503
Methods and Devices STERILE MICROENVIRONMENT FOR POSTOPERATIVE WOUND CARE
JAMES McLAUCHLAN Department of Orthopœdic Surgery, Aberdeen University, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB9 2ZB ALASTAIR D. SCOTLAND
Department of Surgery, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB9 2ZB P. C. TREXLER
Department of Veterinary Gnotobiotics, Royal Veterinary College, London THE ward environment has been incriminated as a potent source of wound infection. The provision of at least 40% singlebedded positively ventilated rooms in a surgical ward reduced the cross-infection rate by 72%.1 Another study showed that the source of infection after total hip replacement was the ward rather than the theatre.2 The expense of providing a ward with 40%-positive-pressure-ventilated single-bedded rooms led to the development of a controlled microenvironment in which to isolate the wound postoperatively. The wound isolator (see accompanying fig.) consists of a flexible plastic polyvinyl chloride dome welded to a plastic adhesive surgical drape. This drape forms the base of the envelope and is placed around the wound after a rectangle has been cut in it to allow an inch and a half clearance between the edge of the drape and the wound. Several cones are welded into the surface of the envelope to form access ports for air supply, wound drainage, suction, and irrigation, if necessary. In one corner of the surface is a siliconised "powder puff" type outlet filter of glass wool. The whole isolator comes pre-packed and gamma irradiated. It is applied in the theatre instead of a dressing with the exit filter in the least dependent position. The sterile air supply, which consists of compressed air fed through an in-line filter with a sodium chloride penetration of
less than 0-001%, is connected as soon as possible and adjusted so that approximately 5 1 of sterile air is supplied to the wound environment per minute. Before the sutures are removed, the wound can be observed through the transparent wall of the isolator and any procedures necessary for the maintenance of a clean wound can be carried out easily through the access cones. Since the airflow into the isolator is maintained at a pressure which is slightly greater than that in the external environment, airborne and direct contact cross-infection of the wound is prevented. A prospective controlled trial of the isolator versus a standard occlusive dressing in operative wounds after fracture of the neck of the femur is in progress. An analysis of the results before the trial is completed would be misleading but the wound isolator seems to prevent airborne and direct contact cross-infection in the ward. Patients tolerate the isolator for a fortnight without any skin problem developing and those wounds with a hxmatoma that leak postoperatively can be kept sterile until they have healed. Extensive bacteriological monitoring of the air within the wound isolator with membrane samplers has proved that the sterility of the air is maintained. This work
was
partly supported by Vickers
Medical.
REFERENCES 1.
2.
G., Davidson, D., McDonald, A., Smith, G. Br. med. J. Smylie, 1971, i, 67. McLauchlan, J., Smylie, H. G., Logie, J. R. C., Smith, G. Postgrad. med. J. 1976, 52, 550. H.
A. I.
A WOUND IRRIGATION DEVICE
S. WESTABY Hammersmith Hospital, DuCane Road, London W12 0HS
W. G. EVERETT Addenbrookes Hospital, Cambridge
Introduction an increasing number of preventive measures, the of infection and breakdown in the contaminated frequency accidental or surgical wound is about 30%. Conventional treatment of a purulent discharging wound is unsatisfactory in
DESPITE
many ways. Dressings are bulky, rapidly becoming offensive, and are time-consuming and expensive to replace. Moreover
such patients are often prescribed expensive or dangerous systemic antibiotics. The wound irrigation device described here was designed to aid the nursing of patients with postoperative wound infection and dehiscence who require several changes of dressing daily. Previous attempts to produce such a device were frustrated by the inability to obtain an adequate seal between device and skin, but we have overcome this difficulty by the use of ’Stomahesive’ (Squibb). Stomahesive sticks avidly to moist skin or mucous surfaces, and has been used extensively to protect the skin around ileostomies, colostomies, ileal conduits, and fistulae. Its application around infected and dehisced wounds is a logical extension of the ways in which it can be used. Wound isolator.
16. Blackwell, B., Marley, E. Lancet, 1964, i, 530. 17. Hanington, E. Br. med. J. 1967, ii, 550. 18. Hanington, E., Harper, A. M. Headache, 1968, 8, 84. 19. Ghose, K., Coppen, A. Carroll, D. Br. med. J. 1977, i, 1191. 20. Dalsgaard-Nielsen, T., Genefke, I. K. Headache, 1974, 14, 26. 21. Ryan, T. J. Major Problems in Dermatology; vol. 7, p. 120. 1976.
Philadelphia, Wound irrigation device.
Methods and Devices STERILE MICROENVIRONMENT FOR POSTOPERATIVE WOUND CARE
JAMES McLAUCHLAN Department of Orthopœdic Surgery, Aberdeen University, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB9 2ZB ALASTAIR D. SCOTLAND
Department of Surgery, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB9 2ZB P. C. TREXLER
Department of Veterinary Gnotobiotics, Royal Veterinary College, London THE ward environment has been incriminated as a potent source of wound infection. The provision of at least 40% singlebedded positively ventilated rooms in a surgical ward reduced the cross-infection rate by 72%.1 Another study showed that the source of infection after total hip replacement was the ward rather than the theatre.2 The expense of providing a ward with 40%-positive-pressure-ventilated single-bedded rooms led to the development of a controlled microenvironment in which to isolate the wound postoperatively. The wound isolator (see accompanying fig.) consists of a flexible plastic polyvinyl chloride dome welded to a plastic adhesive surgical drape. This drape forms the base of the envelope and is placed around the wound after a rectangle has been cut in it to allow an inch and a half clearance between the edge of the drape and the wound. Several cones are welded into the surface of the envelope to form access ports for air supply, wound drainage, suction, and irrigation, if necessary. In one corner of the surface is a siliconised "powder puff" type outlet filter of glass wool. The whole isolator comes pre-packed and gamma irradiated. It is applied in the theatre instead of a dressing with the exit filter in the least dependent position. The sterile air supply, which consists of compressed air fed through an in-line filter with a sodium chloride penetration of
less than 0-001%, is connected as soon as possible and adjusted so that approximately 5 1 of sterile air is supplied to the wound environment per minute. Before the sutures are removed, the wound can be observed through the transparent wall of the isolator and any procedures necessary for the maintenance of a clean wound can be carried out easily through the access cones. Since the airflow into the isolator is maintained at a pressure which is slightly greater than that in the external environment, airborne and direct contact cross-infection of the wound is prevented. A prospective controlled trial of the isolator versus a standard occlusive dressing in operative wounds after fracture of the neck of the femur is in progress. An analysis of the results before the trial is completed would be misleading but the wound isolator seems to prevent airborne and direct contact cross-infection in the ward. Patients tolerate the isolator for a fortnight without any skin problem developing and those wounds with a hxmatoma that leak postoperatively can be kept sterile until they have healed. Extensive bacteriological monitoring of the air within the wound isolator with membrane samplers has proved that the sterility of the air is maintained. This work
was
partly supported by Vickers
Medical.
REFERENCES 1.
2.
G., Davidson, D., McDonald, A., Smith, G. Br. med. J. Smylie, 1971, i, 67. McLauchlan, J., Smylie, H. G., Logie, J. R. C., Smith, G. Postgrad. med. J. 1976, 52, 550. H.
A. I.
A WOUND IRRIGATION DEVICE
S. WESTABY Hammersmith Hospital, DuCane Road, London W12 0HS
W. G. EVERETT Addenbrookes Hospital, Cambridge
Introduction an increasing number of preventive measures, the of infection and breakdown in the contaminated frequency accidental or surgical wound is about 30%. Conventional treatment of a purulent discharging wound is unsatisfactory in
DESPITE
many ways. Dressings are bulky, rapidly becoming offensive, and are time-consuming and expensive to replace. Moreover
such patients are often prescribed expensive or dangerous systemic antibiotics. The wound irrigation device described here was designed to aid the nursing of patients with postoperative wound infection and dehiscence who require several changes of dressing daily. Previous attempts to produce such a device were frustrated by the inability to obtain an adequate seal between device and skin, but we have overcome this difficulty by the use of ’Stomahesive’ (Squibb). Stomahesive sticks avidly to moist skin or mucous surfaces, and has been used extensively to protect the skin around ileostomies, colostomies, ileal conduits, and fistulae. Its application around infected and dehisced wounds is a logical extension of the ways in which it can be used. Wound isolator.
16. Blackwell, B., Marley, E. Lancet, 1964, i, 530. 17. Hanington, E. Br. med. J. 1967, ii, 550. 18. Hanington, E., Harper, A. M. Headache, 1968, 8, 84. 19. Ghose, K., Coppen, A. Carroll, D. Br. med. J. 1977, i, 1191. 20. Dalsgaard-Nielsen, T., Genefke, I. K. Headache, 1974, 14, 26. 21. Ryan, T. J. Major Problems in Dermatology; vol. 7, p. 120. 1976.
Philadelphia, Wound irrigation device.
