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Only suture to address a known risk factor for SSI1
Plus Sutures are the only triclosan-coated sutures commercially available worldwide—supported by a wealth of Level 1A evidence1-13 and a growing number of evidence-based global health authorities.14-18,33 Make Plus Sutures part of your comprehensive, evidence-based surgical site infection (SSI) risk reduction strategy.
5 benefits Plus Sutures can bring to you, your hospital, and your patients
Supported by a wealth of Level 1A evidence1-13
Plus Sutures are supported by 12 meta-analyses,1-13 the highest quality in the Evidence-based Medicine Pyramid. Recent meta-analysis showed a 28% reduction in SSI risk with the use of triclosan-coated sutures.1,34,35 In meta-regression analyses, their effect in reducing the risk of SSI did not vary by CDC wound classification or suture type.1,33,34,35
Inhibits bacterial colonization on the suture2
Sutures, like all implants, can be a nidus for infection.2 Bacterial colonization of the suture can lead to biofilm formation—a known risk factor for SSI.19 Triclosan, the antimicrobial agent used in Plus Sutures, is effective against the most common pathogens associated with SSI.2,19-22
Complements antibiotic use
Antibiotics cannot always reach the incision site.23,24 And once biofilm has formed on the sutures, it increases microorganisms’ resistance to microbial agents.25 The WHO recommends prophylactic antibiotics and triclosan-coated sutures.15 Using both can provide an extra measure of confidence.
Triclosan-coated sutures have not been banned by the FDA
Triclosan has not been banned from Plus Suture, a 10-year clinical survey showed no relationship between triclosan usage and antibiotic resistance,26 and triclosan-coated sutures have a low environmental impact.27 Plus Sutures were shown in vivo and in vitro to be nontoxic, nonirritating, noncarcinogenic, and nonteratogenic.28
Cost-effective SSI intervention
At just 48 cents more per strand on average,29 Plus Sutures are a small price to pay compared to the cost of a single SSI, which can be up to $39,000.30,37 Plus Sutures are one of the lowest cost items in an SSI prevention care bundle.29, 31, 32
The third-party trademarks used herein are trademarks of their respective owners.
¶ 5 meters triclosan-coated suture in a 58 kg patient.
# Single dose of toothpaste with triclosan.
** Full body wash with 1% triclosan.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- Daoud FC. Systematic literature review update of the PROUD Trial: potential usefulness of a collaborative database. Surg Infect (Larchmt). 2014;15(6):857-858.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- WHO 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.
- 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.
- 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 June 10, 2020.
- 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.
- 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.
- Storch ML, Rothenburger SJ, Jacinto G. Experimental efficacy study of coated VICRYL plus antibacterial suture in guinea pigs challenged with Staphylococcus aureus. Surg Infect (Larchmt). 2004;5(3):281-288.
- 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.
- 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.
- Heggers JP. Assessing and controlling wound infection. Clin Plast Surg. 2003;20(1):25-35.
- Nakamura T, Tomizawa A, Inano H, et al. Tissue concentrations of antibiotics given prophylactically during colorectal cancer surgery. Hepatogastroenterology. 2013;60(126):1371-1375.
- Leaper D, Wilson P, Assadian O, et al. The role of antimicrobial sutures in preventing surgical site infection. Ann R Coll Surg Engl. 2017;99(6):439-443.
- Russell A. Whither triclosan? J Antimicrob Chemother. 2004;53:693-695.
- Duran-Alvarez J, Prado B, Gonzalez D, et al. Environmental fate of naproxen, carbamazepine and triclosan in wastewater, surface water and wastewater irrigated soil — Results of laboratory scale experiments. Sci Total Environ. 2015; 538:350-362.
- 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.
- Plus Suture Cost Analysis. 2019. Ethicon, Inc.
- de Lissovoy G, Pan F, Patkar A, et al. Surgical Site Infection Incidence and Burden Assessment Using Multi-institutional Real-world Data. Presented at the EU ISPOR Meeting; November 5-8, 2011; Madrid, Spain.
- Lee I, Agarwal R, Lee B, et al. Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection. Infect Control Hosp Epidemiol. 2010;31(12):1219-1229.
- Wilson S, Turpin R, Kumar N. et al. Comparative costs of ertapenem and cefotetan as prophylaxis for elective colorectal surgery. Surg Infect. 2008;9(3):349-356.
- Guidelines on reducing the risk of surgical site infections are general to triclosan-coated sutures and are not specific to any one brand.
- 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%).
- As shown in coronary artery bypass surgery.