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Must Sutures Be Kept Dry to Prevent Infection?
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Am Fam Physician. 2006 Oct 1;74(7):1200-1202.
Guidelines for wound management recommend that sutures be kept dry and covered for 24 to 48 hours after primary repair to reduce the risk of infection. However, a few small studies have indicated that allowing sutures to get wet (e.g., when showering) does not increase the rate of wound infection. Because there have been few studies on this issue, Heal and colleagues conducted a study of “dry” wound management compared with “wet” wound management among patients treated for minor skin wounds in four Australian general practices.
The study involved 870 patients who had minor skin wounds repaired by general practitioners over eight months. Patients excluded from the study included those with skin excisions on the face and those taking immunosuppressive drugs or antibiotics or requiring immediate postoperative antibiotics. The participating physicians attended a workshop to agree on a standardized technique for wound repair and to develop consensus guidelines for wound management.
After suturing, patients were randomly assigned to wet (i.e., intervention) or dry (i.e., control) management groups. Patients in the dry group followed conventional practice, keeping the wound covered with a dry dressing for 48 hours. Patients in the wet group were asked to remove the dressing within 12 hours and then to bathe as normal until sutures were removed. Patients in both groups were asked to avoid the use of antiseptic washes and soaps until sutures were removed. A practice nurse or physician assessed the wounds for infection on the day of suture removal, or earlier if a clinical wound infection developed. Criteria for wound infection were based on the Australian Centre for Disease Control national nosocomial infection surveillance system.
Follow-up was completed on 857 (98.5 percent) of enrolled patients. Of these, clinical infection was documented in 74 (8.6 percent) patients. For patients in the wet group, the infection rate was 8.4 percent, compared with 8.9 percent in the control group.
The authors conclude that allowing sutures to remain uncovered and get wet following minor surgery does not increase the rate of wound infection. They caution that the study was conducted in a tropical area, so the results may not be generalizable to all practices.
Heal C, et al. Can sutures get wet? Prospective randomised controlled trial of wound management in general practice. BMJ. May 6, 2006;332:1053–6.
Copyright © 2006 by the American Academy of Family Physicians.
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