(PI-001) Enabling Proactive Intervention: Understanding Chronic Inhibitory Bacterial Loads through Fluorescence Imaging and Why It Matters
Thursday, May 16, 2024
7:30 PM – 8:30 PM East Coast USA Time
ashley Jacobs, RN
Introduction: A recently coined acronym, CIBL(chronic inhibitory bacterial load), refers to bacterial loads that stall healing and increase the risk of complications, infection, and hospitalization. CIBL may not present with classic signs of infection. Healing outcomes are shown to improve when these bacterial loads are removed. Irrespective of the clinical appearance, point-of-care fluorescence imaging can highlight the presence and location of CIBL, working with clinical assessment to inform treatment decisions. As wound care moves towards evidence-based practices, the assessement and management of CIBL calls for a robust treatment algorithm. We have developed a standardized framework in our practice to stage and address fluorescence signals of CIBL with good results.
Methods: Through 4 years of employing fluorescence imaging, we have recognized patterns in fluorescence presentation which have prompted different clinical interventions, yielding positive outcomes. Here we present a table describing actionable information in relation to specific fluorescence signal findings, employed regularly in our day-to-day clinical practice. This 6-stage classification system depicts the different presentations of bacterial fluorescence and our chosen clinical interventions for each stage.
Results: Proposed staging of fluorescence imaging findings: Stage 0: no evidence of CIBL stage I and II: CIBL can be eliminated by wound hygiene or is contained to the wound bed. Stage III and IV: persistent CIBL in the periwound after selective or aggressive debridement Stage V: persistent CIBL after aggressive wound hygiene that spreads outside the periwound
Each stage is associated with suggested clinical interventions which we have employed in our practice. Through a number of case studies, we describe the presentation of CIBL and our interventions for each.
Discussion: Detection of CIBL through fluorescence imaging provides an accurate assessment of a wound's bioburden. This study aims to provide guidance to clinicians in the interpretation and reaction to fluorescence imaging information in line with standardized, rational wound care practices. Frequent and thorough treatments to reduce bacterial loads are needed to prevent/disrupt biofilm formation and improve healing rates. Through stepwise progression, we focus on mechanical methods of bacterial removal(cleansing, debridement). Other measures such as antimicrobial dressings and/or systemic antibioticx were incorporated as required.