Raizman Rose
Adjunct Lecturer, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto and Department of Professional Practice, Scarborough Health Network.
J Wound Care. 2019 Sep 1;28(Sup9):S28-S37. doi: 10.12968/jowc.2019.28.Sup9.S28.
Knowledge of wound bioburden can guide selection of therapies, for example, the use of negative pressure wound therapy (NPWT) devices with instillation in a heavily contaminated wound. Wound and periwound bacteria can be visualised in real-time using a novel, non-contact, handheld fluorescence imaging device that emits a safe violet light. This device was used to monitor bacterial burden in patients undergoing NPWT.
Diverse wounds undergoing NPWT were imaged for bacterial (red or cyan) fluorescence as part of routine wound assessments.
We assessed 11 wounds undergoing NPWT. Bacterial fluorescence was detected under sealed, optically-transparent (routine) adhesive before dressing changes, on foam dressings, within the wound bed, and on periwound tissues. Bacterial visualisation in real-time helped to guide: (1) bioburden-based, personalised treatment regimens, (2) clinician selection of NPWT, with or without instillation of wound cleansers, and (3) the extent and location of wound cleaning during dressing changes. The ability to visualise bacteria before removal of dressings led to expedited dressing changes when heavy bioburden was detected and postponement of dressing changes for 24 hours when red fluorescence was not observed, avoiding unnecessary disturbance of the wound bed.
Fluorescence imaging of bacteria prompted and helped guide the timing of dressing changes, the extent of wound cleaning, and selection of the appropriate and most cost-effective NPWT (standard versus instillation). These results highlight the capability of bacterial fluorescence imaging to provide invaluable real-time information on a wound's bioburden, contributing to clinician treatment decisions in cases where bacterial contamination could impede wound healing.
了解伤口生物负荷可指导治疗方法的选择，例如，在污染严重的伤口中使用带有灌洗功能的负压伤口治疗（NPWT）设备。使用一种新型的、非接触式的手持荧光成像设备可以实时观察伤口及伤口周围的细菌，该设备发出安全的紫光。本研究使用该设备监测接受NPWT治疗患者的细菌负荷。
作为常规伤口评估的一部分，对接受NPWT治疗的各种伤口进行细菌（红色或青色）荧光成像。
我们评估了11例接受NPWT治疗的伤口。在更换敷料前，在密封的、光学透明（常规）的敷料下、泡沫敷料上、伤口床内以及伤口周围组织中均检测到细菌荧光。实时细菌可视化有助于指导：（1）基于生物负荷的个性化治疗方案；（2）临床医生选择NPWT，无论是否灌洗伤口清洁剂；（3）更换敷料时伤口清洁的范围和位置。在去除敷料前可视化细菌的能力，使得在检测到高生物负荷时加快了敷料更换速度，而在未观察到红色荧光时将敷料更换推迟24小时，避免了对伤口床的不必要干扰。
细菌荧光成像提示并有助于指导敷料更换的时间、伤口清洁的程度以及选择合适且最具成本效益的NPWT（标准型与灌洗型）。这些结果突出了细菌荧光成像在提供伤口生物负荷的宝贵实时信息方面的能力，有助于临床医生在细菌污染可能阻碍伤口愈合的情况下做出治疗决策。
