Shifting Focus: Implications of Periwound Bacterial Load on Wound Hygiene
Rosemary Hill, BSN, CWOCN, WOCC (C); and Joshua Douglas, MD, FRCPC, ABIM
Introduction: Wound cleansing is the most ubiquitous method to maintain optimal wound hygiene. The periwound is often a neglected area but serves as a source for microbial recontamination if not adequately cleansed. Fluorescence imaging has been used to visualize red-fluorescing, pathogenic bacteria in the wound bed and periwound area at the bedside using a noncontact, handheld device. The visualization of bacterial load can be incorporated to optimize wound hygiene by guiding targeted cleansing and debridement.
Objective: Recently available, improved skin and wound cleansing agents with lower concentrations of sodium hypochlorite, which are purported to disrupt biofilm and kill planktonic bacteria while still safe for the wound bed, may optimize wound hygiene. The effectiveness of such cleansers compared with standard practice is reported here.
Method: In this series of 10 patients, bioburden reduction was assessed by fluorescence imaging and visualization of bacterial load. The wound bed and periwound area were cleansed using saline or 0.057% sodium hypochlorite.
Results: Of the 10 patients, 9 had bacterial load present outside of the wound bed, and periwound/wound cleansing with traditional saline was not sufficient to remove bacterial load from 9 patients. In 6 of 9 patients, the 0.057% sodium hypochlorite was effective at eradiating bioburden; however, 3 of 9 required debridement to fully eliminate the bioburden.
Conclusions: Timely management of wound bioburden is imperative to support overall healing. Wound hygiene can only be possible if the location of bioburden is identified in the wound/periwound area and removed with effective cleansing agents.
Recipient of 1st Place Award in Case Series/Study Category