World Health Organization Issues New Guidelines Suggesting Use of Prophylactic Negative Pressure Wound Therapy to Reduce the Risk of Surgical Site Infections

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San Antonio, TX – November 10, 2016 – The World Health Organization (WHO) announced new global guidelines concerning surgical site infections (SSIs) – a significant contributor to unnecessary costs associated with patient complications. In its announcement, the agency suggests use of prophylactic negative pressure wound therapy (pNPWT, or closed incision negative pressure therapy [ciNPT]) over conventional wound dressings on primarily closed surgical incisions in high-risk wounds for the prevention of SSIs. In establishing these guidelines, WHO has recognized the significant burden SSIs place on global healthcare systems, both in terms of financial implications and patient outcomes, and has taken steps to reduce these burdens by suggesting the use of pNPWT/ciNPT on surgical incisions.

To develop the guidelines, WHO commissioned a systematic review and meta-analysis of 21 studies including both randomized controlled trials and observational studies, of which 76 percent utilized ACELITY™ negative pressure therapy products. The conclusions, published in the September issue of Medicine, found that pNPWT significantly reduced the risk of SSIs compared to traditional dry gauze dressings.[i]

“The new WHO guidelines build upon a significant body of evidence that illustrates the impact negative pressure therapy can have in reducing the incidence of surgical site infections,” said Ron Silverman, M.D., FACS, chief medical officer of Acelity. “We developed PREVENA™ Therapy as the first disposable powered negative pressure system designed specifically for the management of closed surgical incisions six years ago, building off our demonstrated expertise in this space. Acelity brought the gold standard NPWT technology, V.A.C.® Therapy, to market in 1995 and, since then, V.A.C.® Therapy has been used to treat more than 10 million open wounds worldwide. We continue to build upon that track record by expanding our portfolio to improve patient care and address the needs of a changing healthcare system.”

Surgical site infections place a large burden on patients and global healthcare systems, particularly in the U.S., as they are associated with productivity loss, extended hospital stays, increased health care provider visits and greater financial costs. According to one study published in JAMA Internal Medicine, the average cost of an SSI in 2012 was estimated to be $20,785 per patient.[ii] Further evidence on the benefits of ciNPT was published in the August 2016 issue of International Wound Journal, noting SSIs are prevalent in up to 60 percent of inpatient surgical procedures in industrialized countries.[iii] There is a clear need to address the burden of SSIs on patients and the healthcare system. Closed incision negative pressure therapy has demonstrated the ability to reduce the rates of SSIs, and surgeons from various disciplines have found that ciNPT is associated with positive clinical outcomes compared to standard post-operative dressings.[iv]

PREVENA™ Therapy Systems
The PREVENA™ Incision Management System is the first powered negative pressure product designed specifically for the management of closed surgical incisions that continue to drain following sutured or stapled closure. It covers and protects the incision from external contamination, while negative pressure removes fluid and infectious material from the surgical incision, helping clinicians effectively manage surgical incisions. The new PREVENA PLUS™ System offers the proven effectiveness of ciNPT with a customizable dressing designed for linear, non-linear, and intersecting incisions up to 90cm in length, allowing for the treatment of a variety of different incision types.

About Acelity
Acelity L.P. Inc. and its subsidiaries are a global advanced wound care and regenerative medicine company created by uniting the strengths of three companies, Kinetic Concepts, Inc., LifeCell Corporation and Systagenix Wound Management, Limited. Available in more than 80 countries, the innovative and complementary ACELITY™ product portfolio delivers value through solutions that speed healing and lead the industry in quality, safety and customer experience. Headquartered in San Antonio, Texas, Acelity employs more than 5,800 people around the world.

[i] DeVries FE, Wallert ED, Solomkin JS, et al. A systematic review and meta-analysis including GRADE qualification of the risk of surgical site infections after prophylactic negative pressure wound therapy compared with conventional dressings in clean and contaminated surgery. Medicine (Baltimore). 2016;95(36):e4673.
[ii] Zimlichman E, Henderson D, Tamir O, et al.. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med 2013;173:2039–46.
[iii] Willy C, Engelhardt M, Stichling M, et al. The impact of surgical site occurrences and the role of closed incision negative pressure therapy. Int Wound J. 2016;13 Suppl 3:35-46.
[iv] Ibid.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.

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Comments

The WHO based their recommendation on the fact that clinical trials show that NPWT outperforms one of the WORST possible dressing choices: dry gauze. Where are the studies comparing NPWT with advanced dressings which keep wounds appropriately moist? I recently asked industry representatives for data comparing NPWTi (+irrigation) with modern moist dressings. There are none. The manufacturer has only compared NPWTi with conventional NPWT. WHY??? Consider this: Why should they risk conducting studies in which their product may not prove superior if they can get organizations like the WHO to recommend their products without them?
How many facilities use NPWT because it is rumored that it decreases infection rates? In contrast, studies show that NPWT increases infection rates when compared with modern moist wound management.[29,35] This should be expected because NPWT increases patients' pain and stress, the sponge acts as a foreign body, tissue ingrowth traumatizes the wound bed, and NPWT causes losses of electrolytes, proteins, and immunoglobulins greater than those suffered with severe burns.[2,3,4,5,6.7] We, as health care professionals and wound specialists, need to demand evidence that is meaningful to modern practice. Until we do, we will not be able to deliver evidence-based health care.
1. Patmo ASP, Krijnen P, Tuinebreijer WE, Breederveld RS. The Effect of Vacuum-Assisted Closure on the Bacterial Load and Type of Bacteria: A Systematic Review. Adv Wound Care (New Rochelle). 2014;3(5):383-389. doi:10.1089/wound.2013.0510.
2. Lambert KV, Hayes P, McCarthy M. Vacuum assisted closure: a review of development and current applications. Eur J Vasc Endovasc Surg. 2005;29(3):219-226. doi:10.1016/j.ejvs.2004.12.017.
3. Wade C, Wolf SE, Hourigan L, Linfoot JA, et al. Loss of protein, immunoglobulins, and electrolytes in exudates from negative pressure wound therapy. Nutr Clin Pract. 2010;25(5):510-516. doi:10.1177/0884533610379852.
4. Li Z, Yu A. Complications of negative pressure wound therapy: a mini review. Wound Repair Regen. 2014;22(4):457-461. doi:10.1111/wrr.12190.
5. Fagerdahl A-M, Boström L, Ottosson C, Ulfvarson J. Patients’ experience of advanced wound treatment-a qualitative study. Wounds. 2013;25(8):205-211.
6. Ottosen B, Pedersen BD. Patients’ experiences of NPWT in an outpatient setting in Denmark. J Wound Care. 2013;22(4):197-198, 200-202, 204-206. doi:10.12968/jowc.2013.22.4.197.
7. Harries RL, Bosanquet DC, Harding KG. Wound bed preparation: TIME for an update. Int Wound J. 2016;13(S3):8-14. doi:10.1111/iwj.12662.

Linda Benskin, PhD, RN, SRN (Ghana), CWCN, CWS, DAPWCA
Independent Nurse Researcher for Developing Countries and
Clinical Research & Education Liaison and Charity Liaison for Ferris Mfg. Corp.

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