Intended for healthcare professionals

surgeon in operating room
surgeon in operating room

Since 2014, more than 1 billion individual Plus Suture strands have been sold worldwide.1-2

Plus Antibacterial Sutures: the proven standard

The clinical value of triclosan-coated sutures for wound closure is well-established and supported by Level 1A evidence as well as multiple evidence-based clinical practice guidelines.*3-8

Today, Plus Antibacterial Sutures are the wound closure standard 
in a growing number of countries.


*CDC, WHO, ACS/SIS, NICE, and KRINKO guidelines on reducing the risk of surgical site infections are general to triclosan-coated sutures and are not specific to any one brand.

Plus Antibacterial Sutures: the proven standard

The clinical value of triclosan-coated sutures for wound closure is well-established and supported by Level 1A evidence as well as multiple evidence-based clinical practice guidelines.*3-8

Today, Plus Antibacterial Sutures are the wound closure standard 
in a growing number of countries.


*CDC, WHO, ACS/SIS, NICE, and KRINKO guidelines on reducing the risk of surgical site infections are general to triclosan-coated sutures and are not specific to any one brand.

“The panel suggests the use of triclosan-coated sutures for the purpose of reducing the risk of SSI, independent of the type of surgery.”*9

– World Health Organization

*WHO, CDC, and ACS/SIS guidelines on reducing the risk of surgical site infections are general to triclosan-coated sutures and are not specific to any one brand.

Markets that have moved to Plus Antibacterial Sutures as standard:

Every suture counts when it comes to reducing SSI risk

The use of non-coated sutures, compared with Triclosan-coated Sutures was found to increase the risk of SSI by 1.4 times.10


Suture material is a risk factor for SSI. Bacteria can colonize on the suture developing a polymicrobial biofilm which increases the likelihood of an SSI.11

Every suture counts when it comes to reducing SSI risk

The use of non-coated sutures, compared with Triclosan-coated Sutures was found to increase the risk of SSI by 1.4 times.10


Suture material is a risk factor for SSI. Bacteria can colonize on the suture developing a polymicrobial biofilm which increases the likelihood of an SSI.11

~30%

of healthcare acquired infections are SSIs12

1-3%

SSI occurrence in patients undergoinginpatient surgery13

x2

Patients with an SSI are twice as likely to die13

3.7B

SSIs account for $3.7 billion annually in healthcare expenditure.12

8 days

Patients with an SSI were associated with longer length of stay14

x2

Patients with an SSI are twice 
as likely to be readmitted after discharge15

Plus Sutures inhibit bacterial colonization of the suture 
even after direct challenge with bacteria.*16-19



*As shown in vitro

Plus Sutures were associated with up to a 29% reduction in the risk of surgical site
infection in multiple recent meta-analyses.*†20-25

*In multiple meta-analyses

†All triclosan-coated sutures in these RCTs were Ethicon Plus Antibacterial Sutures (MONOCRYL™ Plus, VICRYL™ Plus, and PDS™ Plus)

[If first mention: 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). STRATAFIX™ are the only barbed sutures with Plus Antibacterial Technology]

Proven SSI Reduction

Plus sutures have been proven to reduce the risk of surgical site infections.

See the evidence

26 Meta-analyses

Plus Sutures have been studied in more than 20 meta-analyses, 31 randomized controlled trials, and nearly 14,000 patients.*26-46

*Not all results showed statistical significance.


Review the support

Ready to join the growing global standard?

A comprehensive portfolio for every need

Join the wound closure standard today. Reach out to a member of your Wound Closure and Healing team to discuss how to make the change.

Evidence

Jalalzadeh Meta-Analysis

Triclosan-Containing Sutures for the Prevention of Surgical Site Infection

View article

Otto-Lambertz Meta-Analysis

Can triclosan-coated sutures reduce the postoperative rate of wound infection? Data from a systematic review and meta-analysis

View article

De Jonge Meta-Analysis

Meta-analysis and trial sequential analysis of triclosan-coated sutures for the prevention of surgical site infection

View article

References

For complete indications, contraindications, warnings, precautions, and adverse reactions, please reference full package insert.

  1. Ethicon, 20230904 Global Business Insights Data on Plus Sutures Claim, Global Finance, Strive data. August 2023. 
  2. Ethicon, SAS YTD ACT 1. 2025 
  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. Berrios-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. 2017;152(8):784-791.  
  5. 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. 2017; 224(1):59-74.  
  6. NICE Guideline Updates Team (UK). Surgical site infection: prevention and treatment. NICE website. https:__www.nice.org.uk_guidance_ng125_chapter_Recommendations#closuremethods. Accessed April 3, 2020.  
  7. World Health Organization. Global guidelines for the prevention of surgical site infection. https:__apps.who.int_iris_bitstream_handle_10665_250680_9789241549882-eng.pdf?sequence=8. Published November 2016. Accessed April 3, 2020.  
  8. 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):448-473.68 
  9. World Health Organization. Global guidelines for the prevention of surgical site infection. Accessed November 14, 2022 at https:__apps.who.int_iris_bitstream_handle_10665_277399_9789241550475-eng.pdf?sequence=1&isAllowed=y 
  10. Bustamante Montalvo M, Cainzos M, Carreiras LP et al., Evaluation of the effect of triclosan coated sutures in the prevention of surgical site infections in a Spanish hospital setting: A prospective, observational study, Infection Prevention in Practice, https://doi.org/10.1016/j.infpip.2021100154. 
  11. Edwards M, Graziadio S, Shore J, et al. Plus Sutures for preventing surgical site infection: a systematic review of clinical outcomes with economic and environmental models. BMC Surg. 2023 Oct 3;23(1):300 
  12. Forrester JD, Maggio PM, Tennakoon L. Cost of Health Care-Associated Infections in the United States. J Patient Saf. 2022 Mar 1:18(2):e477-e479. doi: 10.1097/PTS.0000000000000845. PMID: 33881808 
  13. Calderwood MS, Anderson DJ, Bratzler DW, et al. Strategies to prevent surgical site infections in acute-care hospitals: 2023 
  14. Hasan B, Bechenati D, Bethel HM, Cho S, Rajjoub NS, Murad ST, Kabbara Allababidi A, Rajjo TI, Yousufuddin M. A Systematic Review of Length of Stay Linked to Hospital-Acquired Falls, Pressure Ulcers, Central Line-Associated Bloodstream Infections, and Surgical Site Infections. Mayo Clin Proc Innov Qual Outcomes. 2025 Apr 8;9 (3):100607. doi: 10.1016/j.mayocpiqo.2025.100607. PMID: 40256621; PMCID: PMC12008517. 
  15. Shambhu, Sonali et al. The Burden of Health Care Utilization, Cost, and Mortality Associated with Select Surgical Site Infections. Joint Commission Journal on Quality and Patient Safety, Volume 50, Issue 12, 857 - 866 
  16. 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;203:481-489. 
  17. 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 1:S79-87. 
  18. 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. 
  19. Ming X, Rothenburger S, Yang D. In vitro antibacterial efficacy of MONOCRYL plus antibacterial suture (Poliglecaprone 25 with triclosan). Surg Infect (Larchmt). 2007 Apr;8(2):201-8. 
  20. 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. Brit J Surg. 2017;ePub-DOI: 10.1002_bjs.10445. 
  21. Miyoshi N, Fujino S; Clinical Study Group of Osaka University; Colorectal Cancer Treatment Group (CSGOCG). Triclosan-coated sutures to reduce surgical site infection in abdominal gastrointestinal surgery: A meta-analysis and systematic review. Surg Open Sci. 2023 Sep 14;16:73-76. 
  22. Edwards M, Graziadio S, Shore J, et al. Plus Sutures for preventing surgical site infection: a systematic review of clinical outcomes with economic and environmental models. BMC Surg. 2023 Oct 3;23(1):300. 
  23. Suleiman AS, Abbass M, Hossain M, Choudhary P, Bhattacharya P, Islam MA. Impact of antibiotic-coated sutures on surgical site infections: a second-order meta-analysis. Int J Surg. 2024 Jan 1;110(1):507-519. doi: 10.1097/JS9.0000000000000822. PMID: 37830948; PMCID: PMC10793740. https://journals.lww.com/international-journal-of-surgery/fulltext/2024/01000/impact_of_antibiotic_coated_sutures_on_surgical.51.aspx. 
  24. Jalalzadeh H, Timmer AS, Buis DR, et al. Triclosan-Containing Sutures for the Prevention of Surgical Site Infection: A Systematic Review and Meta-Analysis. JAMA Netw Open. 2025;8(3):e250306. Published 2025 Mar 3. doi:10.1001/jamanetworkopen.2025.0306. 
  25. Jenks PJ, Laurent M, McQuarry S,Watkins R. Clinical and economic burden of surgical site infection (SSI) and predicted financial consequences of elimination of SSI from an English hospital. J Hosp Infect 2014; 86: 24–33. 
  26. de Jonge SW, et al. Meta-analysis & trial sequential analysis of triclosan-coated sutures for the prevention of SSI. Brit J Surg. 2017;104(2):e118-e133 
  27. Leaper DJ, et al. Meta-analysis of the potential economic impact following introduction of absorbable antimicrobial sutures. Br J Surg. 2017;104(2):e134-e144 
  28. Apisarnthanarak A, et al. Triclosan-coated sutures reduce the risk of SSI. Infect Control Hosp Epidemiol. 2015;36:169-179 
  29. Chang WK, et al. Triclosan-impregnated sutures to decrease. SSI. Ann Surg. 2012;255(5):854-859 
  30. Daoud FC, et al. Meta-analysis of prevention of SSI following incision closure with triclosan-coated sutures: robustness to new evidence. Surg Infect (Larchmt). 2014;15(3):165-181 
  31. Daoud FC. Systematic literature review update of the PROUD Trial: potential usefulness of a collaborative database. Surg Infect (Larchmt). 2014;15(6):857-858 
  32. Edmiston CE, et al. Is there an evidence-based argument for embracing an antimicrobial (triclosan)-coated suture technology to reduce the risk for SSI?: A meta-analysis. Surgery. 2013;154(1):89-100 
  33. Guo J, et al. Eicacy of triclosan-coated sutures for reducing risk of SSI in adults. J Surg Res. 2016; 201(1):105-117 
  34. Sajid MS, et al. Use of antibacterial sutures for skin closure in controlling SSI: a systematic review of published randomized, controlled trials. Gastroenterol Rep (Oxf). 2013;1(1):42-50 
  35. Sandini M, et al. Systematic review & meta-analysis of sutures coated with triclosan for the prevention of SSI after elective colorectal surgery according to the PRISMA statement. Medicine (Baltimore). 2016;95(35):e4057 
  36. Wang ZX, et al. Systematic review & meta-analysis of triclosan-coated sutures for the prevention of SSI. Brit J Surg. 2013;100(4): 465-473 
  37. Wu X, et al. Antimicrobial-coated sutures to decrease SSI. Eur J Clin Microbiol Infect Dis. 2017;36(1):1932 
  38. Ahmed I, et al. The use of triclosan-coated sutures to prevent SSI. BMJ Open. 2019;9:e029727 
  39. Uchino M, et al. The efficacy of antimicrobial-coated sutures for preventing incisional SSI in digestive surgery. J Gastrointest Surg. 2018;22(10):1832-1841 
  40. Konstantelias AA, et al. Triclosan-coated sutures for the prevention of SSI. Acta Chir Belg. 2017;117(3):137-148 
  41. Henriksen NA, et al. Triclosan-coated sutures & SSI in abdominal surgery: the TRISTAN review, meta-analysis & trial sequential analysis. Hernia. 2017;21(6):833-841 
  42. Elsolh B, et al. The effect of antibiotic-coated sutures on the incidence of SSI in abdominal closures. Journal of Gastrointestinal Surgery. 2017; 18: 1-8 
  43. Hunger R, et al. Triclosan-coated sutures in colorectal surgery: assessment & meta-analysis of the recommendations of the WHO guideline. 2019; 90(1): 37-46 
  44. Miyoshi, N., et al. Clinical Study Group of Osaka University, Colorectal Cancer Treatment Group (CSGOCG). 2022. Effectiveness of Triclosan-Coated Sutures Compared with Uncoated Sutures in Preventing SSI after Abdominal Wall Closure in Open_Laparoscopic Colorectal Surgery. Journal of the American College of Surgeons, 234(6), 1147–1159 
  45. National Institute of Health Research Unit on Global Surgery (2022). Alcoholic chlorhexidine skin preparation or triclosan-coated sutures to reduce SSI. The Lancet. Infectious diseases, 22(8), 1242–1251 
  46. © NICE 2021. MEDICAL TECHNOLOGY GUIDANCE: PLUS SUTURES FOR PREVENTING SSI. Available from: nice.org.uk_guidance_MTG59 Accessed on: 28 June 2021. All rights reserved. Subject to Notice of rights. NICE guidance is prepared for the National Health Service in England. All NICE guidance is subject to regular review & may be updated or withdrawn. NICE accepts no responsibility for the use of its content in this product_publication 

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