Is it better to keep sutures covered to prevent infection?

Should Sutures Be Kept Covered?

Yes, sutures should be kept covered with appropriate dressings, but they can safely get wet within 24-48 hours after placement without increasing infection risk.

Initial Wound Coverage Strategy

• Cover all fresh suture sites immediately after closure to prevent contamination and optimize healing 1
• Use semi-permeable transparent polyurethane dressings as the preferred option, which should be routinely changed every 7 days 2
• If the patient has profuse perspiration or if the insertion site is bleeding or oozing, use sterile gauze dressing instead 2
• Change dressings sooner if they are no longer intact or if moisture collects underneath 2

Early Wound Care (First 24-48 Hours)

• Patients can get their sutured wounds wet within the first 24 to 48 hours without increasing the risk of infection 1
• This contradicts traditional teaching that wounds must stay completely dry, but evidence supports early wetting 1
• Keep the wound clean during this initial period 1

When to Transition Away from Coverage

• Replace gauze dressings with transparent dressings as soon as possible after bleeding/oozing stops 2
• For tunneled or implanted sites, continue dressing changes every 7 days until the insertion site has healed 2
• Assess daily whether gauze dressings need replacement based on dampness, loosening, or soiling 2

Special Considerations for High-Risk Wounds

• For patients at high risk of infection, consider chlorhexidine-impregnated dressings (such as Biopatch), which effectively reduce extraluminal contamination at the exit site 2
• These antimicrobial-impregnated dressings have demonstrated effectiveness in preventing catheter colonization in multiple prospective trials 2
• Evaluate cost-effectiveness before routine use, as these specialized dressings are more expensive 2

Critical Pitfall to Avoid

• Never use sutures to secure catheters or dressings routinely, as traditional suture securing is associated with high risk of contamination at the exit site 2
• Use manufactured catheter stabilization devices, sterile tapes, or surgical strips instead 2
• Sutures should no longer be used routinely for stabilization purposes 2

Topical Antimicrobial Application

• Topical antimicrobial ointments like Neosporin can be applied 1 to 3 times daily in a small amount (equal to the surface area of a fingertip) 3
• The treated area may be covered with a sterile bandage 3