I have a colostomy, about 1" opening, and for 8 years I had no problem with my pouches. Then for 3 or 4 months I can't seem to have a bag on for more than a day, and there is leakage. What is deep convexity and should I have different kind of pouches that have a deep convexity? Would that help? Thank you.
A Cross-sectional Validation Study of Using NERDS and STONEES to Assess Bacterial Burden
- 7/31/2009
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48 Wound size was estimated by measuring the longest length and the widest width perpendicular to the length.30 Change in wound size at the time of the visit was recorded according to patient history or existing documentation. A sterile cotton applicator was used to determine wound depth and test whether the wound probed to bone, and a handheld infrared thermometer was used to compare the temperature of the periwound area with a similar location on the opposite extremity. The presence or absence of new areas of breakdown, including satellite lesions, was assessed and documented.
Microbiological analysis. To ensure that surface bacterial contaminants were not sampled, wounds were cleansed or irrigated with normal saline until all visible debris was washed away.14 This was followed by rotating the swab tip in a 1-cm2 area of the cleanest part of the wound, preferably in an area of granulation. Adequate pressure was used to extract tissue exudate for successful culturing. The swab then was rotated 360° and placed in the transport media (Levine technique14). The swabs were sent to a local laboratory to be processed in a timely fashion. To provide semi-quantitative culture data, the bacterial swabs were inoculated onto standard media in a Petri dish and serially diluted and streaked into four quadrants on the culture plate. Primary isolation plates were assessed after 5 days. Bacterial species isolated from the four quadrants were reported as scant (first quadrant), light (second quadrant), moderate (third quadrant), or heavy growth (fourth quadrant). Critical colonization (NERDS© variables) was evaluated by scant to light bacterial growth and STONEES© variables (deep wound infection) were evaluated by moderate to heavy growth. In a nonrandomized prospective study, Ratliff and Rodeheaver31 evaluated semi-quantitative swabs to determine bacterial burden (n = 124). Wounds where quantitative swabs revealed 105 or more bacteria/cm2 were defined as infected. Swabs that yielded moderate to heavy bacterial growth in quadrants 3 and 4 were correlated to wound infection (105 or more bacteria/cm2) with a sensitivity of 79%.
Statistical analysis. Each NERDS© and STONEES© variable was coded as a dichotomous variable based on whether the specific sign was present or absent on clinical evaluation. Data were entered into a computerized statistical program (SPSS version 16.0, Chicago, IL) and analyzed by the investigators. Odds ratios were calculated to determine the probability of bacterial growth and quantity in subjects who exhibited each individual sign and in combination of two to four signs. The accuracy of NERDS© and STONEES© to assess scant/light or moderate to heavy bacterial growth was estimated by computing the sensitivity and specificity for each clinical sign and combination of two to four signs.
Results
A total of 112 patients with 44 leg ulcers and 68 foot ulcers were evaluated in an ambulatory wound care clinic and on community visits. Most patients were male (60.4%); average age of all subjects was 66 years (range 33 to 95). The average duration of the ulcers was 6.3 months. Leg ulcers were related to venous disease (28 patients, 63.6%), lymphedema (six, 13.6%), arterial disease (two, 4.5%), mixed venous arterial disease (five, 11.3%), and miscellaneous etiologies (three, 6.8 %).
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RE: NERDS & STONEES:
I would suggest an additional criteria in deciding whether systemic therapy is indicated: 'FARTT' (Failure to Adequately Respond to Topical Therapy)
Julie A. Anderson, M.D.
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