Activated Collagen Powder Significantly Reduces Surgical Site Infections In Patients Undergoing Elective Surgery

Samir Awad; Ryan Nowrouzi; William Lightle

Surgical site infections(SSI) are the most common hospital acquired infection (HAI) accounting for 20% with increase in morbidity, mortality and cost. Activated collagen(AC) has been shown to promote wound healing in surgical incisions, preventing wound dehiscence with a decrease in surgical site infections(SSI). In vitro, AC has been shown to significantly retard gram positive bacterial growth with a zone of inhibition(ZOI) comparable to vancomycin (ZOI=8 mm) and also mildly retards various gram negative bacteria growth. 

Our objective was to evaluate the impact of AC (CellerateRX, Sanara Med Tech) on SSI rate in patients undergoing elective surgery. We hypothesized that AC would decrease SSIs in patients undergoing elective surgery.

A retrospective review of a prospective data base of patients undergoing elective surgery at a tertiary academic hospital was performed from 1-1-2018 to 12-1-2021. Age, gender, comorbidities and demographics were collected. Surgical specialties included general, surgical oncology, orthopedic, vascular, neurosurgery, cardiothoracic, plastic and gynecology. All patients underwent preoperative decontamination with Chlorhexidine wipes day prior and on day of surgery; all had surgery site appropriate prophylactic antibiotics prior to incision; and all had chloraprep or duraprep as the skin prep. In the AC group, AC was applied prior to skin closure. Cases were stratified for clean and clean contaminated (CC). Patients in the AC group were compared to case matched 1:3 Non-AC patients. SSI rates were calculated for each group. Student’s ttest was used to compare continuous data. Chi square analysis was used to compare SSI rates between groups using p<0.05 as significant.

A total of 5335 cases were performed, 76%(4068) clean, 24%(1287) CC. Overall, the mean age was 61+/-1 years, mean BMI was 31.1+/-0.65. 87% were male, 53% were white, 31% with DM, 21% with COPD and 13% with CKD. The AC and Non-AC groups were well matched with no significant differences in age, gender, comorbidities, demographics, BMI, surgical specialty. Overall AC was used in 23% (Total=1489;Clean=1089;CC=400) of cases. There was a significant decrease in overall SSI rate with use of AC(AC SSI= .63,Non-AC SSI= 1.52,p=.008). There was a significant decrease in SSI rate in clean cases(AC SSI=.30,Non-AC SSI=.97,p=.026) and a trend towards decreased SSI rate in CC cases(AC SSI=3.36,Non-AC SSI=1.54,p=.058).

The use of AC in patients undergoing elective surgery resulted in a significant 59% reduction in SSI rate. This was most pronounced in the clean cases with a 69% decrease SSI rate. AC can be safely used in elective cases to promote wound healing of incisions and decrease SSI rates.