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NICE best practice guidelines for PICO

NICE medical technology guidance supports the case for adopting PICO

Evidence demonstrates improved outcomes likely for high-risk patients, and similar overall costs, compared with standard care

New guidance from the National Institute for Health and Care Excellence (NICE) supports the case for adopting  PICO Single Use Negative Pressure Wound Therapy System (sNPWT) as a treatment option for closed surgical incisions in high-risk patients.

The guidance, including clinical evidence(i) and cost-analyses,  highlights reductions in surgical site infection and seroma, compared to standard care1.

Read the guidance >


Adopting PICO sNPWT as a treatment option for closed surgical incisions in high-risk patients offers improved benefits across the wider healthcare system, at a similar overall cost, compared with standard dressings1.


Rethink and challenge your understanding of ‘standard’ care.


Start with a treatment option that can offer superior outcomes to high-risk patients

Sub-optimal wound care can impact patient wellbeing and healthcare systems2, such as:

  • Delays in wound healing and abnormal scar formation
  • Impact on morbidity and mortality
  • Readmissions, further surgery and extended hospital stay

All of these factors have cost implications. With a substantial global impact caused by surgical site infections (SSIs)3, it’s time to adopt PICO sNPWT as a clinically effective and cost efficient standard of care.

PICO sNPWT has demonstrated (compared with standard care):

  63% overall risk reduction in SSIs(iii)4.
  30% reduction in dehiscence(iii)4.
  77% reduction in the incidence of seroma(iv)4.
  89% reduction in skin necrosis(iv)4.


Discover more evidence about the performance of PICO across different surgical settings.

Make a small change, see a big difference

Improving the wider picture across your healthcare systems

The final step of surgery can be the first step in wider complications: consider the cost of high-risk patient complications. Think in terms of time and money for resources, readmissions and bed days3, and the impact on patient wellbeing.

As the guidance suggests, proactively investing in a solution to reduce surgical sit complications (SSCs) for high-risk patients may ultimately create time and money savings whilst simultaneously improving outcomes:

- 8.6-day average reduction in length of hospital stay, demonstrated in closed laparotomy wounds, compared with standard dressings(vi)5
- Average length of stay reduced by 1.75 days across surgical specialties, when used prophylactically on closed surgical incisions, compared with standard dressings(vii)3.

Rethink your best practice protocol on a growing body of evidence

PICO sNPWT is backed by clinical evidence across a wide range of surgical specialties4,6, including cardiothoracic, colorectal, breast and obstetric, aiming to change the landscape of standard care.

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Clinical performance, delivered by proprietary technology

The technology found only in PICO sNPWT has proven clinically effective in helping reduce SSCs4,6, when compared with standard care.

  • Proprietary AIRLOCK Technology layer distributes pressure evenly and consistently for up to 7 days across the wound surface, with optimal fluid management to minimise the risk of maceration7,8.
  • Soft port & filter allow PICO to be used on weight-bearing areas, with nominal -80mmHg NPWT delivered even when pressure is applied to the port9.
  • Silicone adhesive will not adhere to newly formed tissue, helping minimise trauma and pain to the peri-wound area on dressing removal10
  • Treats the underlying zone of injury*7,8 and reduces lateral tension11.
  • In vitro testing demonstrated that over 99% of bacteria are locked away from the wound once absorbed into the AIRLOCK layer12.



Across a wide range of surgical specialities

Learn more about PICO sNPWT in:


Helping you get CLOSER TO ZERO surgical site complications.


i) 31 studies, including 15 RCTs, over diverse locations and multiple surgery types.
ii) 19 studies, 4530 patients. p<0.00001.
iii) 9 studies, 1790 patients. p=0.01.
iv) 6 studies, 771 patients. p<0.00001.
v) 2 studies, 474 patients. p=0.0007.
vi) n=50. p=0.019
vi) 10 studies, 948 patients. p=0.0002.


*demonstrated in vitro





1) NICE Medical Technologies Consultation Document – PICO Negative Pressure Wound Dressings for Closed Surgical Incisions. December 2018.
2) World Union of Healing Societies (WUWHS) Consensus Document. Closed surgical incision management: understanding the role of NPWT. 2016.
3) World Health Organization. Global guidelines for the prevention of surgical site infection, second edition. Geneva 2018.
4) Saunders C et al. The incidence of surgical site complications with PICO single-use negative pressure wound therapy compared to conventional dressings when used prophylactically on closed surgical incisions: a systematic literature review and meta-analysis. February 2019.
5) O’Leary DP, Pierce C, Anglim B et al. Prophylactic Negative Pressure Dressing Use in Closed Laparotomy Wounds Following Abdominal Operations: A Randomised Controlled, Open-Label Trial: The PICO Trial. Ann Surg. 2017; 265(6):1082-1086.
6) Strugala V and Martin R. Meta-analysis of comparative trials evaluating a prophylactic single-use negative pressure wound therapy system for the prevention of surgical site complications. Surgical Infections Vol 18 Number 07 (2017). DOI: 10.1089/sur.2017.156. 810-819.
7) Smith & Nephew November 2017.  version2. Project Opal PICO 7 system stability testing, initial time point. Internal report DS/17/253R, version 2.
8) Malmsjö, M, Huddlestone, E & Martin, R. . Biological effects of a disposable, canisterless Negative Pressure Wound Therapy system. Eplasty 2014; 14:e15.
9) Smith & Nephew November 2017. PICO 7 Softport Dressing: Negative Pressure Transmission through Dressing Port under a Compressive Force. Internal Report. DS/17/669/R
10) Hurd T, Trueman P, Rossington A. Use of a portable, single-use negative pressure wound therapy device in home care patients with low to moderately exuding wounds: a case series; Ostomy Wound Management supplement, 60: 30-36. Issue 3, 2014.
11) Loveluck J, Copeland T, Hill J, Hunt A & Martin R.. Biomechanical modelling of forces applied to closed incision during single-use negative pressure wound therapy. Eplasty 2016; 16e20.
12) Smith & Nephew December 2017. . The retention of P.aeruginosa and S. aureus bacteria within PICO dressings after 72 hours under NPWT in a dynamic model. Internal report 1712012.

NICE recognition for PICO

Read the NICE guidelines, recommending the adoption of PICO sNPWT
to help reduce surgical site complications in high-risk patients.

Read the guidelines

Helping you get
surgical site complications

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