(PI-026) Using Bacterial Fluorescence Imaging to Evaluate & Improve the Effectiveness of Wound Hygiene
Thursday, May 16, 2024
7:30 PM – 8:30 PM East Coast USA Time
Amit Rao, MD; Christina Del Pin, MD FACS; Marisa Ranire-Maguire, MD
Introduction: Effective wound hygiene is fundamental to favorable wound healing outcomes. The first line of defense is cleansing the wound bed and periwound area. Without a means to visualize bacterial location, presence, and extent, cleansing can leave behind bacterial burden which puts the wound at risk for delayed healing, infection, and poor CTP outcomes. Objective, reliable methods to improve wound hygiene are much needed. This leads us to present practical guidance on using fluorescence-imaging to accomplish more effective hygiene.
Methods: A case series showcasing how real-time fluorescence-imaging* can be used to better target bacterial burden during wound hygiene, with examples of traditional hygiene performed without the guidance of fluorescence-imaging for comparison. We also present a clinical decision tree based on the practices in our clinic describing our recommendations for subsequent approaches depending on the effectiveness of initial fluorescence-guided hygiene. This algorithm incorporates objective justification on cleansing method/solution selection, demonstrated through a prior clinical study.
Results: Better removal of bacterial burden occurred during cleansing when regions of bacterial burden were illuminated and targeted by fluorescence imaging. Despite evidence suggesting the superior efficacy of certain cleansers over others, even the most effective cleanser demonstrated weakened performance when not utilized under fluorescence guidance. When performing traditional, unguided cleansing, significant bacterial burden was often left behind. In cases where bacterial fluorescence cannot be removed after a single round of guided hygiene, we recommend additional rounds with the iterative use of fluorescence-imaging to assess for remaining bacteria. Debridement and topical antimicrobials are other useful means to address stubborn bacterial loads.
Discussion: Fluorescence-imaging is a useful technology that can improve the effectiveness of routine wound hygiene at the bedside. It can also alert to any remaining bacterial burden, possibly prompting iterative rounds of hygiene and fluorescence-imaging, or additional interventions including debridement and topical antimicrobials. Altogether, fluorescence-imaging provides clinicians with real-time data on bacterial burden that supports an objective approach to bacterial-infection management.