Prevention of Projectile and Aerosol Contamination During Pulsatile Lavage Irrigation Using a Wound Irrigation Bag

Author(s): 
J. Angobaldo, MD; C. Sanger, DO; M. Marks, MD

Discussion

The management of infected wounds remains a challenging problem for wound care specialists. Removing foreign bodies and debriding necrotic tissues are first line actions, but decreasing the bacterial colony count in the wound is of equal importance. Tissue bacteria levels ≥ 105 are associated with compromised wound healing.

The removal of bacterial exotoxins, endotoxins, and metalloproteinases is essential to preventing a colonized wound from progressing to an infected wound. Irrigation in the form of pulsatile lavage is pivotal in the reduction colony forming units. Pulsatile lavage not only washes away bacteria, but also breaks up dangerous biofilms that block the penetration of systemic antibiotics and contribute to sensitive bacteria acquiring resistance.11

The utility of pulsatile lavage is well documented as evidenced by its routine use in the management of infected wounds. However, with the alarming problem of antimicrobial resistance, it is imperative to develop techniques that prevent the spread of potentially lethal bacteria, while effectively treating difficult wounds. Pulsatile lavage offers several advantages when used in the treatment of wounds infected with multidrug-resistant bacteria. Pulsatile lavage is effective in removing the infectious bioburden of the bacteria and does not promote the further development of resistance. Pulsatile lavage may reduce the need for additional antibiotics. However, because of the mechanical debridement caused by pulsatile lavage and the difficulty in maintaining a closed system while irrigating, additional measures should be taken to prevent the dissemination of infectious material.

This study demonstrates that infection control can be accomplished with the use of containment devices such as the WIB. The WIB effectively reduced the number of bacterial colony forming units captured on the agar plates within a 3-foot radius by physically blocking the splatter created during pulsatile lavage. Containment cuts down on risk of exposing personnel to infectious pathogens and protects the treatment facility from contamination. Examples can be found in the literature where contamination has been traced back to pulsatile lavage of wounds with multidrug-resistant bacteria. Maragakis et al9 reported an outbreak of multidrug-resistant Acinetobacter baumannii where the investigators determined transmission was caused by pulsatile lavage contaminating the treatment facility and spreading the infection to multiple patients. Such outbreaks likely can be avoided with improved containment techniques, ultimately protecting patients and personnel while preventing nosocomial infections.

Hospitals and wound care facilities have addressed the issue of contamination by isolating patients during treatment in special treatment rooms. While this strategy is effective, it is also costly and time consuming. A better strategy is to isolate the treatment process itself. The WIB, which traps infectious material in a self-sealing disposable bag, allows containment to be brought to the patient. This eliminates the need and risk of transporting the infected patient through the facility to a special treatment room. Daily treatments can be performed safely at the patient’s bedside without leaving the hospital room or ICU bed.

References: 

1. Tobias AM, Chang B. Pulsed irrigation of extremity wounds: a simple technique for splashback reduction. Ann Plast Surg. 2002;48(4):443–444.
2. Gerberding JL, Littell C, Tarkington A, Brown A, Schecter WP. Risk of exposure of surgical personnel to patients’ blood during surgery at San Francisco General Hospital. N Engl J Med. 1990;322(25):1788–1793.
3. Bessinger CD Jr. Preventing transmission of human immunodeficiency virus during operations. Surg Gynecol Obstet. 1988;167(4):287–289.
4. Abouzahr MK, Wider TM. Prevention of splashing during high-pressure irrigation of contaminated wounds. Plast Reconstr Surg. 1996;98(4):751–752.
5. Brearley S, Buist LJ. Blood splashes: an underestimated hazard to surgeons. BMJ. 1989;299(6711):1315.
6. Porteous MJ. Hazards of blood splashes. BMJ. 1990;300(6722):466.
7. Witte KK, Thomas EM, Porteous MJ. An effective shield for free: pulsed lavage in total knee replacement. Ann R Coll Surg Engl. 1996;78(4):383.
8. Chernofsky MA, Murphy RX Jr., Jennings JF. A barrier technique for pulsed irrigation of cavity wounds. Plast Reconstr Surg. 1993;91(2):365–366.
9. Maragakis LL, Cosgrove SE, Song X, et al. An outbreak of multidrug-resistant Acinetobacter baumannii associated with pulsatile lavage wound treatment. JAMA. 2004;292(24):3006–3011.
10. Greene DL, Akelman E. A technique for reducing splash exposure during pulsatile lavage. J Orthop Trauma. 2004;18(1):41–42.
11. Otto M. Bacterial evasion of antimicrobial peptides by biofilm formation. Curr Top Microbiol Immunol. 2006;306:251–258.



Post new comment

  • Lines and paragraphs break automatically.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Use to create page breaks.

More information about formatting options

Image CAPTCHA
Enter the characters shown in the image.