Experiences implementing hydrocolloid dressings after caesarean section

Despite increasing interest in reduction of surgical site infection (SSI) after caesarean section, there is limited evidence around optimal dressing choice. We report the experience of a secondary hospital in regional New Zealand changing from a basic contact dressing to a hydrocolloid dressing over a three-month period, reporting SSI rates, midwifery and nursing experience, and cost.

A retrospective cohort study of hydrocolloid dressings for caesarean sections over three months, compared with basic contact dressings in caesarean sections in the same period one year previously. We report wound swabs with significant growth; results from a survey sent to midwifery and nursing staff; and cost per dressing, as well as the number of dressing changes before discharge.

In the hydrocolloid group (n=94) four patients had significant growth on wound swabs (4.3%, 95% confidence interval (CI): 0-10.6%) compared with six patients in the basic contact group (n=117) (5.1%, 95% CI: 1.0-7.1%). Only 9/20 (45%) midwives reported that they liked the hydrocolloid dressings, compared with 19/21 (90%) liking the basic contact dressings, primarily due to difficulty removing the dressings. When accounting for the number of dressing changes on the ward, the cost per caesarean section was $5.11 NZD for hydrocolloid dressings, compared with $5.72 NZD for basic contact dressings.

Our initial experience with a change to hydrocolloid dressings showed promising results with regard to SSI rates, as well as a cost reduction. This, however, is to be balanced with dressings that are potentially more difficult to remove, resulting in reduced midwifery and nursing satisfaction.