Cotton Swab Use Slashes Postsurgical Wound Infections

A simple item found in almost every medicine cabinet, the lowly cotton swab, may be a key tool in the fight against postsurgical wound infections, according to a new study.

Researchers at Cedars-Sinai Medical Center (Los Angeles, CA, USA) and the University of Southern California (Los Angeles, CA, USA) conducted a prospective randomized clinical trial involving 76 adult patients undergoing an open appendectomy for perforated appendicitis between January 1, 2007, and December 31, 2009. The patients were randomized to a simple wound-probing protocol (WPP) study arm, involving loosely stapled closure with daily probing between staples with a cotton-tipped applicator until the wound is impenetrable, or to a control arm, involving loose wound closure with staples every 2 cm. Intravenous antibiotic therapy was initiated preoperatively and continued until resolution of fever and normalization of the white blood cell (WBC) count; follow-up was at 2 weeks and at 3 months. Outcome measures included wound pain, surgical site infection (SSI), length of hospital stay, other complications, and patient satisfaction.

The results showed that 49 (64%) patients completed the 3-month follow-up. The patients in the WPP arm had a significantly lower SSI rate (3% versus 19%) and shorter hospital stays (5 versus 7 days with no increase in pain) than the control group; other complications were similar. On regression analysis, only WPP significantly affected SSI rates. Age, wound length, body mass index (BMI), abdominal circumference, and diabetes mellitus (DM) had no effect on SSI. Patient satisfaction at 3 months was similar. The study was published in the April 2011 issue of Archives of Surgery.

“This practice was introduced to me as a surgical resident 15 years ago; I've used it routinely since then,” said lead author Shirin Towfigh, MD, of the Cedars-Sinai Medical Center department of surgery. “While I thought all surgeons were aware of this treatment approach, I learned otherwise when I began my professional career. Since it was evident to me that probing certain wounds after surgery resulted in far fewer infections, I developed this clinical trial so that my colleagues across the country could learn about, and confidently adopt the practice.”

SSI’s most commonly occur in contaminated wounds, such as after trauma, bowel surgery, or a perforated appendix. Until now, no preventative treatment at the contaminated wound site--including topical antibiotics, wound drains, or delayed closure of the wound--has proven to decrease these infections reliably. The exact mechanism by which the technique prevents SSI is unclear; the authors surmise that wound probing allows contaminated fluid trapped within soft tissues to drain, reducing the bacterial burden while maintaining a moist environment needed for successful wound healing.

Related Links:
Cedars-Sinai Medical Center
University of Southern California