Ultraviolet Light C in the Treatment of Chronic Wounds with MRSA: A Case Study
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A worldwide development of virulent bacteria that are resistant to multiple antimicrobial treatments is occurring.1 One strain of antibiotic-resistant bacteria currently receiving attention is methicillin-resistant Staphylococcus aureus (MRSA). In many hospitals in the United States and Europe, the prevalence of MRSA has increased from less than 3% in the early 1980s to rates as high as 40% in the 1990s.2-5 Since the first report of MRSA in Canada in 1981, the number of MRSA cases has increased dramatically, and cases of community-acquired MRSA also have been documented.6-15 Methicillin-resistant S. aureus bacteria colonize the skin and open wounds and may interfere with wound healing.16
Artificially produced ultraviolet light (UVL) was introduced as a therapeutic treatment for skin disorders at the beginning of the 20th century.17 Cell culture and animal studies that have examined mechanisms by which UVL augments wound repair propose that UVL can stimulate cell proliferation,18 epidermal thickness,19 blood flow in the cutaneous capillaries,20 and wound debridement.21 A particular wavelength of UVL of between 200 nm and 290 nm called ultraviolet light C (UVC) has been shown to have bactericidal effects.22-26
Recent studies indicate that UVC can kill antibiotic-resistant strains of bacteria such as MRSA in laboratory cells and in animal tissue.24,26 However, whether UVC can kill these bacteria when applied to human chronic wounds, using suggested clinical protocols, is not known. The purpose of this case study was to evaluate the potential role of UVC in reducing wound bioburden and improving wound status in chronic ulcers infected with MRSA.
UVC treatment protocol. Using an application technique that has been previously described by Nussbaum et al,21 UVC was applied at a distance of 1 inch and perpendicular to the wound using premeasured disposable spacers. Before treatment, a 254-nm, cold quartz UVC generator, approved for clinical use in Canada (supplied by Medfaxx Inc., Raleigh, NC) was warmed for 5 minutes before being placed over the wound. The ulcer was cleansed with sterile saline, a thick layer of petroleum jelly was applied to the surrounding periulcer skin and any healthy granulation tissue, and the wound edges were covered with a drape.
The UVC generator was applied to the wound for 180 seconds per wound site. This length of time is recommended for the treatment of infected ulcers21 and was selected based on the MRSA killing rates reported in a previous in vitro study.24 To shield the eyes from UVC, the therapist and patient wore protective goggles. All products applied to the patient were sterilized or discarded after a single use. Equipment that had to be reused was decontaminated using appropriate protocols.
Subject recruitment. Approval for research involving human subjects was obtained from appropriate institutional review boards. The purpose, method, risks, and benefits of UVC treatment were explained to the patients and/or their substitute-decision makers and informed consent was obtained. Patients included in this case series had a chronic ulcer present for at least 3 months that was infected with MRSA. By definition, an infected wound has a positive swab culture and clinical signs of infection, including: marked redness extending beyond the wound margins; increased pain; and increased amounts of foul smelling, purulent wound exudates. Oral antibiotic or topical antimicrobial therapy may or may not be required.27
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