Effect of Ultraviolet Light C on Bacterial Colonization in Chronic Wounds

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Author(s): 
Thao P. Thai, BScPT, MSc; David H. Keast, MSc, MD, CCFP; Karen E. Campbell, RN, MScN, NP; M. Gail Woodbury, BScPT, MSc, PhD; and Pamela E. Houghton, BScPT, PhD

M ethicillin-resistant Staphylococcus aureus (MRSA) is a strain of antibiotic-resistant bacteria commonly found in wounds. The prevalence of MRSA increased from less than 3% to rates as high as 40% between the early 1980s and 1990s in many hospitals in the US and Europe.1,2 In Canada, hospitals and long-term care facilities have recorded cases of MRSA,3,4 and community-acquired cases also have surfaced.5 Methicillin-resistant S. aureus is spread primarily by direct or indirect person-to-person contact. In hospitals, hand, environment, and equipment contamination are the acknowledged vehicles for the spread of MRSA from one individual to another.6

The development of antibiotic-resistant bacteria in chronic wounds has resulted in the search for new antimicrobial therapies.7 Antibiotic resistance is most often recognized in vulnerable groups such as the very young or old8; the consequences of antibiotic resistance may include increased length of hospitalization, costs of diagnostic testing, and risk of morbidity and mortality to the individual.9,10

Ultraviolet light (UVL) occupies the electromagnetic spectrum between X-rays and visible light. The wavelengths of UVL are divided into three bands: UVA (320 nm to 400 nm), UVB (290 nm to 320 nm), and UVC (200 nm to 290 nm). Previous studies have suggested that UVL, a combination of UVA, UVB, and UVC wavelengths, triggers cellular actions and physiological effects required for treating chronic wounds by stimulating cell proliferation,11 increasing epidermal thickening,12 enhancing blood flow in the cutaneous capillaries,13 facilitating wound debridement,14 and killing bacteria.15,16 Ultraviolet light A and B, the longer and mid-range wavelengths, respectively, have minimal bactericidal properties. They are used primarily to treat dermatological conditions such as psoriasis and dermatitis.17 Ultraviolet light C is used primarily in wound healing.

Relatively few studies have examined the efficacy of UVL treatment in chronic wounds. The results of a randomized controlled study by Wills et al18 suggested that subjects with superficial pressure ulcers treated with a combination of UVA, B, and C healed faster than control subjects receiving only standardized wound care. Crous and Malherbe19 compared the effects of UVL and laser irradiation on the healing of chronic ulcers and observed that the effectiveness of both modalities in the treatment of chronic ulcers was clinically significant. Nussbaum et al14 reported that a combined therapy of ultrasound and UVC had a greater effect than laser therapy on wound healing. However, in both studies UVC was given in combination with either other types of UVL (UVA and UVB18) or together with ultrasound14; therefore, from this previous study, determining the effects of UVC alone on healing of chronic wounds is not possible.

Ultraviolet light C has been reported in previous in vitro and in vivo studies to have the ability to kill bacteria, including antibiotic-resistant bacteria such as MRSA, in laboratory cells and in animal tissue.20-23 Conner-Kerr et al20 studied the effects of UVC on laboratory cells of MRSA and reported a MRSA kill rate of 99.9% at 5 seconds and 100% at 90 seconds. In a follow-up in vivo study, Conner-Kerr et al21 examined the effects of UVC on experimental wounds placed in mice artificially inoculated with MRSA. Ultraviolet light C was effective in lowering MRSA without adversely effecting healthy wound tissue. However, clinical studies to demonstrate that UVC can affect antibiotic-resistant bacteria that have colonized chronic wounds are not available.

References: 

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