Cotton Swabs Decrease Surgical Site Infections

By Nadine Salmon, BSN, IBCLC, Clinical Content Specialist AMN Healthcare

According to the Centers for Disease Control and Prevention (CDC), more than 500,000 surgical site infections occur in the U.S each year, accounting for nearly one-quarter of hospital-acquired infections – and a major source of illness and cause of death in patients (Medline, 2011).

Now, findings of a recent clinical study at Cedars-Sinai Medical Center suggest that regular cotton swabs may be a cheap and effective tool in the fight against post-surgical wound infections. Earlier this year, a surgeon at Cedars-Sinai Medical Center demonstrated a drastic decrease in post-surgical site wound infections in wounds that were gently probed with a dry cotton swab during the early postoperative period. This study showed that only three percent of patients who underwent gentle, daily wound probing contracted surgical site infections, compared to a control group of 19 percent who did not (Medline, 2011). The rate of wound infection in the control group was thus 16 times higher than that of the study group.

As reported in the Archives of Surgery (2011), all study participants had undergone an appendectomy for a perforated appendicitis. Half of the 76 patients in the prospective, randomized trial were placed in a control group. This group had their incisions loosely closed with staples, then swabbed daily with iodine.  The study group had their incisions loosely closed, and their wounds were gently probed between the surgical staples, with a dry, sterile cotton tip applicator each day.

In this study, patients in the cotton swab group experienced less postoperative pain, significantly shorter hospital stays (five versus seven days), and better cosmetic healing of their incisions. The researchers believe that using cotton swabs to probe the incision site enables contaminated fluid trapped within soft tissues to drain. This may reduce the amount of bacteria in the wound while maintaining the moist environment needed for successful wound healing.

The traditional surgical wound classification system describes four classes of wounds as Class I (clean), Class II (clean-contaminated), Class III (contaminated), and Class IV (dirty) (NFID, 2006). The risk of infection increases by operative class. Other factors that are important in the reduction of surgical site infections include operative site management, hair removal, cleaning, tight glucose control in the postoperative period, postponement of elective surgery for patients with active remote infection, reduced use of drains, and, although hard to prove, surgical technique (NFID, 2006). Most importantly, healthy patients have the best results in surgical procedures and the lowest risk of infection.



Centers for Disease Control and Prevention [CDC], (2010). Preventing Surgical Site Infections: A Surgeon’s Perspective. Retrieved from: http://www.cdc.gov/ncidod/eid/vol7no2/nichols.htm

Medline Plus (2011). Cotton Swabs Help Prevent Surgical Site Infections: Study. Retrieved from: http://www.nlm.nih.gov/medlineplus/news/fullstory_113823.html

National Foundation for Infectious Diseases [NFID], (2006). Clinical Updates in Infectious Diseases. Surgical Site Infections in the Era of Antimicrobial Resistance. Retrieved from: http://www.nfid.org/pdf/id_archive/surgicalsiteinfections.pdf

Science Daily (2011). Surgeon Shows Simple Cotton Swab Slashes Post-Surgical Wound Infections. Retrieved online from: http://ujang-ujung.blogspot.com/2011/06/health-medical-news_28.html#37