Advanced dressings for the prevention of surgical site infection in women post-caesarean section: a systematic review and meta-analysis

Samodani Wijetunge, Ruby Hill, R. Katie Morris, Victoria Hodgetts Morton*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

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Objective(s): Surgical site infections (SSIs) are a common complication post-caesarean section. Advanced dressings aim to provide an optimal wound environment, primarily by physically or chemically controlling moisture, in order to promote timely healing. A systematic review and meta-analysis was conducted to evaluate the effectiveness of advanced dressings in SSI prevention post-caesarean section. Secondary effectiveness outcomes included superficial SSI, endometritis, wound dehiscence, rehospitalisation and length of rehospitalisation.

Study design: We conducted a systematic review and meta-analysis according to PRISMA guidelines. A protocol was registered a priori. MEDLINE, EMBASE, CENTRAL and CINAHL databases were searched from inception to May 2021, without date or language restrictions. Keywords included: caesarean section; bandages; dressing and surgical wound infection. Randomised controlled trials (RCTs) were included if they investigated any advanced dressing in women post-caesarean section compared to simple dressings and assessed SSI incidence. Relative risks (RR), with 95% confidence intervals (CIs) and p-values, were calculated using Review Manager software (RevMan version 5.0, The Cochrane Collaboration). I2 percentages were reported to assess heterogeneity and a funnel plot was produced to assess publication bias. Quality assessment was performed using the Cochrane Risk of Bias Assessment Tool. All data were double-extracted and discrepancies were finalised by a third reviewer.

Results: From 253 citations identified, six RCTs were included in the systematic review and meta-analysis. Two studies investigated dialkylcarbamoyl chloride (DACC)-impregnated dressings; two investigated silver-impregnated dressings; one investigated copper-impregnated dressings and one investigated chlorhexidine gluconate dressings. The overall meta-analysis showed that advanced dressings did not reduce SSI risk (RR 0.81 [95% CI 0.52–1.24; p = 0.32]). However, subgroup analysis revealed that DACC-impregnated dressings reduced SSI risk (RR 0.33 [95% CI 0.14–0.77; p = 0.01]). Silver-impregnated dressings caused a nonsignificant increase in SSI risk (RR 1.20 [95% CI 0.77–1.88; p = 0.41]). All studies showed a high risk of bias.

Conclusion: This systematic review and meta-analysis suggests DACC dressings potentially reduce SSI. However we have shown no benefit of silver dressings. Further high-quality RCTs are required to recommend a change in clinical practice.

Original languageEnglish
Pages (from-to)226-233
Number of pages8
JournalEuropean Journal of Obstetrics and Gynecology and Reproductive Biology
Early online date11 Nov 2021
Publication statusPublished - Dec 2021

Bibliographical note

Funding Information:
SW and RH contributed equally as the main reviewers conducting all stages of research and manuscript writing. VHM and KM were supervisors for the systematic review and provided guidance at every stage of research, and manuscript editing and proof-reading. Support during this review was very gratefully received from the Sir Arthur Thomson Trust (CN: 233005). The Trust played no part in the conduct of research or writing of the paper.


  • Advanced dressing
  • Caesarean section
  • Dialkylcarbamoyl chloride
  • Endometritis
  • Surgical site infection
  • Wound infection

ASJC Scopus subject areas

  • Reproductive Medicine
  • Obstetrics and Gynaecology


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