By Barbara Greenwood Dufour

For most people, anticipating surgery is stressful for a variety of reasons. Concern that infection-causing germs will get into their incision may or may not be one of them. But, in Canada, more than 200,000 patients a year end up with a health care-associated infection while receiving care and, according to the World Health Organization, surgical site infections (SSIs) are one of the most common of these infections.

There are, fortunately, measures that can be taken to reduce the risk of infection. According to a newly released study by the Canadian Nosocomial Infection Surveillance Program, these measures appear to be working. Hospital-acquired infections in Canada — one fifth of which are surgical site infections — declined by 30 per cent between 2009 and 2017. This is likely a result of the improved use of infection-control measures.

Several of the measures used to decrease the risk of infection involve reducing the amount of germs in the surgical environment — on the patient, on surgical team members, and on surgical equipment. There are also medical devices and medical consumables on the market that are coated with or contain antimicrobials such as triclosan. But do these products really help reduce the risk of SSIs?

A few years ago, CADTH — an independent agency that finds, assesses, and summarizes the research on drugs and medical devices — reviewed the published research on antimicrobial-treated sutures and found evidence to suggest that these products might help reduce SSIs. This year, CADTH looked for more recent information. The newer CADTH review looked for evidence on any type of single-use medical device or consumable treated with an antimicrobial, but it looked specifically for those treated with triclosan.

Triclosan may be familiar to a lot of people. Fairly recently, it had been added to a range of household products, from hand soaps and toothpaste to kitchen cutting boards. This use has since been scaled back in light of concerns that such a wide use of antimicrobials might contribute to the development of antibiotic-resistant organisms without providing a significant benefit (e.g., triclosan-treated hand soap wasn’t found to be more effective than plain hand soap).

However, the use of antimicrobials to reduce infections from surgery is quite reasonable — it’s a targeted use where the risk of infection is much higher.

Although a variety of surgical products — including surgical instruments, catheters, and sutures — can contain triclosan, CADTH found research only on sutures. This newer evidence — from one health technology assessment, one systematic review, six randomized controlled trials, and one non-randomized study — strengthens the findings of the previous review. The evidence continues to, overall, indicate that that triclosan-coated sutures are associated with a lower risk of SSIs in hospitalized patients compared with uncoated sutures.

In addition, there was a new study on the use of triclosan-coated sutures in children, a patient group that hadn’t previously been studied. This high-quality randomized controlled trial, which included pediatric patients undergoing general or orthopedic surgery, found that triclosan-coated sutures appeared to lower the risk of SSIs in children as well.

With new evidence becoming available, new evidence-based guidelines have also been released. There were none at the time of CADTH’s previous review. The new guidelines — by the Centers for Disease Control and Prevention, National Institute for Health and Care Excellence, and the World Health Organization — all recommend considering the use of triclosan-coated sutures to prevent SSIs.

We don’t know how much the use of triclosan-coated sutures has contributed to improvements in the rate of SSIs. And the findings from the CADTH review come with a moderate degree of uncertainty, meaning that additional research is needed for us to be more confident that these sutures lead to better patient outcomes. But the evidence is encouraging, and there was no evidence to suggest that triclosan-coated sutures lead to negative patient outcomes.

If you’re interested in finding out more about CADTH’s review of triclosan-coated sutures for preventing SSIs, including its findings for other related outcomes, the report is freely available on our website. To learn more about CADTH, visit www.cadth.ca, follow us on Twitter @CADTH_ACMTS, or speak to a Liaison Officer in your region.

Barbara Greenwood Dufour is a Knowledge Mobilization Officer at CADTH.