Hydrodebridement of wounds: effectiveness in reducing wound bacterial contamination and potential for air bacterial contamination

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• 作者：Frank L Bowling (1)
  Daryl S Stickings (2)
  Valerie Edwards-Jones (3)
  David G Armstrong (1) (4)
  Andrew JM Boulton (1)
  
• 刊名：Journal of Foot and Ankle Research
• 出版年：2009
• 出版时间：December 2009
• 年：2009
• 卷：2
• 期：1
• 全文大小：3921KB
• 参考文献：1. Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, LeFrock JL, Lew DP, Mader JT, Norden C, Tan JS: Diagnosis and treatment of diabetic foot infections. / Clin Infect Dis 2004, 39: 885-10. CrossRef
  2. Armstrong DG, Lipsky BA: Diabetic foot infections: stepwise medical and surgical management. / Int Wound J 2004, 1: 123-32. CrossRef
  3. Brem H, Stojadinovic O, Diegelmann RF, Entero H, Lee B, Pastar I, Golinko M, Rosenberg H, Tomic-Canic M: Molecular Markers in Patients with Chronic Wounds to Guide Surgical Debridement. / Molecular Medicine 2007, 13: 30-9. CrossRef
  4. Attinger CE, Bulan E, Blume PA: Surgical Debridement: the Key to Successful Wound Healing and Reconstruction. / Clin Podiatr Med Surg 2000, 17: 599-30.
  5. Brem H, Sheehan P, Rosenberg HJ, Schneider JS, Boulton AJ: Evidence-based protocol for diabetic foot ulcers. / Plast Reconstr Surg 2006, 117: 193S-209S. discussion 210S-11S CrossRef
  6. Falabella AF: Debridement and wound bed preparation. / Dermatol Ther 2006, 19: 317-25. CrossRef
  7. Granick M, Boykin J, Gamelli R, Schultz G, Tenenhaus M: Toward a common language: surgical wound bed preparation and debridement. / Wound Repair Regen 2006, 14 (Suppl 1) : S1-0. CrossRef
  8. CDC Guidelines for Environmental Infection Control in Health-Care Facilities [http://www.cdc.gov/ncidod/dhqp/gl_environinfection.html] 2003, 89-4.
  
• 作者单位：Frank L Bowling (1)
  Daryl S Stickings (2)
  Valerie Edwards-Jones (3)
  David G Armstrong (1) (4)
  Andrew JM Boulton (1)
  
  1. Department of Medicine Manchester Royal Infirmary, University of Manchester, Manchester, UK
  2. Manchester Foot Clinic, Manchester Community Health, Manchester, UK
  3. Department of Clinical Microbiology, Manchester Metropolitan University, Manchester, UK
  4. Department of Surgery, University of Arizona College of Medicine, Tucson, AZ, USA
  

文摘

Background The purpose of this study was to assess the level of air contamination with bacteria after surgical hydrodebridement and to determine the effectiveness of hydro surgery on bacterial reduction of a simulated infected wound. Methods Four porcine samples were scored then infected with a broth culture containing a variety of organisms and incubated at 37°C for 24 hours. The infected samples were then debrided with the hydro surgery tool (Versajet, Smith and Nephew, Largo, Florida, USA). Samples were taken for microbiology, histology and scanning electron microscopy pre-infection, post infection and post debridement. Air bacterial contamination was evaluated before, during and after debridement by using active and passive methods; for active sampling the SAS-Super 90 air sampler was used, for passive sampling settle plates were located at set distances around the clinic room. Results There was no statistically significant reduction in bacterial contamination of the porcine samples post hydrodebridement. Analysis of the passive sampling showed a significant (p < 0.001) increase in microbial counts post hydrodebridement. Levels ranging from 950 colony forming units per meter cubed (CFUs/m3) to 16780 CFUs/m3 were observed with active sampling of the air whilst using hydro surgery equipment compared with a basal count of 582 CFUs/m3. During removal of the wound dressing, a significant increase was observed relative to basal counts (p < 0.05). Microbial load of the air samples was still significantly raised 1 hour post-therapy. Conclusion The results suggest a significant increase in bacterial air contamination both by active sampling and passive sampling. We believe that action might be taken to mitigate fallout in the settings in which this technique is used.