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Why risk an SSI?
Like wearing seat belts, following SSI risk-reduction guidelines may provide protection from catastrophic outcomes.1,2 Make triclosan-coated sutures part of your SSI risk-reduction strategy for every case. Plus Sutures—an easy and effective way to help prevent catastrophic outcomes.3
Plus Sutures are supported by the highest quality evidence3-14
Sutures can be a nidus for infection15
Like all implants, sutures can lower the infective threshold.16 Once bacteria colonize on the surface, biofilm can form—a known risk factor for SSI.17 Plus Sutures are shown in vitro to inhibit bacterial colonization of the suture for 7 days or more against the most common organisms associated with SSI.18-20*†
Shown to reduce SSI risk3
Meta-analysis demonstrated a 28% reduction in SSI risk with the use of triclosan-coated sutures.3‡§ Meta-regression analysis demonstrated that the effect of Plus Sutures in reducing the risk of SSI did not vary by Centers for Disease Control and Prevention (CDC) wound classification or suture type.3‡§||
Recommended by 6 independent authorities21-25
Triclosan-coated sutures are included in SSI-prevention bundles recommended by a number
of evidence-based organizations, including the WHO, CDC, ACS/SIS, NICE, and RKI.
CDC, WHO, ACS/SIS, NICE, and RKI guidelines on reducing the risk of surgical site infections are general to triclosan-coated sutures and are not specific to any one brand.
Low-cost part of an SSI prevention bundle3,22,29¶
A single SSI can cost up to $39,000.29,30# But at up to $5 more per surgery than traditional sutures, Plus Sutures are an affordable part of the WHO-recommended SSI-prevention care bundle.3,22,29¶
Triclosan sutures were not banned by the FDA
Triclosan was questioned in several other products because of insufficient evidence, not confirmed lack of safety or efficacy.31,32 Plus Sutures were shown in vivo and in vitro to be nontoxic, nonirritating, noncarcinogenic, and nonteratogenic.33 And a 10-year clinical survey showed no relationship between triclosan usage and antibiotic resistance.34
*As shown in vitro.
†Staphylococcus aureus, Staphylococcus epidermidis, Methicillin-resistant Staphylococcus aureus (MRSA), Methicillin-resistant Staphylococcus epidermidis (MRSE), Escherichia coli, and Klebsiella pneumoniae.
‡21 RCTs, 6462 patients, 95% CI: (14, 40%), P<0.001.
§All triclosan-coated sutures in these RCTs were Ethicon Plus Antibacterial Sutures (MONOCRYL® Plus Antibacterial [poliglecaprone 25] Suture, Coated VICRYL® Plus Antibacterial [polyglactin 910] Suture, and PDS® Plus Antibacterial [polydioxanone] Suture).
||Clean wounds 10 RCT, 2842 patients 95% CI (11-43%). P= 0.003; non-clean wounds 14 RCT, 3620 patients. 95% CI (7 – 42%).
¶Assuming 10 or fewer strands used per surgical case.
#As shown in coronary artery bypass surgery.
**5 meters triclosan-coated suture in a 58kg patient.
††Single dose of toothpaste with triclosan.
‡‡Full body wash with 1% triclosan.
1. Anderson D, Podgorny K, Berrios-Torres S, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605-627.
2. National Highway Traffic Safety Administration. Risky driving: seat belts. https://www.nhtsa.gov/risky-driving/seat-belts. Accessed 7/31/20.
3. de Jonge SW, Atema JJ, Solomkin JS, Boermeester MA. Meta-analysis and trial sequential analysis of triclosan-coated sutures for the prevention of surgical-site infection. Br J Surg. 2017;104(2):e118-e133.
4. Leaper DJ, Edmiston CE Jr, Holy CE. Meta-analysis of the potential economic impact following introduction of absorbable antimicrobial sutures. Br J Surg. 2017;104(2):e134-e144.
5. Apisarnthanarak A, Singh N, Bandong AN, et al. Triclosan-coated sutures reduce the risk of surgical site infections: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2015;36:169-179.
6. Chang WK, Srinivasa S, Morton R, et al. Triclosan-impregnated sutures to decrease. Surgical Site Infections: Systematic Review and Meta-Analysis of Randomized Trials. Ann Surg. 2012;255(5):854-859.
7. Daoud FC, Edmiston CE Jr, Leaper D. Meta-analysis of prevention of surgical site infections following incision closure with triclosan-coated sutures: robustness to new evidence. Surg Infect (Larchmt). 2014;15(3):165-181.
8. Daoud FC. Systematic literature review update of the PROUD Trial: potential usefulness of a collaborative database. Surg Infect (Larchmt). 2014;15(6):857-858.
9. Guo J, Pan LH, Li YX, et al. Efficacy of triclosan-coated sutures for reducing risk of surgical site infection in adults: a meta-analysis of randomized clinical trials. J Surg Res. 2016; 201(1):105-117.
10. Sajid MS, Craciunas L, Sains P, et al. Use of antibacterial sutures for skin closure in controlling surgical site infections: a systematic review of published randomized, controlled trials. Gastroenterol Rep (Oxf). 2013;1(1):42-50.
11. Sandini M, Mattavelli I, Nespoli L, Uggeri F, Gianotti L. Systematic review and meta-analysis of sutures coated with triclosan for the prevention of surgical site infection after elective colorectal surgery according to the PRISMA statement. Medicine (Baltimore). 2016;95(35):e4057.
12. Wang ZX, Jiang CP, Cao Y, et al. Systematic review and meta-analysis of triclosan-coated sutures for the prevention of surgical-site infection. Brit J Surg. 2013;100(4): 465-473.
13. Wu X, Kubilay NZ, Ren J, et al. Antimicrobial-coated sutures to decrease surgical site infections: a systematic review and meta-analysis. Eur J Clin Microbiol Infect Dis. 2017;36(1):19-32.
14. Ahmed I, Boulton AJ, Rizvi S, et al. The use of triclosan-coated sutures to prevent surgical site infections: a systematic review and meta-analysis of the literature. BMJ Open. 2019;9:e029727. doi:10.1136/bmjopen-2019-029727.
15. Edmiston CE, Seabrook GR, Goheen MP, et al. Bacterial adherence to surgical sutures: can antibacterial-coated sutures reduce the risk of microbial contamination? J Am Coll Surg. 2006;203(4):481-489.
16. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR, Hospital Infection Control Practices Advisory Committee. Guideline for Prevention of Surgical Site Infection, 1999. Infect Control Hosp Epidemiol. 1999;20(4):250-278.
17. Edmiston CE, Daoud FC, Leaper D. Is there an evidence-based argument for embracing an antimicrobial (triclosan)-coated suture technology to reduce the risk for surgical-site infections?: A meta-analysis. Surgery. 2013;154:89-100.
18. Ming X, Rothenburger S, Yang D. In vitro antibacterial efficacy of Monocryl Plus Antibacterial Suture (poligelcaprone 25 with triclosan). Surg Infect (Larchmt). 2007;8(2):201-207.
19. Rothenburger S, Spangler D, Bhende S, Burkley D. In vitro antimicrobial evaluation of coated Vicryl Plus Antibacterial Suture (coated polyglactin 910 with triclosan) using zone of inhibition assays. Surg Infect (Larchmt). 2002;3 (suppl):S79-S87.
20. Ming X, Rothenburger S, Nichols MM. In vivo and in vitro antibacterial efficacy of PDS Plus (polidioxanone with triclosan) suture. Surg Infect (Larchmt). 2008;9(4):451-457.
21. Berríos-Torres SI, Umscheid CA, Bratzler DW, et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. doi:10.1001/jamasurg.2017.0904.
22. World Health Organization Global Guidelines for the Prevention of Surgical Site Infection, 2018. https://apps.who.int/iris/bitstream/handle/10665/277399/9789241550475-eng.pdf. Accessed May 9, 2020.
23. Ban KA, Minei JP, Laronga C, et al. American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update. J Am Coll Surg. 2016;224(1):59-74.
24. National Institute for Health and Care Excellence (NICE) Guideline. Surgical site infections: prevention and treatment. NICE website. https://www.nice.org.uk/guidance/ng125/chapter/Recommendations#closure-methods. Accessed October 17, 2019.
25. Prevention of postoperative wound infections. Recommendation of the Committee for Hospital Hygiene and Infection Prevention (KRINKO) at the Robert Koch Institute. Bundesgesundheitsbl. 2018; 61(4):448-473.
26. MONOCRYL® Plus Antibacterial (Poliglecaprone 25) Suture Instructions for Use. 2016. Ethicon, Inc.
27. Coated VICRYL® Plus Antibacterial (Polyglactin 910) Suture Instructions for Use. 2016. Ethicon, Inc.
28. PDS® Plus Antibacterial (Polydioxanone) Suture Instructions for Use. 2018. Ethicon, Inc.
29. Plus Suture Cost Analysis. 2019. Ethicon, Inc.
30. de Lissovoy G, Pan F, Patkar A, et al. Surgical Site Infection Incidence and Burden Assessment Using Multi-institutional Real-world Data. Presented at: EU ISPOR Meeting; November 5-8, 2011; Madrid, Spain.
31. Food and Drug Administration. Safety and Effectiveness of Consumer Antiseptics; Topical Antimicrobial Drug Products for Over-the-Counter Human Use. Federal Register. 2016. https://www.federalregister.gov/documents/2016/09/06/2016˜21337/safety-and-effectiveness-of-consumer-antiseptics-topical-antimicrobial-drug-products-for. Accessed February 6, 2020.
32. Food and Drug Administration. Safety and Effectiveness of Health Care Antiseptics; Topical Antimicrobial Drug Products for Over-the-Counter Human Use. Federal Register. 2017. https://www.federalregister.gov/documents/2017/12/20/2017˜27317/safety-and-effectiveness-of-health-care-antiseptics-topical-antimicrobial- drug-products-for. Accessed February 6, 2020.
33. Barbolt TA. Chemistry and safety of triclosan, and its use as an antimicrobial on Coated VICRYL* Plus Antibacterial Suture (coated polyglactin 910 suture with triclosan). Surg Infect (Larchmt). 2002;3 (suppl):S45-S53.
34. Russell A. Whither triclosan? J Antimicrob Chemother. 2004;53:693-695.