Practice Innovations
This was a prospective observational study of 200 consecutive wounds seen for routine outpatient wound care at Madigan Army Medical. Wound types included DFU, VLU, arterial ulcers, PI, and surgical wounds. Fluorescence imaging scans denoting regions of high bacterial load were acquired of each wound and of its wound dressing immediately upon removal. For each consecutive wound we recorded days since last dressing change, the dressing type, imaging findings on presence/absence of bacterial signals and their locations, any signs or symptoms of infection, and any impact of the dressing scan on the patient’s care plan.
Results: We were able to readily detect bacterial signals from fluorescence scans within wound dressings, on q-tips used to probe, on wicks, in diabetic shoes/socks, and on insoles/orthotics. Dressing signals often matched the fluorescence signal from the wound itself, but we did see cases where the wound itself appeared clean on images while the dressing revealed bacterial burden. The latter didn’t always mean that no intervention was needed; on the contrary, it meant intervention should be further pursued. This was particularly useful in wounds containing surgically implanted hardware, where aggressive preventative care is needed to avoid infection and forced hardware removal.
Discussion: Our clinical decisions are only as strong as the information we have available to us. Scans of wound dressings informed on their efficacy, absorptive limitations, appropriateness for a given wound, and on bacterial loads that were not always apparent on scans of the wound itself. Scans of q-tip probes and wicks revealed immediately – without microbiology - information on bacterial presence deep in the wounds.
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