Effectiveness of an enhanced silver-containing dressing in hard-to-heal venous leg ulcers: a randomised controlled trial

OBJECTIVE

To assess the efficacy and safety of a carboxymethylcellulose dressing containing ionic silver, ethylenediaminetetraacetic acid and benzethonium chloride (CISEB) versus a dialkylcarbamoyl chloride-coated dressing (DACC) in hard-to-heal venous leg ulcers (VLUs).

METHOD

In a multinational, multicentre, randomised controlled trial, patients with hard-to-heal VLUs were randomised 1:1 to receive CISEB (n=100) or DACC (n=103) for up to four weeks. VLUs that were not healed by week 4 were managed with standard of care for up to 12 weeks or until healed (whichever was sooner). The primary endpoint was complete wound closure at week 12. Additional endpoints included time to complete wound closure and incidence of adverse events (AEs).

RESULTS

The trial cohort included 203 patients. CISEB achieved a higher rate of complete wound closure by week 12 compared to DACC (74.8% versus 55.6%, respectively; p<0.0031), and was associated with a 35% increased likelihood of healing (risk ratio, 1.35; 95% confidence interval: 1.10-1.65). Median time to complete wound closure was shorter in the CISEB arm (56 days) compared to the DACC arm (70 days; p<0.0272). A smaller proportion of patients experienced an AE with CISEB compared to DACC (5.0% versus 17.6%, respectively).

CONCLUSION

Management of hard-to-heal VLUs with CISEB was associated with improved healing outcomes compared to DACC, without additional safety concerns. CISEB is a gelling fibre dressing with antimicrobial, metal-chelating and surfactant components that may promote an optimal healing environment to address the challenge of hard-to-heal wounds.

Safety and effectiveness of an antiseptic wound cleansing and irrigation solution containing polyhexamethylene biguanide

OBJECTIVE

There is currently a wide range of cleansing and irrigation solutions available for wounds, many of which contain antimicrobial agents. The aim of this study was to assess the safety of HydroClean Solution (HARTMANN, Germany), a polyhexamethylene biguanide (PHMB)-containing irrigation solution, in a standard cytotoxicity assay, and to assess its effect in a three-dimensional (3D) full-thickness model of human skin.

METHOD

A number of commercially available wound cleansing and irrigation solutions, including the PHMB-containing irrigation solution, were tested in a cytotoxicity assay using L929 mouse fibroblasts (ISO 10993-5:2009). The PHMB-containing irrigation solution was then assessed in an in vitro human keratinocyte-fibroblast 3D full-thickness wounded skin model to determine its effect on wound healing over six days. The effect of the PHMB-containing irrigation solution on tissue viability was measured using a lactate dehydrogenase (LDH) assay, and proinflammatory effects were measured using an interleukin-6 (IL-6) production assay.

RESULTS

The PHMB-containing irrigation solution was shown to be equivalent to other commercially available cleansing and irrigation solutions when tested in the L929 fibroblast cytotoxicity assay. When assessed in the in vitro 3D human full-thickness wound healing model, the PHMB-containing irrigation solution treatment resulted in no difference in levels of LDH or IL-6 when compared with levels produced in control Dulbecco's phosphate-buffered saline cultures. There was, however, a pronounced tissue thickening of the skin model in the periwound region.

CONCLUSION

The experimental data presented in this study support the conclusion that the PHMB-containing irrigation solution has a safety profile similar to other commercially available cleansing and irrigation solutions. Evidence also suggests that the PHMB-containing irrigation solution does not affect tissue viability or proinflammatory cytokine production, as evidenced by LDH levels or the production of IL-6 in a 3D human full-thickness wound healing model. The PHMB-containing irrigation solution stimulated new tissue growth in the periwound region of the skin model.

Experimental and clinical evidence for DACC-coated dressings: an update

OBJECTIVE

To update the evidence in relation to the use of dialkylcarbamoyl chloride (DACC)-coated wound dressings in the prevention, treatment and management of wounds.

METHOD

PubMed and PubMed Central databases were searched to identify articles published since 2020 describing the experimental and clinical evidence for DACC-coated dressings, and their antimicrobial effect, as well as their impact on the prevention and treatment of infected wounds. The identified articles were then narratively reviewed.

RESULTS

The search yielded 113 articles (plus references from ad hoc sources), of which nine met the inclusion criteria. Of the nine included studies, five related to clinical aspects and four were laboratory studies.

CONCLUSION

A number of new studies have provided further evidence for the mode of action of the antimicrobial effect of DACC-coated dressings and its wide spectrum effect (including World Health Organization-prioritised microorganisms). Additional clinical studies have provided evidence of new applications, such as in treating wounds in paediatric patients, and extended the evidence relating to their use in treating surgical site infections. Evidence also shows that DACC-coated wound dressings can aid in the binding of biofilms, and how this technology can align and support antimicrobial stewardship in the prevention of antimicrobial resistance.

In vivo observations of biofilm adhering to a dialkylcarbamoyl chloride-coated mesh dressing when applied to diabetes-related foot ulcers: A proof of concept study

In this proof-of-concept study of twenty participants, we sought to determine if a DACC (Dialkylcarbamoyl chloride)-coated mesh dressing demonstrates an ability to adhere biofilm when placed on Diabetes Related Foot Ulcers (DRFUs) with chronic infection. The study also sought to determine if removal of the DACC-coated mesh dressings contributes to reducing the total number of bacteria in DRFUs, by exploring the total microbial loads, microbial community composition, and diversity. Standard of care was provided in addition to the application of DACC or DACC hydrogel every three days for a total of two weeks. Wound swabs, tissue curettage, and soiled dressings were collected pre and post-treatment. Tissue specimens obtained pre-treatment were analysed with scanning electron microscopy (SEM) and peptide nucleic acid fluorescent in situ hybridisation (PNA-FISH) with confocal laser scanning microscopy and confirmed the presence of biofilm in all DRFUs. SEM confirmed the presence of biofilms readily adhered to soiled DACC-coated mesh dressings pre- and post-treatment in all participants. Real-time quantitative polymerase chain reaction (qPCR) demonstrated the mean total microbial load of DRFUs in 20 participants did not change after two weeks of therapy (pre-treatment = 4.31 Log10 16 S copies (±0.8) versus end of treatment = 4.32 Log10 16 S copies (±0.9), P = .96, 95% CI -0.56 to 0.5). 16 S sequencing has shown the microbial composition of DACC dressings and wound swabs pre- and post-treatment remained similar (DACC; R = -.047, P = .98, Swab; R = -.04, P = .86), indicating the microbial communities originate from the ulcer. Biofilms adhere to DACC-coated mesh dressings; however, this may not reduce the total microbial load present within DRFU tissue. Wound dressings for use in hard-to-heal wounds should be used as an adjunct to a good standard of care which includes debridement and wound bed preparation.

Dialkyl Carbamoyl Chloride-Coated Dressing Prevents Macrophage and Fibroblast Stimulation via Control of Bacterial Growth: An In Vitro Assay

In this work, we evaluated the direct effect of a dialkyl carbamoyl chloride (DACC)-coated dressing on Staphylococcus aureus adhesion and growth in vitro, as well as the indirect effect of the dressing on fibroblast and macrophage activity. S. aureus cultures were treated with the dressing or gauze in Müller-Hinton medium or serum-supplemented Dulbecco’s modified Eagle medium. Bacterial growth and attachment were assessed through colony-forming units (CFU) and residual biomass analyses. Fibroblast and macrophage co-cultures were stimulated with filtered supernatants from the bacterial cultures treated with the DACC-coated dressing, following which tumor necrosis factor (TNF)-α/transforming growth factor (TGF)-β1 expression and gelatinolytic activity were assessed by enzyme-linked immunosorbent assays (ELISA) and zymography, respectively. The DACC-coated dressing bound 1.8−6.1% of all of the bacteria in the culture. Dressing-treated cultures presented biofilm formation in the dressing (enabling mechanical removal), with limited formation outside of it (p < 0.001). Filtered supernatants of bacterial cultures treated with the DACC-coated dressing did not over-stimulate TNF-α or TGF-β1 expression (p < 0.001) or increase gelatinolytic activity in eukaryotic cells, suggesting that bacterial cell integrity was maintained. Based on the above data, wound caregivers should consider the use of hydrophobic dressings as a first option for the management of acute or chronic wounds.

Antimicrobial effects of bacterial binding to a dialkylcarbamoyl chloride-coated wound dressing: an in vitro study

OBJECTIVE

Wound dressings that inactivate or sequestrate microorganisms, such as those with a hydrophobic, bacteria-binding dialkylcarbamoyl chloride (DACC) surface, can reduce the risk of clinical infections. This 'passive' bioburden control, avoiding bacterial cell wall disruption with associated release of bacterial endotoxins aggravating inflammation, is advantageous in hard-to-heal wounds. Hence, the full scope of DACC dressings, including the potential impact of higher inoculum densities, increased protein load and different pH on antibacterial activity, needs to be evaluated.

METHOD

The Japanese Industrial Standard (JIS) L 1902 challenge test was used to evaluate the antimicrobial activity of the DACC-coated dressing against several World Health Organization (WHO)-prioritised wound pathogens (e.g., meticillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, microorganisms with extended-spectrum beta-lactamases and Acinetobacter baumannii), the effect of repeated bacterial challenge in an adverse wound environment, and antimicrobial performance at wound-related pH.

RESULTS

High antibacterial activity of the DACC-coated dressing against the WHO-prioritised bacteria strains by its irreversible binding and inhibition of growth of bound bacteria was confirmed using JIS L 1902. At increased inoculation densities, compared to standard conditions, the DACC-coated dressing still achieved strong-to-significant antibacterial effects. Augmenting the media protein content also affected antibacterial performance; a 0.5-1 log reduction in antibacterial activity was observed upon addition of 10% fetal calf serum. The pH did not influence antibacterial performance. The DACC-coated dressing also sustained antibacterial activity over subsequent reinfection steps.

CONCLUSION

It can be assumed that the DACC-coated dressing exerts beneficial effects in controlling the wound bioburden, reducing the overall demand placed on antibiotics, without using antimicrobial substances.

An Overview on the Recent Advances in the Treatment of Infected Wounds: Antibacterial Wound Dressings

A wound can be surgical, cuts from an operation or due to accident and trauma. The infected wound, as a result of bacteria growth within the damaged skin, interrupts the natural wound healing process and significantly impacts the quality of life. Wound dressing is an important segment of the skincare industry with its economic burden estimated at $ 20.4 billion (in 2021) in the global market. The results of recent clinical trials suggest that the use of modern dressings can be the easiest, most accessible, and most cost-effective way to treat chronic wounds and, hence, holds significant promise. With the sheer number of dressings in the market, the selection of correct dressing is confusing for clinicians and healthcare workers. The aim of this research was to review widely used types of antibacterial wound dressings, as well as emerging products, for their efficiency and mode of action. In this review, we focus on introducing antibiotics and antibacterial nanoparticles as two important and clinically widely used categories of antibacterial agents. The perspectives and challenges for paving the way for future research in this field are also discussed. This article is protected by copyright. All rights reserved.

Estrategias de protección antimicrobiana en el cuidado de heridas: evidencia para el uso de apósitos recubiertos con DACC

BACKGROUND

Antimicrobial resistance (AMR) is one of the most serious health threats globally. The development of new antimicrobials is not keeping pace with the evolution of resistant microorganisms, and novel ways of tackling this problem are required. One of such initiatives has been the development of antimicrobial stewardship programmes (AMS). The use of wound dressings that employ a physical sequestration and retention approach to reduce bacterial burden offers a novel approach to support AMS. Bacterial-binding by dressings and their physical removal can minimise their damage and prevent the release of harmful endotoxins.

OBJECTIVE

To highlight AMS to promote the correct use of antimicrobials and to investigate how dialkylcarbamyl chloride (DACC)-coated dressings can support AMS.

METHOD

MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar were searched to identify articles relating to AMS, and the use of wound dressings in the prevention and treatment of wound infections. The evidence supporting alternative wound dressings that can reduce bioburden and prevent wound infection in a way that does not kill or damage the microorganisms were reviewed.

RESULTS

The evidence demonstrated that using bacterial-binding wound dressings that act in a physical manner (eg, DACC-coated dressings) to preventing infection in both acute and hard-to-heal wounds does not exacerbate AMR and supports AMS.

CONCLUSION

Some wound dressings work via a mechanism that promotes the binding and physical sequestration and removal of intact microorganisms from the wound bed (eg, a wound dressing that uses DACC technology to prevent/reduce infection). They provide a valuable tool that aligns with the requirements of AMS by effectively reducing wound bioburden without inducing/selecting for resistant bacteria.

Wound Care for Venous Ulceration

Venous leg ulcers (VLUs) affect as many as 20% of patients with advanced chronic venous insufficiency and are associated with significant morbidity and health care costs. VLUs are the most common cause of leg ulcers; however, other etiologies of lower extremity ulcerations should be investigated, most notably arterial insufficiency, to ensure appropriate therapy. Careful clinical examination, standardized documentation, and ultrasound evaluation are needed for diagnosis and treatment success. Reduction of edema and venous hypertension through compression therapy, local wound care, and treatment of venous reflux or obstruction is the foundation of therapy. As key providers in venous disease, interventional radiologists should be aware of current standardized disease classification and scoring systems as well as treatment and wound care guidelines for venous ulcers.

Antimicrobial stewardship strategies in wound care: evidence to support the use of dialkylcarbamoyl chloride (DACC)- coated wound dressings

BACKGROUND

Traditionally, infections are treated with antimicrobials (for example, antibiotics, antiseptics, etc), but antimicrobial resistance (AMR) has become one of the most serious health threats of the 21st century (before the emergence of COVID-19). Wounds can be a source of infection by allowing unconstrained entry of microorganisms into the body, including antimicrobial-resistant bacteria. The development of new antimicrobials (particularly antibiotics) is not keeping pace with the evolution of resistant microorganisms and novel ways of addressing this problem are urgently required. One such initiative has been the development of antimicrobial stewardship (AMS) programmes, which educate healthcare workers, and control the prescribing and targeting of antimicrobials to reduce the likelihood of AMR. Of great importance has been the European Wound Management Association (EWMA) in supporting AMS by providing practical recommendations for optimising antimicrobial therapy for the treatment of wound infection. The use of wound dressings that use a physical sequestration and retention approach rather than antimicrobial agents to reduce bacterial burden offers a novel approach that supports AMS. Bacterial-binding by dressings and their physical removal, rather than active killing, minimises their damage and hence prevents the release of damaging endotoxins.

AIM

Our objective is to highlight AMS for the promotion of the judicious use of antimicrobials and to investigate how dialkylcarbamoyl chloride (DACC)-coated dressings can support AMS goals.

METHOD

MEDLINE, Cochrane Database of Systematic Reviews, and Google Scholar were searched to identify published articles describing data relating to AMS, and the use of a variety of wound dressings in the prevention and/or treatment of wound infections. The evidence supporting alternative wound dressings that can reduce bioburden and prevent and/or treat wound infection in a manner that does not kill or damage the microorganisms (for example, by actively binding and removing intact microorganisms from wounds) were then narratively reviewed.

RESULTS

The evidence reviewed here demonstrates that using bacterial-binding wound dressings that act in a physical manner (for example, DACC-coated dressings) as an alternative approach to preventing and/or treating infection in both acute and hard-to-heal wounds does not exacerbate AMR and supports AMS.

CONCLUSION

Some wound dressings work via a mechanism that promotes the binding and physical uptake, sequestration and removal of intact microorganisms from the wound bed (for example, a wound dressing that uses DACC technology to successfully prevent/reduce infection). They provide a valuable tool that aligns with the requirements of AMS (for example, reducing the use of antimicrobials in wound treatment regimens) by effectively reducing wound bioburden without inducing/selecting for resistant bacteria.

Antimicrobial stewardship in wound care

Strategies to tackle the global crisis of antimicrobial resistance include implementing antimicrobial stewardship across the healthcare and agricultural sectors. Many clinical specialities have developed policies to advise practitioners on how to prescribe antibiotics more effectively, but there is still a lack of data on the impact of this change. Overuse and misuse of antibiotics have been commonplace since their introduction 70 years ago, and have contributed to the development of the resistance seen today. There is a dearth of new antibiotics and, if nothing is done to restrict the use of those that remain effective, there is a risk of returning to the pre-antibiotic era where simple infections could result in death. In wound care, it is essential that antibiotic treatment is appropriate to reduce infections. Many medical conditions predispose people to wounds that are difficult to heal and become chronic unless the underlying causes are addressed. Most wound infections are caused by bacteria, which are becoming increasingly resistant to commonly used antibiotics. This necessitates strict regimens for managing infection, which include prescribing antibiotics only when they are essential. Antimicrobial stewardship is undertaken in all UK healthcare facilities, and local advisory committees oversee the prudent use of antibiotics and other antimicrobial agents to try to prevent further increases in resistance. National guidance has been produced but whether full compliance has been followed has yet to be established and the impact of implementation needs to be analysed.

Modern and Classic Wound Dressing Comparison in Wound Healing, Comfort and Cost

 Introduction: Wound care has also developed rapidly after the dissemination of the concept of TIME (Tissue, Infection, Moisture, and Wound Edge) in modern dressing (MD). The aim of this study was to compare modern dressings (MDs) and classic dressings (CDs) in terms of patient comfort, cost effectiveness and wound healing.Methods: A prospective study design with total of 25 participants. The sampling technique used was consecutive sampling. Patient comfort was assessed through the frequency of wound care and pain scale using the Visual Analogue Scale (VAS). Cost-effectiveness was assessed using direct and indirect costs. Wound healing was assessed using the Bates-Jensen Wound Assessment Tool (BWAT) score. The data was analyzed using the independent t and Mann-Whitney tests.Results: In terms of comfort, the mean for the number of times that wound care was performed and the pain scale in the participants using MD was (3.07 ± 0.88 times and VAS 4.59  ± 0.72, respectively), which is less compared to using CD (4.60  ±  1.84 times each and VAS 5.43  ± 0.75). Referring to the indirect and direct costs, MD (13.67  ± 6.09 and 527.63  ± 84.47, respectively) has the same cost-effectiveness as CD (14.00  ± 7.64 and 482.68 ± 98.08, respectively). In terms of healing, the mean of the BWAT score in MD (31.26  ± 1.69) was better compared to CD (33.07  ± 1.65).Conclusion: The application of MD has the same cost-effectiveness as CD with a more satisfactory outcome for the wounds in terms of comfort and healing.

Dialkylcarbamoyl chloride-coated versus alginate dressings after pilonidal sinus excision: a randomized clinical trial (SORKYSA study)

Background

Disease of the pilonidal sinus is a common condition that affects mainly young adults. Options for management include excision of the sinus tracts, leaving the wound open to heal by secondary intention. The aim of this study was to compare wound healing with dialkylcarbamoyl chloride (DACC)‐coated dressings versus alginate dressings.

Methods

This multicentre trial randomized consecutive patients undergoing surgery for pilonidal disease to postoperative wound care with either DACC‐coated or alginate dressings. The primary outcome was the proportion of wounds healed after 75 days. Secondary outcomes were the local status of wounds during the healing process, the quality assessment of the dressings by the patient, and the time needed to return to usual activities.

Results

A total of 246 patients were included: 120 in the DACC‐coated group and 126 in the alginate group. In per‐protocol analysis, there were significantly more patients with completely healed wounds after 75 days in the DACC group than in the alginate group: 78 of 103 (75·7 per cent) versus 58 of 97 (60 per cent) respectively (odds ratio 2·55, 95 per cent c.i. 1·12 to 5·92; P = 0·023). During follow‐up, wounds with alginate dressings had more fibrin than those with DACC‐coated dressings, but the difference was not significant (P = 0·079). There was no difference between the two arms in patients' assessment of the dressings.

Conclusion

The number of wounds completely healed at 75 days was significantly higher for DACC‐coated compared with alginate dressings. However, the preplanned, clinically significant improvement in healing of 20 per cent was not reached. Registration number: NCT02011802 ( https://clinicaltrials.gov/).

Non-antibiotic antimicrobial interventions and antimicrobial stewardship in wound care

Control of wound infection today relies largely on antibiotics, but the continual emergence of antibiotic-resistant microorganisms threatens a return to the pre-antibiotic era when physicians used antiseptics to prevent and manage infection. Some of those antiseptics are still used today, and others have become available. A diverse variety of non-antibiotic antimicrobial interventions are found on modern formularies. Unlike the mode of action of antibiotics, which affect specific cellular target sites of pathogens, many non-antibiotic antimicrobials affect multiple cellular target sites in a non-specific way. Although this reduces the likelihood of selecting for resistant strains of microorganisms, some have emerged and cross-resistance between antibiotics and antiseptics has been detected. With the prospect of a post-antibiotic era looming, ways to maintain and extend our antimicrobial armamentarium must be found. In this narrative review, current and emerging non-antibiotic antimicrobial strategies will be considered and the need for antimicrobial stewardship in wound care will be explained.

Restoring balance: biofilms and wound dressings

Biofilms are responsible for stimulating and maintaining wound inflammation, increasing infection risk and delaying wound closure. Appropriate biofilm management is required to fight against local and systemic infection and to restore balance to the wound environment. The most effective way to remove biofilms involves the use of mechanical techniques, with the wound dressing representing an important component of this strategy. Wound dressing fibres, such as polyacrylate fibres, have been shown to be effective in affecting biofilm architecture by disrupting the biofilm matrix. This helps enhance the efficacy of antimicrobials, such as silver. Focusing an antibiofilm strategy on active agents alone does not constitute a sustainable approach to biofilm management. Furthermore, adding too many active chemicals into a wound can be highly detrimental to the wound bed, and potentially may have both short- and long-term biological concerns. Particular attention on the characteristics and key features of wound dressings is discussed in this paper. The aim of the paper is to review the ideal characteristics of wound dressings, in conjunction with antimicrobials, that are considered a fundamental part of an antibiofilm strategy and growing requirement for enhanced wound healing.

Identifying and managing wound infection in the community

A large proportion of community wound care consists of managing chronic wounds. Given the increasingly complex patient comorbidities, early identification and treatment of wound infection can impact greatly not only on wound healing but also on the patient physically, psychologically and socially. Identifying wound infection can be challenging for clinicians, particularly in the chronic wound where infection may not always present itself as it does in acute wounds. The management of infected wounds can be complicated. Managing multiple symptoms and recognising these as being due to infection is not always straightforward and relies on the practitioner's knowledge and skills. An understanding of more commonly used antimicrobial treatments and when to employ these is paramount in enabling the practitioner to provide care that is effective, evidence based and cost efficient.

A pilot feasibility randomised clinical trial comparing dialkylcarbamoylchloride-coated dressings versus standard care for the primary prevention of surgical site infection

A surgical site infection (SSI) may occur in up to 30% of procedures and results in significant morbidity and mortality. We aimed to assess the feasibility of conducting a randomised controlled trial (RCT) examining the use of dialkylcarbamoylchloride (DACC)-impregnated dressings, which bind bacteria at the wound bed, in the prevention of SSI in primarily closed incisional wounds. This pilot RCT recruited patients undergoing clean or clean-contaminated vascular surgery. Participants were randomised intraoperatively on a 1:1 basis to either a DACC-coated dressing or a control dressing. Outcomes were divided into feasibility and clinical outcomes. The primary clinical outcome was SSI at 30 days (assessed using Centers for Disease Control criteria and Additional treatment, Serous discharge, Erythema, Purulent exudate, Separation of the deep tissues, Isolation of bacteria and duration of inpatient Stay scoring methods). This study recruited 144 patients in 12 months at a median rate of 10 per month. Eligibility was 73% and recruitment 60%. At 30 days, there was a 36.9% relative risk reduction in the DACC-coated arm (16.22% versus 25.71%, odds ratio 0.559, P = 0.161). The number needed to treat was 11 patients. A large-scale RCT is both achievable and desirable given the relative risk reduction shown in this study. Further work is needed to improve the study protocol and involve more centres in a full-scale RCT.

Assessing the effectiveness of dialkylcarbamoylchloride (DACC)-coated post-operative dressings versus standard care in the prevention of surgical site infection in clean or clean-contaminated, vascular surgery (the DRESSINg trial): study protocol for a pilot feasibility randomised controlled trial

Background

Surgical site infection in vascular surgery has a reported incidence of up to 19%. A novel method of reducing this rate of infection is dressings coated with dialkylcarbamoylchloride (DACC), a hydrophobic wound contact layer that binds bacteria and removes them from the wound bed. Early research has suggested that DACC-coated wound dressings are effective in reducing surgical site infection when applied to wounds healing by primary intention post-operatively, therefore this trial aims to assess the feasibility of producing high-quality evidence assessing this theory.

Methods

Patients undergoing clean or clean-contaminated vascular surgery will be randomised to have their surgical wounds dressed with a DACC-coated dressing or a non-coated occlusive absorbent post-operative dressing. All other aspects of their peri-operative care will be standardised or carried out in line with hospital policy. Wound assessments will be carried out between day 5–7, day 30 (± 3 days) and 6 months post-operatively (± 7 days) by a blinded assessor using the ASEPSIS scoring tool. Quality of life data using EQ-5D and SF-36, resource use and mortality data will also be collected. This feasibility trial will dictate the conduct of a full-scale trial through the collection of data on recruitment and retention rates, and fitness-for-purpose of the follow-up arrangements.

Discussion

Surgical site infections are now the second most common hospital acquired infections with a significant cost implication. The aim of the DRESSINg trial is to investigate the effectiveness of a novel preventative measure at reducing wound infections post-surgery and will provide robust evidence to support or deny its use.

Trial registration

Clinicaltrials.gov identifier: NCT02992951, Registered 12/12/16. REC Reference: 16/LO/2135.