With the approval by the Medical Executive Committee of Northern Hospital of Surry County (NHSC), Mt. Airy, North Carolina, a retrospective chart review was performed of data from all outpatients who received UVC treatment in addition to standard care and whose treatment was completed (defined as patients who were discharged from the wound center regardless of reason for discharge) within an 8-month assessment period (January 1, 2015, through August 30, 2015) at The Wound Care Center and Lymphedema Clinic of NHSC. Extracted variables included patient age and gender, wound duration (how long the patient had the wound before initiation of treatment) and type (etiology), initial and final wound dimensions (calculated based on length and width of each wound extracted from the electronic health record), number of UVC treatments, time to healing (defined by the primary investigator as 100% reepithelialization and calculated from start to end date of treatment), final wound status (healed or unhealed), and occurrence of treatment-related adverse events. All patient data were deidentified during abstraction (following Health Insurance Portability and Accountability Act guidelines) from Meditech (Medical Information Technology, Inc, Westwood, MA) into an Excel (Microsoft Corp, Redmond, WA) file by the primary investigator.
Standard care per specific wound etiologies. All wounds were provided standard care appropriate to their etiology each time UVC treatment was performed.
VLUs. Wounds were cleaned with pulsatile lavage at 6 psi with concurrent suction and 0.9% normal saline as an irrigation solution or a saline wash, with a primary wound dressing such as carboxymethylcellulose (CMC)/alginate selected to maintain a moist wound healing environment, covered as necessary with a secondary dressing, and provided multilayer compression.
Neuropathic/DFUs. Wounds received sharp, selective debridement as required, cleansed with pulsatile lavage at 6 psi with concurrent suction and 0.9% normal saline as an irrigation solution or a saline wash, and covered with a primary wound dressing to facilitate a moist wound healing environment and a gauze/absorbent pad as a secondary dressing. Total contact casts, orthopedic wedge shoes, and heel offloading shoes were provided as needed.
Pressure ulcers/injuries (PU/Is) and all other wound types. Wounds were cleaned with pulsatile lavage at 6 psi with concurrent suction and 0.9% normal saline as an irrigation solution or a saline wash with a primary wound dressing selected to maintain a moist wound healing environment and covered with an appropriate secondary dressing. Support surfaces and pressure redistribution devices were utilized for all PU/Is.
Dressing selection. Primary wound dressings (applied directly to the wound bed) were selected based on recommendations for clinical assessment of superficial infection and treatment of chronic wounds according to the mnemonic, NERDS, as recommended by Sibbald et al12 in which N = nonhealing wounds, E = exudative wounds, R = red and bleeding wound surface granulation tissue, D = debris (yellow or black necrotic tissue) on the wound surface, and S = smell or unpleasant odor from the wound. If 2 or more of the signs of infection were present, a primary dressing such as CMC/alginate dressing containing silver was applied. Otherwise, a CMC/alginate dressing without silver was applied to the wound.
Secondary dressings were selected based on wound size and amount of exudate. These included absorbent pads, cotton gauze, and a self-adhering wrap. Multilayer compression was applied to patients with VLUs.
Procedure for UVC application. Before dressing application, UVC was applied at a distance of 1 inch perpendicular to the wound base for 90 seconds for each wound after cleansing. A model V-254 UVC lamp (Medfaxx Inc, Raleigh, NC) was used for each treatment (see Figure 1). This model lamp has an output intensity of 4 mW/cm2 with a therapeutic dose of 120 to 360 mJ/cm2.15 In preparation for treatment, the periwound can be protected with draping materials as well as applying petrolatum jelly. However, it has been argued that protecting the adjacent periwound area eliminates a potential source of epithelial cells and wound healing factors that have been known5 to be stimulated with treatment. Therefore, in the authors’ clinic, the periwound was not protected. The periwound was assessed after each treatment for any adverse reaction to UVC. Although manufacturer information15 states shortwave UV is generally considered harmless to the average person, patients were assessed before and after each treatment for photosensitivity. Care also was taken to ensure eyes were protected from the light beams, even though eye protection is not needed with this model of UVC lamp because very little UVC is produced at a distance of 3 to 4 inches away from the filter, certainly not enough to create a basal cell response (as reported by Medfaxx, Inc).16 Although the lamp did not contact the wound or patient’s skin, the lens was cleaned with saline after each treatment and the wand handle was disinfected with a germicidal wipe. UVC is contraindicated in the presence of melanoma or a history of melanoma, history of invasive squamous cell carcinomas, human immunodeficiency virus, fever, deep x-ray therapy, and light sensitive diseases such as, but not limited to, porphyria and lupus erythematosus.16
Patients received treatment as described twice per week until the wounds were healed as determined by the primary investigator or the patient was discharged. All initial wound assessments (including initial measurements) and all final wound assessments were completed by the primary investigator; 2 investigators entered the data into the patient records. UVC was added to treatments on January 1, 2015, when the instrumentation became available at the authors’ facility.
Statistical analysis. Initially, wound types classified according to the etiology of the wound resulted in 15 different categories. However, several of these categories had <10 wounds (most had <5), which limited subsequent analysis. Nonparametric analysis showed no significant differences in data among the smaller groups. For a more robust analysis, several of the smaller groups were combined into 1 group, which then allowed for a more complete analysis. The wound etiologies that were combined included cat scratch, dog bite, MRSA infections, burn, abscess, wounds of mixed etiology (multiple contributing etiologies), and surgical wounds. Analyses included descriptive statistics for all dependent variables, and means are presented with 1 standard deviation. A chi-squared analysis was used to determine the association between gender and wound category. If a patient had more than 1 wound, each wound was analyzed separately/independently. Analysis of variance (ANOVA) was used to determine differences between wound classification groups for time to healing and number of treatments. Differences were considered significant if P ≤.05. All analyses were performed using SPSS, version 23 (IBM, Armonk, NY).