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Informed choices improve results

Surgical site infection (SSI) is the most common complication after surgery worldwide.1 WHO guidelines and NICE recommend diverse interventions to prevent SSI, including the use of alcoholic chlorhexidine skin preparation and triclosan-coated sutures to prevent SSIs.1

However, a more recent study, such as the independently conducted, pragmatic, multicenter, stratified, randomized controlled FALCON study, published in The Lancet Infectious Diseases Journal, found triclosan-coated sutures offer no significant advantages over standard sutures† in the prevention of SSI.2,‡

Read FALCON

Is generalization of triclosan coated sutures the answer to preventing SSI?

The FALCON trial stated

  • “Both the current WHO SSI prevention guidelines and subsequently updated meta-analyses could not resolve methodological and generalizability issues of the underlying trials”.2
  • “The included trials were mostly at high risk of bias, contained narrow groups of patients, and did not include any patients undergoing contaminated surgery”.2
  • Studies such as the NIHR meta-analysis show that triclosan-coated sutures may not be more effective than non-coated sutures in preventing surgical site infections (SSI).1-4,§,‡
  • Triclosan- coated sutures may also cost more per suture compared to non-coated sutures.5,6,♢
  • Generalized use of Triclosan Coated sutures may not be beneficial from a clinical and financial perspective.1,2

Read the evidence for yourself and make an informed choice for your patients and your practice.

Read the NIHR meta-analysis

No clear benefit

The NIHR meta-analysis and FALCON studies discovered that triclosan-coated sutures show no superiority over non-triclosan-coated sutures in preventing SSI.1,2

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Freedom to choose

Triclosan-coated sutures can significantly increase your suture costs.5,6,◊ Medtronic offers an alternative with our triclosan-free sutures. They are readily available, providing reliable access without compromising on quality.

Explore Medtronic sutures

FALCON Study


Triclosan sutures surgeons study

NIHR meta-analysis FALCON summary

Triclosan sutures procurement study
 

References

† This trial did not show benefit from 2% alcoholic chlorhexidine skin preparation compared with povidone–iodine, or with triclosan-coated sutures compared with non-coated sutures.

‡ The UK National Institute for Health and Care Excellence (NICE) has published in 2021 a Medical Technology Guidance “Plus Sutures for preventing surgical site infection” which recommends considering the use of triclosan coated sutures as part of a bundle of care for preventing SSI. It is to be noted that The FALCON study and the NIHR meta-analysis were published after 2021 and therefore were not part of the publications considered by the NICE guidance for making their recommendation. NICE. Medical Technology Guidance: Plus Sutures For Preventing Surgical Site Infection. Available from: nice.org.uk/guidance/MTG59. Published: 28 June 2021.

§ Including patients undergoing abdominal surgery with a skin incision of 5 cm or greater.

◊ The analysis by the NICE external assessment centre utilized a cost for triclosan-coated sutures of £4.25 and non-triclosan-coated sutures of £3.35.

¶ The WHO overall conditional recommendation on the use of triclosan-coated sutures for the purpose of reducing the risk of SSI, independent of the type of surgery, noted the low to moderate quality of the evidence and the low quality of comparisons in the subgroups of the RCTs included in the meta-regression analyses (as provided in the WHO Global Guidelines for the Prevention of Surgical Site Infection, pages 153 onwards)

  1. National Institute of Health Research Unit on Global Surgery. Alcoholic chlorhexidine skin preparation or triclosan-coated sutures to reduce surgical site infection: a systematic review and meta-analysis of high-quality randomised controlled trials. Lancet Infect Dis. 2022 Aug;22(8):1242-1251. doi: 10.1016/S1473-3099(22)00133-5. Epub 2022 May 26. Erratum in: Lancet Infect Dis. 2022 Aug;22(8):e207. doi: 10.1016/S1473- 3099(22)00371-1. PMID: 35644158. The meta-analysis' conclusion that there was no difference in the risk of SSI between triclosan-coated sutures and non-coated sutures differed from the conclusion of many other meta-analyses on the topic, including some of those referenced in the NICE Plus Sutures for preventing surgical site infection - Medical technologies guidance. The Lancet published two additional letters regarding the methodology used in the NIHR meta-analysis: (i) Elizabeth Li, et al. “Concerns on the evidence used to challenge established guidelines – Authors' reply.” Published: October, 2022 https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00587-4/fulltext ; and (ii) de Jonge, et al. Concerns on the evidence used to challenge established guidelines - Published:October, 2022DOI:https://doi.org/10.1016/S1473-3099(22)00585-0
  2. NIHR Global Research Health Unit on Global Surgery. Reducing surgical site infections in low-income and middle-income countries (FALCON): a pragmatic, multicentre, stratified, randomised controlled trial. Lancet. 2021 Nov 6;398(10312):1687-1699. doi: 10.1016/S0140-6736(21)01548-8. Epub 2021 Oct 25. PMID: 34710362; PMCID: PMC8586736. As per the findings from a study conducted in low-income and middle-income countries: NIHR Global Research Health Unit on Global Surgery. Reducing surgical site infections in low-income and middle-income countries (FALCON): a pragmatic, multicentre, stratified, randomised controlled trial. Lancet. 2021 Nov 6;398(10312):1687-1699. doi: 10.1016/S0140-6736(21)01548-8. Epub 2021 Oct 25. PMID: 34710362; PMCID: PMC8586736. The study's conclusion that there was no difference in the risk of SSI between triclosan-coated sutures and non-coated sutures differed from the conclusion of many other studies on the topic, including some of those referenced in the NICE Plus Sutures for preventing surgical site infection - Medical technologies guidance.
  3. Li E, Kamarajah SK, Nepogodiev D, Simoes JFF, Glasbey JC, Bhangu AA. Concerns on the evidence used to challenge established guidelines - Authors' reply. Lancet Infect Dis. 2022 Oct;22(10):1415-1416. doi: 10.1016/S1473-3099(22)00587-4. PMID: 36152653
  4. de Jonge S, Wolfhagen N, Timmer S, Leaper D, Boermeester M. Concerns on the evidence used to challenge established guidelines. Lancet Infect Dis. 2022 Oct;22(10):1415. doi: 10.1016/S1473-3099(22)00585-0. PMID: 36152652
  5. National Institute for Health and Care Excellence (NICE) (2021) Medical Technology Guidance. Plus Sutures for preventing surgical site infection. Available from: https://www.nice.org.uk/guidance/mtg59. Published 28 June 2021.
  6. National Institute for Health and Care Excellence (NICE). Medical Technology Guidance: Plus-Sutures For Preventing Surgical Site Infection. Supporting Documentation. Available from: https://www.nice.org.uk/guidance/mtg59/documents/supporting-documentation. Published 28 June 2021

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