Early Versus Delayed Bathing of Orthopaedic Surgical Wounds

Study Overview
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Brief Summary
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This is a single center randomized control trial assessing the effect of early versus delayed bathing on orthopaedic surgical wounds in patients undergoing surgical treatment of fractures. Patients will be recruited by screening all patients undergoing surgical treatment for fractures at our institution. Patients who provide written consent will be randomized to one of two treatment arms after confirming eligibility criteria. Group A will be advised to begin early normal bathing (non-submerged showering) with uncovered surgical wounds. Group B will be advised to follow traditional delayed bathing with covered wounds.

Detailed Description
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The study is a single center, non-inferiority, parallel group, randomized control trial assessing the effect of early versus delayed bathing on orthopaedic surgical wounds in patients undergoing surgical treatment of fractures. Patients will be recruited by screening all patients undergoing surgical treatment for fractures at our institution. Patients who provide written consent will be randomized to one of two treatment arms after confirming eligibility criteria. Group A will be advised to begin early normal bathing (non-submerged showering) with uncovered surgical wounds. Group B will be advised to follow traditional delayed bathing with covered wounds. Patients will have follow-up with data collection at two, six and 12 weeks post-operatively. The primary outcome measure will be patient satisfaction as measured by a Likert Scale. The Likert Scale as utilized will be a patient reported outcome measure consisting of one question allowing the subject to express their attitude towards a particular subject: How satisfied are you with your surgical treatment with possible answers consisting of: very satisfied, somewhat satisfied, neutral, somewhat unsatisfied, and very unsatisfied. The secondary outcome measures will be development of an infection (subcategorized as either superficial or deep) and development of peri-incisional inflammation (eg. adhesive rash). Primary Objective: The primary objective of the study is to compare patient satisfaction as measured using a Likert Scale associated with early and delayed surgical site bathing. Secondary Objectives: The secondary objective is to compare the infection rate of orthopaedic surgical wounds between early and delayed bathing.

Official Title
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Early Versus Delayed Bathing of Orthopaedic Surgical Wounds: a Prospective Randomized Controlled Study

Conditions
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Surgical Wound, Post Operative Wound Infection

Intervention / Treatment
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* Other: Time to bathing (delayed)
* Other: Time to bathing (early)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients over 18 years of age Patient who are not pregnant Isolated acute fractures of the upper or lower extremities (humerus, radius, ulna, femur, tibia, or fibula) Diagnosis of a fracture meeting indication for operative intervention Any fracture not requiring a splint for post-operative management Non-complicated wounds (non-traumatic wounds, closed injuries, fractures not requiring external fixation, and acute fracture surgery) Exclusion Criteria: Fractures associated with presumed infection Patients with multiple fractures Fractures in patients with underlying associated immune compromise Fractures in patients with underlying peripheral vascular disease Use of VAC Surgery performed through previous surgical wound Patient homeless Fractures in patients with underlying diabetes mellitus Complicated wounds (traumatic wounds, need for post-op wound care, open injuries, need for external fixation)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Triple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Delayed Bathing<br>Delayed bathing-- patients will be told to begin showering after wound exam and suture removal (10-20 day postoperative). | Other: Time to bathing (delayed)<br>* Delayed bathing-- patients will be told to begin showering after wound exam and suture removal (10-20 day postoperative).<br>|
| Active Comparator: Early Bathing<br>Early bathing--Patients will be told to remove dressings and begin showering with body soap on postoperative day 3. | Other: Time to bathing (early)<br>* Early bathing--Patients will be told to remove dressings and begin showering with body soap on postoperative day 3.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient satisfaction associated with early and delayed surgical site bathing | The primary endpoint of the study will be a statistically significant difference in patient satisfaction as measured using a Likert Scale between the two groups. Scale will be on scale 0-10. A score of 10 will be Very Satisfied and a score of 0 will be Very Dissatisfied. | Weeks 2, 6 and 12 post surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Infection rate of orthopaedic surgical wounds between early and delayed bathing | The secondary endpoint in this study will be a statistically significant or clinically important difference in infection rate of orthopaedic surgical wounds between the early and delayed bathing groups | Weeks 12 post surgery |