George Hadjidekov, Boyan Balev, Savina Hadjidekova, Ivan Plachkov, Kristian Tzvetankov and Violeta Groudeva

Objective: To test the null hypothesis that administering silver ion-eluting wound dressing or paper cloth adhesive wound dressing to women undergoing cesarean section will result in no difference in the incidence of surgical site infection.
MaterialsAnd Methods: 514 women met inclusion criteria and were randomly assigned to receive one of two surgical dressing regimens: standard soft paper cloth or silver ion-eluting dressings. Patients were evaluated for signs of infection during their hospitalization, and again at 1-week postpartum. Sample size was calculated to allow a two-tailed alpha of 0.05 and power of 80%. Data were analyzed on intent-to-treat basis using parametic and nonparametic statistics. Categorical data were presented as frequencies; P-values were calculated using Pearson’s chi-square test. Logistic regression was performed to control for the effect of maternal BMI.
Results: Analysis involved 236 women in the cloth dressing group and 239 in the silver ion-eluting dressing group. Nineteen of 236 patients (8%) randomized to the cloth dressing group met clinical criteria for surgical site infection infection compared to 25 of 239 (10%) in the silver ion-eluting dressing group. No statistically significant difference in infection rate was detected, p=0.36, RR = 1.3, CI = 0.7-2.5. A multivariable model adjusted for BMI confirmed no evidence of an association between dressing type and infection rate. Cost analysis for the cloth dressing used in this study was $1.30 per dressing ($306.80 group total), compared to $46.36 per dressing ($11,080.04 group total) in the silver ion-eluting dressing group.
Conclusion: There was no statistically significant difference in the incidence of post-cesarean section surgical site infection rates when comparing paper cloth to silver ion-eluting dressings in an obstetrical population.