Plus-Hex CLINICAL
Advanced postoperative wound dressings can be helpful in patients at increased risk of an SSI , although the use of topical antimicrobial agents is not recommended in surgical wounds healing by primary intention , as they will not reduce the incidence of SSIs [ 13 , 14 ] .
Silver-impregnated dressings ( Acticoat ) offer broadspectrum bactericidal activity and can be useful in heavily infected wounds , but are not recommended for preventing the development of an SSI [ 14 ] .
The author suggests introducing pets to these aids early in their lives – for example , whenever they visit the veterinary practice – so if the animal requires surgery or treatment later in life it will be better acclimatised to intervention aids , making it easier to select the most appropriate one at the point of need ( Figure 4 ).
Polyhexamethylene biguanide ( PHMB ) -impregnated wound dressings ( Kendall AMD and Prontosan ) contain an antiseptic that disrupts the membrane and wall of cells to cause apoptosis , and offers broad-spectrum activity against both bacteria and fungi [ 14 ] . For surgical wounds where partial closure has been achieved , a PHMB-impregnated foam could be used to aid in the reduction of bioburden ( the number of micro-organisms living on a surface that has not been sterilised ) and help minimise the risk of an infection developing [ 14 ] .
Postoperative wound dressings with a dialkylcarbamoyl chloride ( DACC ) -coated surface ( Leukomed and Sorbact ) have bacteriostatic properties and irreversibly bind to bacteria and fungi at the incision site [ 15 ] . A review of DACC-coated postoperative wound dressings carried out in 2017 [ 15 ] found that DACC was able to reduce SSIs and effectively minimise bioburden . Another review [ 16 ] , which was carried out in 2023 and included 113 studies , found that DACC-coated dressings were effective against a broad spectrum of microbes , including resistant microbes on the WHO Bacterial Priority Pathogens List . Due to the dressing ' s physical mode of action , through binding to microbes , no active agents are released , so it can be used prophylactically without the risk of antimicrobial resistance , thus supporting antimicrobial stewardship practices [ 16 ] .
Intervention aids
Postoperative wound dressings play an important role in the management and prevention of postoperative wound complications , but intervention aids can also be critical . There are a variety of options available , including Elizabethan collars and pet shirts , which should be discussed with a patient ' s owner to assess which is the most suitable intervention aid for the individual animal and its home environment .
Creating a collaborative relationship with pet owners is important , especially in cases where an Elizabethan collar or pet shirt is used as an intervention aid . It should be noted that the use of Elizabethan collars has been linked to increased postoperative complications , most likely due to patient interference [ 1 ] . This type of collar – or a pet shirt – is usually introduced only when a patient is discharged , and the patient can find it distressing to wear , especially if it has not worn one before , which may cause the owner stress and reduce compliance .
Figure 4 . A patient wearing various intervention aids to prevent it from interfering with the surgical incision site .
Pain is another reason an animal may interfere with its surgical incision , causing delayed healing and self-mutilation . Therefore , having a multimodal and individualised analgesic approach can also help prevent postoperative wound complications [ 1 ] .
Reporting and monitoring
Clinical photography of surgical incision sites is used in wound management to monitor healing and report progress to the staff members involved with the case . A photo can be taken at the end of the surgery , prior to the placement of a postoperative wound dressing , for addition to the patient ' s file . The image is then available for reference by the veterinary team and , if appropriate , can be shared with the owner to support home monitoring and the reporting of any concerning changes . The image can be referred to during the first postoperative check-up , and further images taken and used at subsequent check-ups to monitor the progression of healing and detect any early signs of infection , enabling rapid intervention if necessary . This approach has proved useful in human healthcare settings , where multidisciplinary teams and agencies can be involved in a patient ' s care [ 2 ] .
Although there is not currently a national database for SSI recording in veterinary patients , the monitoring and recording of postoperative wound complications could be done at a local level , within veterinary practices . An internal active surveillance system can help identify
Volume 39 ( 4 ) • August 2024
23