Surgical Site Infection Clinical Trial
Official title:
Randomised Controlled Trial on the Effect of Copper Impregnated Dressings and Maternity Pads on the Healing of Obstetric Wounds and Wound Infection
The most common complication of vaginal delivery is perineal tearing with a prevalence of 85% and 70% will need suturing. The caesarean section rate worldwide is rising and the rate in Croydon University Hospital is in the region of 25% of all deliveries. One in ten women will develop a wound infection of their perineal tear or caesarean section wound. Wound infection can cause pain, dehiscence, delayed wound healing, prolonged hospital stay, readmissions and interfere with a woman's ability to nurture their baby and enjoy motherhood. Copper has shown to have strong antimicrobial properties, with the ability to kill various bacteria including MRSA. It has also been shown that copper promotes new blood vessel formation and therefore enhance wound healing. This study is to investigate the effect of copper impregnated dressings and maternity pads on wound infection. Women will be randomised for a wound dressing or maternity pad with (study group) or without copper (control group). Both the clinician and the woman will be blinded to the randomised group. Wound infection will be assessed via a telephone questionnaire after 7, 14 and 30 days after delivery. When wound infection is suspected, based on the questionnaire, a swab of the wound site will be taken to detect the causative bacteria.
This is a double blind randomised controlled pilot study to assess feasibility of copper
impregnated wound dressings and maternity pads for the healing of obstetric wounds. All women
having a caesarean section or with perineal sutures after a vaginal delivery will be
recruited from the antenatal clinic (in case of an elective caesarean section) or from the
maternity wards within Croydon Health Services. All women will be given a patient information
sheet describing the study prior to consent and will be giving adequate time to read the
information before signing the Informed consent. Participants will be followed up via a
telephone questionnaire 7, 14 and 30 days after the delivery.
Randomisation:
After inclusion all participants will be randomised for a wound dressing or maternity pad
with (study group) or without copper (control group). The two sets of wound dressings and
pads will be marked "A" or "B". Both the clinician and the participant will be blinded to the
randomised group. Only the manufacturer will be aware of which group contains copper.
Copper impregnated dressings:
As soon as possible, but within 12 hours after primary closure of the caesarean section
incision, the randomised study dressing will be applied. The two study dressings were
equivalent to the dressing normally used within this Trust, except the foam of one set of
dressings was impregnated with 3% copper oxide ions. The two sets of wound dressings were
marked "A" and "B" and both the women and clinician were blinded to the randomised group.
According to local protocol the wound dressing will be left intact for 7 days following
surgery and will be renewed if necessary.
Copper impregnated maternity pads As soon as possible, but within 12 hours after suturing,
women will be asked to wear the study maternity pads, which will be provided. The two sets of
study maternity pads will be equivalent to the currently recommended pads, except that one
set of pads will have a thin top layer of non-woven polyester fibres with 3% copper oxide
ions permanently attached to it. Women will be asked to use the pads for 14 days.
Patient data, history and physical examination:
Demographic data such as age, ethnicity, height and weight will be collected as well as
obstetric data and delivery details. Past medical history such as concomitant (chronic)
diseases and the use of medications will be obtained. Wound infection will be assessed via a
telephone questionnaire after 7, 14 and 30 days after delivery. The data will be stored in a
secure room within Trust facilities. All electronic data will be stored within password
protected IT system within the Trust, which is only accessible by the clinical and research
team.
Questionnaire:
For the assessment of surgical site infection, the Post Discharge Questionnaire used by the
HPC surgical site infection surveillance will be used, which is according to the worldwide
used definition of surgical site infection by the CDC.
Statistical analysis Statistical analysis will be performed using SPSS version 20.0 or
higher. Infection rates in the perineal tear group and the caesarean section group will be
analysed seperately. The infection rates in the study group (with copper) will be compared to
the control group and possible risk factors for infection will be explored. the Chi-Square
will be used to analyse categorical variables and the T-test or Mann Whitney-U test will be
used to analyse continuous variables. Multivariable logistic regression will be used to
investigate risk factors for development of infection.
Sample size calculation Since the effect of copper on infection rates is currently unknown,
we will conduct a pilot study for 12 months.
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