Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Division of Care Innovation, Global Nursing Research Center, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Int Wound J. 2020 Feb;17(1):191-196. doi: 10.1111/iwj.13256. Epub 2019 Nov 4.
For optimal wound bed preparation, wound debridement is essential to eliminate bacterial biofilms. However, it is challenging for clinicians to determine whether the biofilm is completely removed. A newly developed biofilm detection method based on wound blotting technology may be useful. Thus, we aimed to investigate the effect of biofilm elimination on wound area decrease in pressure ulcers, as confirmed using the wound blotting method. In this retrospective observational study, we enrolled patients with pressure ulcers who underwent sharp debridement with pre- and post-debridement wound blotting. Biofilm was detected on the nitrocellulose membrane using ruthenium red or alcian blue staining. Patients were included if the test was positive for biofilm before wound debridement. Percent decrease in wound area after 1 week was calculated as an outcome measure. We classified the wounds into a biofilm-eliminated group and a biofilm-remaining group based on the post-debridement wound blotting result. Sixteen wound blotting samples from nine pressure ulcers were collected. The percent decrease in wound area was significantly higher in the biofilm-eliminated group (median: 14.4%, interquartile range: 4.6%-20.1%) than in the biofilm-remaining group (median: -14.5%, interquartile range: -25.3%-9.6%; P = .040). The presence of remaining biofilms was an independent predictor for reduced percent decrease in wound area (coefficient = -22.84, P = .040). Biofilm-based wound care guided by wound blotting is a promising measure to help clinicians eliminate bacterial bioburden more effectively for wound area reduction.
为了达到最佳的伤口床准备，清除细菌生物膜对于伤口清创至关重要。然而，临床医生很难确定生物膜是否已完全清除。一种新开发的基于伤口擦拭技术的生物膜检测方法可能会有所帮助。因此，我们旨在研究使用伤口擦拭法确认的生物膜消除对压疮伤口面积减少的影响。在这项回顾性观察性研究中，我们招募了接受锐性清创术且在清创前后进行伤口擦拭的压疮患者。使用钌红或阿利新蓝染色在硝酸纤维素膜上检测生物膜。如果在伤口清创前生物膜检测为阳性，则纳入患者。将 1 周后伤口面积减少的百分比作为观察指标。我们根据清创后的伤口擦拭结果将伤口分为生物膜消除组和生物膜残留组。从 9 个压疮中收集了 16 个伤口擦拭样本。生物膜消除组（中位数：14.4%，四分位距：4.6%-20.1%）的伤口面积减少百分比明显高于生物膜残留组（中位数：-14.5%，四分位距：-25.3%-9.6%；P =.040）。生物膜残留的存在是伤口面积减少百分比降低的独立预测因子（系数=-22.84，P =.040）。基于生物膜的伤口护理，由伤口擦拭指导，有望帮助临床医生更有效地消除细菌生物负荷，以减少伤口面积。
