Is it possible in an era of such complex medical technology for anything new and effective to also be stone simple? My answer is, of course — and this is something we should never lose sight of. Latest example:I’ve come across a fascinating new medical study describing a technique for preventing infections in certain surgical wounds using nothing but a cotton swab similar to the Q-tips brand that we all grew up with. This approach is used solely for patients who have what surgeons call “dirty” wounds. Because of the type of operation — for example, bowel surgery, perforated appendix or surgery for trauma — the area is likely to be heavily contaminated with bacteria, putting patients at high risk for developing wound infections.
Infection Rates Drop, So Does Pain
As a rule, efforts to prevent postsurgery infection in dirty wounds have included inserting under-the-skin drains, leaving the site open and cleaning it regularly or applying topical antibiotics, but the success rate with these methods is disturbingly low. Risk for infection can reach up to 50% in the US depending on the amount of contamination, which translates to more than 500,000 such infections each year, representing 25% of all hospital-acquired infections and a major cause of patient death. The new study, done in Los Angeles, included 76 patients who had undergone surgery for a perforated appendix. In half of the patients, doctors used iodine to clean the incision wounds, and in the other half, they gently probed the wounds with cotton swabs daily. The results were impressive. While 19% of the iodine-only group developed wound infections, just 3% of the patients in the probed group did. The probed group also had shorter hospitals stays, on average (five days versus seven)… less postoperative pain… and better cosmetic healing of the incisions.
A Study Speaks to Doubters
The author of this study was surgeon Shirin Towfigh, MD, attending surgeon at Cedars-Sinai Medical Center in Los Angeles. She told me that she learned this technique while a resident at another medical center and assumed that it was common knowledge. Much to her surprise, she later discovered that very few doctors knew anything about it. Indeed she initially got a lot of resistance from her colleagues. “They were worried that the probing would be painful and thought it best to leave an incision alone to heal,” she told me. This prompted her to do the clinical study and now, as she says, “the evidence speaks for itself.”
To be able to do cotton-swab probing, the incision must be closed loosely, with staples placed at least two centimeters apart, says Dr. Towfigh. This provides enough room for doctors to insert the dry swabs deep into the incision between the staples. (Contrary to doctors’ fears, Dr. Towfigh says, patients experience only a minimum amount of pain from the technique.) Daily probing starts the morning after surgery, takes two to four minutes, and continues until the wound closes completely, generally in three to five days. Gentle insertion doesn’t open up the sealed portions of the wound, and the trick here is that bacterial fluid is removed from the site, allowing the body’s natural defenses to deal with the infection. Some patients are ready to leave the hospital before their wounds have completely sealed — and believe it or not, they are given instructions on how to probe the incisions themselves so they can continue at home.
The Word Spreads
Dr. Towfigh says that her study has engendered excitement among surgeons around the country and abroad and that they have been contacting her to learn more. (She also is preparing an instructional video of the technique.) Doctors at Cedars-Sinai now are using the technique on appropriate patients throughout the hospital, and a team of colorectal surgeons there has started a similar study in their patient population. The success of this simple method is a good reminder that an easy, low-tech approach is sometimes just exactly what is needed.