A Comparison of an Antimicrobial Wound Cleanser to Normal Saline in Reduction of Bioburden and its Effect on Wound Healing

  • 7/31/2004
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Author(s): 
Julie Lindfors, RN, CWCCN



In this study, anaerobic specimens were obtained by means of a sterile, polyester-tipped swab and immediately inoculated onto pre-marked four quadrants of prepared BBL™, CDC Anaerobic Blood Agar culture plates. Shortly thereafter, the inoculated plates were placed into a BBL™ Gas Pak System™ that was activated to create an anaerobic environment. All anaerobic specimens were then transferred to the microbiology laboratory at Anacapa Technologies, Inc., where they were incubated at 30 degrees C to 35 degrees C for 48 hours. Bioburden levels were ascertained from the growth, by quadrant, on the CDC Anaerobic Blood Agar Plates. Identification was limited to a Gram stain differentiation and reported by microscopic morphology.

Wound measurement. Wounds were measured in linear fashion.24 Wounds were considered decreased in size if one or more measurements of length, width, depth, or undermining had decreased by at least 0.5 cm. Likewise, increase in wound size was measured by an increase of at least 0.5 cm in measurement of length, width, depth, or undermining. Other wound characteristics were not consistently noted; thus, they are not included in the study.

Results

Bioburden. After 2 weeks of treatment, the aerobic bioburden was reduced in 100% of the wounds cleansed with AWC; however, it was reduced only in 33% of the wounds cleansed with normal saline (see Table 1). It is also important to note that the aerobic bioburden increased in 56% of the wounds cleansed with normal saline but no increase in the bioburden occurred in the wounds cleansed with the AWC. Bioburden was reduced by 1 to 4 logs in all wounds treated with AWC (see Figure 1); in wounds cleansed with normal saline, bioburden increased in many cases (see Figure 2). Also, anaerobic bioburden was reduced in 86% of the wounds cleansed with AWC (see Table 2), but no reduction in anaerobic bioburden occurred in wounds cleansed with normal saline (see Figure 3).

Wound healing. Of the wounds cleansed with AWC, 22% decreased in size, while only 11% of the wounds cleansed with normal saline decreased in size. In addition, none of the wounds cleansed with AWC increased in size; however, 56% of the wounds cleansed with normal saline increased in size (see Table 3). The remaining wounds did not display greater than 0.5 cm of change in any measurement. The wounds cleansed with the AWC developed granulation tissue and were reduced in size at a faster rate than wounds cleansed with normal saline. No signs of any toxic effects or tissue damage were noted with the use of the AWC, and no relationship between wound healing and wound location was observed (see Table 4).

Discussion

The results of this study demonstrated that normal saline was not effective in reducing wound bioburden, an acknowledged influencing factor in the delay of wound healing. Comparatively, a broad spectrum antimicrobial25,26 proved effective in reducing bioburden and appeared to stimulate wound healing. The proportion of wounds exhibiting a reduction in wound size was higher in the AWC than in the saline treated group. The number of subjects evaluated in the study limited a thorough statistical review. Wound dressings used on some patients were not completely controlled and may have influenced some outcomes. Wound dressings varied from wound to wound and included absorbent foam dressing, hydrogel, debriding agents, and alginates. Because the purpose of the study was to assess a wound-cleansing product that could be used with almost any dressing, no further consideration was given to dressing selection, other than clinical appropriateness.

References: 

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