Sunnybrook Health Sciences Centre, Toronto, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
Sunnybrook Health Sciences Centre, Toronto, Canada.
Wounds. 2022 Aug;34(8):201-208. doi: 10.25270/wnds/21076. Epub 2022 Jun 10.
Wounds are increasing in number and complexity within the hospital inpatient system, and coordinated and dedicated wound care along with the use of emerging technologies can result in improved patient outcomes.
This prospective implementation study at 2 hospital inpatient sites examines the effect of bedside fluorescence imaging of wounds in the detection of elevated bacterial loads and its location in/around the wound on the inpatient wound population.
Clinical assessment and fluorescence imaging assessments were performed on 26 wounds in 21 patients. Treatment plans were recorded after the clinical assessment and again after fluorescence imaging, and any alterations made to the treatment plans after imaging were noted.
Prior to fluorescence imaging, antimicrobial use in this patient population was common. An antimicrobial dressing, a topical antibiotic, or an oral antibiotic was prescribed in 23 wounds (88% of assessments), with antimicrobial dressings prescribed 73% of the time. Based on clinical assessment, more than half of the treated wounds were deemed negative for suspected infection. In 12 of 26 wounds, the fluorescence imaging information on bacterial presence had the potential to prompt a change in whether an antimicrobial dressing was prescribed. Five of these 12 wounds were fluorescence imaging-positive and an antimicrobial drug was not prescribed, whereas 7 of the 12 wounds were negative upon fluorescence imaging and clinical assessment but antimicrobial dressing was prescribed. Overall, fluorescence imaging detected 70% more wounds, with bacterial fluorescence indicating elevated bacterial loads, compared with clinical assessment alone, and use of imaging resulted in altered treatment plans in 35% of cases.
Fluorescence imaging can aid in antimicrobial stewardship goals by supporting evidence-based decision-making at the point of care. In addition, use of such imaging resulted in increased communication, enhanced efficiency, and improved continuity of care between wound care providers and hospital sites.
医院住院患者系统中的伤口数量和复杂性不断增加，通过协调和专门的伤口护理以及新兴技术的应用，可以改善患者的治疗效果。
本前瞻性实施研究在 2 家医院住院部，调查了伤口床边荧光成像对检测伤口中升高的细菌负荷及其在伤口内/周围位置的影响，以及对住院部伤口人群的影响。
对 21 名患者的 26 个伤口进行了临床评估和荧光成像评估。在临床评估后和荧光成像后记录治疗计划，记录对治疗计划的任何更改。
在荧光成像之前，该患者人群中经常使用抗生素。在 23 个伤口（评估的 88%）中开具了抗菌敷料、局部抗生素或口服抗生素，抗菌敷料的处方率为 73%。基于临床评估，超过一半的治疗伤口被认为没有可疑感染。在 26 个伤口中，有 12 个的荧光成像信息显示细菌存在，这有可能促使改变是否开具抗菌敷料。这 12 个伤口中有 5 个荧光成像阳性且未开具抗菌药物，而在 12 个荧光成像阴性和临床评估的伤口中有 7 个开具了抗菌敷料。总的来说，荧光成像比单独的临床评估检测到的伤口多 70%，荧光成像显示细菌荧光指示升高的细菌负荷，并且在 35%的情况下使用成像会改变治疗计划。
荧光成像可以通过支持护理点的循证决策，帮助实现抗菌药物管理目标。此外，此类成像的使用增加了伤口护理提供者和医院之间的沟通、提高了效率并改善了护理连续性。
