• Vignesh Raman, Kelly A Thompson-Brazill, Kathy Kane, Charles D Harr, Abdul G Chaudhry, Robert Merrill Hunter, Bryon J Boulton, William A Killinger, and Judson B Williams.
• From the WakeMed Health and Hospitals, Raleigh, NC USA; and Duke University Medical Center, Durham, NC USA.
• Innovations (Phila). 2018 Jul 1; 13 (4): 296-299.

ObjectiveSternal wound infections complicate 1% to 8% of cardiac surgeries and carry significant morbidity. We investigated the utility of silver-impregnated dressing in decreasing sternal wound infections after sternotomy cases.MethodsA single-institution cohort study was performed as part of a quality improvement trial of a new sternal dressing. Five hundred fifty-seven sternotomy cases were performed in 2015 with application of a traditional gauze dressing. In 2016, 682 sternotomy cases were performed with the use of a commercially available silver-impregnated dressing. Prospectively identified metrics were analyzed for each patient population along with nursing assessments and structured questionnaires.ResultsBaseline characteristics of patients in traditional gauze and silver-impregnated dressing groups were similar. Morbidity and mortality were similar. Nine (1.6%) and 12 (1.8%) sternal wound infections were reported in traditional gauze and silver-impregnated dressing groups, respectively. There was no difference in the rate of sternal wound infections (P = 0.80). The number of organ space infections (3) and deep sternal wound infections (3) was the same; however, the number of superficial infections was greater in the silver-impregnated dressing cohort (3 vs. 6). Among patients in either group with sternal wound infection, there were no differences in the proportion of superficial infections (44% vs. 50%, P = 0.8) or the organism cultured (67% vs. 50% staphylococcus, P = 0.45). A total of 22% of patients reported "not satisfied" with silver-impregnated dressing.ConclusionsSilver dressings did not reduce sternal wound infection after sternotomy for cardiac surgery in a large-cohort study. We discontinued the routine use of silver dressings for adult cardiac surgery based on these results because traditional gauze likely represents an equally effective and less costly alternative.

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