(PI-003) The Role of Fluorescence Bacterial Scanning in the Identification and Treatment of Intertriginous Bacteria in Diabetic Feet
Co-Author(s):
Katherine McLeod, RN; Rowena Steffan, RN
Introduction: Intertriginous (between toes) bacteria in diabetic patients can be a significant source of infection. Previously we were able to identify, only through fluorescence scans of bacteria, an intertriginous micro-fissure as the entry point for bacteria in a diabetic foot infection patient who did not have a wound. This pilot study aimed to determine prevalence and management strategies for intertriginous bacteria in diabetic patients.
Methods: 10 consecutive diabetic patients being seen for lower extremity wounds not involving the toes were scanned for intertriginous bacteria using fluorescence imaging*.
Results: Of the scanned patients, 50% had intertriginous bacteria. Of those positive, 2/5 had unexpected small fissures. In our treatment algorithm all patients with diabetes and lower extremity wounds are scanned for intertriginous bacteria. Negative scan patients are educated on daily washing between their toes and not using lotion between the toes; lotion creates a moist environment where bacteria can thrive. If the scan is positive, we first clean between the toes (flossing) with Dakins. If the bacterial signal remains patients are told to wash between toes daily and then use a silver alginate strip** to clear the remaining bacteria.
Discussion: Small fissures are a potential entry point for the bacteria that can lead to infection, even without a wound in the region. Diabetic education should include the importance of washing between the toes and not applying lotion between the toes. Fluorescence imaging provides objective information on incidence of intertriginous bacteria and can document clearance of bacteria with flossing and good foot care. This may decrease risk of diabetic foot infections originating from intertriginous bacteria. Fluorescence scans are a foundation for educating patients on the importance of at-home cleansing between toes and provide point-of-care imaging that can potentially improve patient compliance.