A Comparison of an Antimicrobial Wound Cleanser to Normal Saline in Reduction of Bioburden and its Effect on Wound Healing
- 0 Comments
- 20955 reads
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.
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).
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.
1. Bendy RH, Nuccio PA, Wolfe E, Collins B, Tamburro C, Class W, Martin CM. Relationship of quantitative wound bacterial counts to healing of decubiti. Effect of topical gentamicin. Antimicrob Agents Chemo Ther. 1964;4:147-155.
2. Robson MC, Lea CE, Dalton JB, Heggers JP. Quantitative bacteriology and delayed wound closure. Surg Forum. 1968;20:501-502.
3. Robson M., Duke W, Krizek T. Rapid bacterial screening in the treatment of civilian wounds. J Surg Res. 1973;14:14:420.
4. Robson M, Heggers J. Surgical infection II: the beta hemolytic streptococcus J Surg Res. 1969;9:289.
5. Sapico F, Canawati H, Witte J, Montgomerie J, et al. Quantitative aerobic and anaerobic bacteriology of infected diabetic feet. J Clin Microbiol. 1980;12:413.
6. Deresinski S. Infections in the diabetic patient strategies for the clinician. Infectious Disease Reports. 1995;January(1):1.
7. Meleney FL. Bacterial synergism in disease process. Ann Surg. 1931;22:961-981.
8. Puhvel S, Reisner R. Anaerobic Bacteria Role in Disease: Dermatologic Anaerobic Infections. Springfield, Ill.: Charles C. Thomas Publisher;1974:442.
9. Bohnen J, Matlow A, Nohr C, et al. Pathogenicity of enterococcus in a rat model of fecal peritonitis. Program abstract 276. The Interscience Conference Antimicrobial Agents. Chemotherapy;1983.
10. Hartley P. Obituaries. Dr. H.D. Dakin. Nature. 1952:169:481-482.
11. Rutaia W, Cole E, Thomann C, Weber D. Stability and bactericidal activity of chlorine solutions, infection control and hospital epidemiology. Infection Control and Epidemiology. 1998;19(5):323-327.
12. Dow G, Browne A, Sibbald G. Infection in chronic wounds: controversies in diagnosis and treatment. Ostomy/Wound Management. 1999;45(8):23-40.
13. Lineweaver WC, Howard R, Soucy D, et al. Topical antimicrobial toxicity. Arch Surg. 1985;120:267-270.
14. Kozol RA, Gillies C, Elgebaly SA. Effects of sodium hypochlorite (Dakin's solution) on cells of the wound module. Arch Surg. 1988;123:420-423.
15. Cuono CB, Barese MS. Correspondence to the editor. Arch Surg. 1989;124:133.
16. Heggers JP, Sazy JA, Stenberg BD, et al. Bacterial and wound-healing properties of sodium hypochlorite solutions. The 1991 Lindenberg Award. J Burn Care Rehab. 1991;12:420-424.
17. Cotter JL, Fader RC, Lilley C, Herndon DN. Chemical parameters, antiseptic actives, and tissue toxicity of 0.1% and 0.5% sodium hypochlorite solutions. Antimicrob Agents Chemother. 1985;28:118-122.
18. Robson MC. Wound infection: a failure of wound healing caused by an imbalance of bacteria. Surg Clin North Am. 1997;77:637-650.
19. Rodeheaver G. Wound cleansing, wound irrigation, wound disinfection. In: Krasner D, Rodeheaver G, Sibbald RG, eds. Chronic Wound Care: A Clinical Source Book for Health Care Professionals, 2nd ed. Wayne, Pa.: Health Management Publications Inc.;1997:97-109.
20. Bowler PG. The 105 bacterial growth guideline: reassessing its clinical relevance in wound healing. Ostomy/Wound Management. 2003;49(1):44-53.
21. Levine N, Lindberg R, Mason A, et al. The quantitative swab culture and smear: a quick, simple method for determining the number of viable aerobic bacteria on open wounds. J Trauma. 1976;16(2):89.
22. United States Pharmacopeia. USP23. 1995 Edition: Microbial Limits Tests (61). Total Aerobic Microbial Count:1684-1685.
23. Lennette EH. Manual of Clinical Microbiology, 4th ed. Washington, DC: American Society of Microbiology;1985:73-98.
24. Sussman C, Bates-Jensen BM. Wound Care: A Collaborative Practice Manual for Physical Therapists and Nurses. Gaithersburg, Md.: Aspen Publishers;1998:88-89.
25. Hoffman PN, Death JE, Coates D. The stability of sodium hypochlorite solutions. In: Collins CH, Allwood MC, Bloomfield SF, Fox A, eds. Disinfectants: Their Use and Evaluation of Their Effectiveness. London: Academic Press;1981:77-83.
26. Dychdala GR. Chlorine and chlorine compounds In: Block SS, Fox A, eds. Disinfection, Sterilization and Preservation, 4th ed. Philadelphia, Pa.: Lea & Febiger;1991:131-151.
27. Edlich RF, Rodeheaver GT, Thacker JG, et al. Management of soft tissue injury. Clin Plast Surg. 1977;4:191-201.