antimicrobial Wound Dressing Containing Silver Sulfadiazine With High Biocompatibility: In Vitro Study. Artificial Organs, 40(8), 765–773. https://doi.org/10.1111/aor.12682

Okoye, E. I., & Okolie, T. A. (2015). Development and in vitro characterization of ciprofloxacin loaded polymeric films for wound dressing. International Journal of Health & Allied Sciences, 4(4), 234–242. https://doi.org/10.4103/2278-344X.167660

Percival, S. L., Mayer, D., & Salisbury, A. (2017). Efficacy of a surfactant-based wound dressing on biofilm control. Wound Repair & Regeneration, 25(5), 767–773. https://doi.org/10.1111/wrr.12581

Pettus, D. C., Dunnigan, A., Veeh, C. A., Howard, M. O., Scheyett, A. M., & Roberts, L. A. (2017). Enhancing Social Support Postincarceration: Results From a Pilot Randomized Controlled Trial. Journal of Clinical Psychology, 73(10), 1226–1246. https://doi.org/10.1002/jclp.22442

Quirós, J., Boltes, K., & Rosal, R. (2016). Bioactive Applications for Electrospun Fibers. Polymer Reviews, 56(4), 631–667. https://doi.org/10.1080/15583724.2015.1136641

Rodriguez-Merchan, E. C. (2012). Surgical wound healing in bleeding disorders. Haemophilia, 18(4), 487–490. https://doi.org/10.1111/j.1365-2516.2012.02760.x

Sade, R. M. (2017). INTRODUCTION: Controversies in Clinical Research Ethics. Journal of Law, Medicine & Ethics, 45(3), 291–294. https://doi.org/10.1177/1073110517737525

Shimizu, N., Ishida, D., Yamamoto, A., Kuroyanagi, M., & Kuroyanagi, Y. (2014). Development of a functional wound dressing composed of the hyaluronic acid spongy sheet containing bioactive components: evaluation of wound healing potential in animal tests. Journal of Biomaterials Science — Polymer Edition, 25(12), 1278–1291. https://doi.org/10.1080/09205063.2014.929427

Vasconcelos, A., & Cavaco-Paulo, A. (2011). Wound dressings for a proteolytic-rich environment. Applied Microbiology & Biotechnology, 90(2), 445–460. https://doi.org/10.1007/s00253-011-3135-4

Wibaux, A., Thota, P., Mastej, J., Prince, D. L., Carty, N., & Johnson, P. (2015). Antimicrobial Activity of a Novel Vascular Access Film Dressing Containing Chlorhexidine Gluconate. PLoS ONE, 10(11), 1–10. https://doi.org/10.1371/journal.pone.0143035

Wulfmeyer, V., Behrendt, A., Lange, D., Metzendorf, S., Muppa, S. K., Späth, F.Buban, M. (2018). A New Research Approach for Observing and Characterizing Land–Atmosphere Feedback. Bulletin of the American Meteorological Society, 99(8), 1639–1667. https://doi.org/10.1175/BAMS-D-17-0009.1

Xiao-ling Huang, Jing-qi Zhang, Shu-ting Guan, & Wu-jin Liang. (2016). Comparison of Sterile and Clean Dressing Techniques in Post-operative Surgical Wound Infection in a Chinese Healthcare Facility. Tropical Journal of Pharmaceutical Research, 15(2), 415–419. https://doi.org/10.4314/tjpr.v15i2.27