Rosemary Hill BSN CWOCN CETN (C), Joshua Douglas MD, FRCPC, ABIM
Infectious Disease and Critical Care Internal Medicine, Vancouver Coastal Health
Poster presented at: SAWC Spring Conference, April 6-8, 2017 in San Diego, CA, USA
Aim: Real-time, point-of-care detection of critical bacterial colonization relies primarily on visual inspection and clinical signs and symptoms. Fluorescence imaging has recently been used to detect bacterial fluorescence in wounds at the bedside1. This pilot study aimed to assess its effects on clinician decisions and patient care.
Method: Over a 7-week period, diverse acute and chronic wounds (n=40) were imaged as part of routine wound assessments. Wounds positive for red or cyan fluorescence were considered to have clinically significant bacterial loads. Any resulting change in clinician practice or effect on patient care was noted.
Results: Positive effects of bacterial fluorescence imaging on patient care and wound management were noted in 6 areas: (1) Led clinicians to swab wounds which had otherwise been considered in balance. Targeted sampling of fluorescence-positive regions resulted in heavy growth of one or more pathogenic bacterial species from all swabs, eliminating risk of false negatives; (2) Prevented imminent discharge of three patients requiring systemic antibiotics; (3) Guided selection of antimicrobials and directly influenced antimicrobial stewardship practices; (4) Facilitated patient education on bacterial presence and provided patient reassurance; (5) Images negative for bacterial fluorescence allowed for confidence when skin grafting; (6) guided the extent and location of wound debridement, sparing non-contaminated tissue. The recently published principles of best practice from the International Wound Infection Institute (2016) indicate that debridement provides a window of opportunity in which biofilm defences are temporarily interrupted, allowing increased efficacy of topical and systemic management strategies. (2)
Conclusion: These results highlight the potential of bacterial fluorescence imaging, used in conjunction with best clinical practices, to positively impact patient care and bacterial management, guiding clinician treatment decisions at the point-of-care in cases where bacterial contamination could impede wound healing.
1 DaCosta, PLoS One, 2014
2 Swanson, T. et al. International Wound Infection Institute (IWII) Wound Infection in Clinical Practice. Wounds International 2016