Therapeutic index for local infections score (TILI): a new diagnostic tool

How effective is simple mechanical wound debridement in reducing bacterial colonisation? Results of a prospective clinical study

BACKGROUND AND AIMS

Bacteria in wounds can lead to stagnation of wound healing as well as to local or even systemic wound infections up to potentially lethal sepsis. Consequently, the bacterial load should be reduced as part of wound treatment. Therefore, the efficacy of simple mechanical wound debridement should be investigated in terms of reducing bacterial colonisation.

PATIENTS AND METHODS

Patients with acute or chronic wounds were assessed for bacterial colonisation with a fluorescence camera before and after mechanical wound debridement with sterile cotton pads. If bacterial colonisation persisted, a second, targeted wound debridement was performed.

RESULTS

A total of 151 patients, 68 (45.0%) men and 83 (55.0%) women were included in this study. The male mean age was 71.0 years and the female 65.1 years. By establishing a new analysis method for the image files, we could document that the bacterial colonised areas were distributed 21.9% on the wound surfaces, 60.5% on the wound edges (up to 0.5 cm) and 17.6% on the wound surroundings (up to 1.5 cm). One mechanical debridement achieved a significant reduction of bacterial colonised areas by an average of 29.6% in the wounds, 18.9% in the wound edges and 11.8% in the wound surroundings and was increased by performing it a second time.

CONCLUSIONS

It has been shown that even a simple mechanical debridement with cotton pads can significantly reduce bacterial colonisation without relevant side effects. In particular, the wound edges were the areas that were often most contaminated with bacteria and should be included in the debridement with special attention. Since bacteria remain in wounds after mechanical debridement, it cannot replace antimicrobial therapy strategies, but offer a complementary strategy to improve wound care. Thus, it could be shown that simple mechanical debridement is effective in reducing bacterial load and should be integrated into a therapeutic approach to wounds whenever appropriate.

IWII Wound Infection in Clinical Practice consensus document: 2022 update

ABSTRACT

Wound infection is a major challenge for clinicians globally, with accurate and timely identification of wound infection being critical to achieving clinical and cost-effective management, and promotion of healing. This paper presents an overview of the development of the International Wound Infection Institute (IWII)'s 2022 Wound Infection in Clinical Practice consensus document. The updated document summarises current evidence and provides multidisciplinary healthcare providers with effective guidance and support on terminology, paradigms related to biofilm, identification of wound infection, wound cleansing, debridement and antimicrobial stewardship. Integral to the update is revision of wound infection management strategies which are incorporated within the IWII's Wound Infection Continuum (IWII-WIC) and management plan. The aim of the 2022 IWII consensus document update was to provide an accessible and useful clinical resource in at least six languages, incorporating the latest evidence and current best practice for wound infection and prevention. Dissemination techniques for the consensus are discussed and highlighted.

Lokaltherapeutisches Vorgehen bei Blasen der Haut: Ein Positionspapier der Initiative Chronische Wunden (ICW) e. V

Blasen an der Haut können durch sehr unterschiedliche Krankheitsbilder verursacht werden. Daher handelt es sich hierbei um eine interdisziplinär und interprofessionell relevante Herausforderung. Im klinischen Alltag werden derzeit verschiedene lokaltherapeutische Vorgehensweisen praktiziert. Entweder wird die Blase belassen oder die Blase wird punktiert und das Blasendach wird belassen, alternativ wird das komplette Blasendach abtragen. Jede dieser Vorgehensweisen hat potenzielle Vor- und Nachteile. Es erfolgte die Durchsicht der aktuellen Literatur und Konsensfindung durch die Expert*innen der Initiative Chronische Wunden (ICW) e. V. Folgende Vorgehensweisen werden empfohlen: unkomplizierte Blasen ohne Druckschmerz: Blasen belassen; druckschmerzhafte sowie palmar und plantar lokalisierte Blasen: Blase punktieren und Dach belassen; rupturierte Blasen ohne klinische Infektionszeichen: Reste des Blasendachs belassen; rupturierte Blasen mit klinischen Infektionszeichen: Reste des Blasendachs abtragen; Blasen bei Verbrennungen ab Grad 2a oder bei unklarer Verbrennungstiefe oder bei chemischer Verbrennung: Blasendach abtragen. Anschließend erfolgt jeweils die Anlage eines sterilen Wundverbandes. Beim Auftreten von Blasen an der Haut gibt es nicht die eine richtige lokaltherapeutische Vorgehensweise. Bei der Planung eines Behandlungskonzepts sollte die Genese der Blasen geklärt werden, ggf. sollte eine kausale Behandlung erfolgen. Die Lokaltherapie orientiert sich dann an verschiedenen individuellen Faktoren. Somit kann das gemeinsam mit den Patient*innen gewählte Vorgehen interindividuell sehr unterschiedlich sein.

In Vitro Efficacy of Bacterial Cellulose Dressings Chemisorbed with Antiseptics against Biofilm Formed by Pathogens Isolated from Chronic Wounds

Local administration of antiseptics is required to prevent and fight against biofilm-based infections of chronic wounds. One of the methods used for delivering antiseptics to infected wounds is the application of dressings chemisorbed with antimicrobials. Dressings made of bacterial cellulose (BC) display several features, making them suitable for such a purpose. This work aimed to compare the activity of commonly used antiseptic molecules: octenidine, polyhexanide, povidone-iodine, chlorhexidine, ethacridine lactate, and hypochlorous solutions and to evaluate their usefulness as active substances of BC dressings against 48 bacterial strains (8 species) and 6 yeast strains (1 species). A silver dressing was applied as a control material of proven antimicrobial activity. The methodology applied included the assessment of minimal inhibitory concentrations (MIC) and minimal biofilm eradication concentration (MBEC), the modified disc-diffusion method, and the modified antibiofilm dressing activity measurement (A.D.A.M.) method. While in 96-well plate-based methods (MIC and MBEC assessment), the highest antimicrobial activity was recorded for chlorhexidine, in the modified disc-diffusion method and in the modified A.D.A.M test, povidone-iodine performed the best. In an in vitro setting simulating chronic wound conditions, BC dressings chemisorbed with polyhexanide, octenidine, or povidone-iodine displayed a similar or even higher antibiofilm activity than the control dressing containing silver molecules. If translated into clinical conditions, the obtained results suggest high applicability of BC dressings chemisorbed with antiseptics to eradicate biofilm from chronic wounds.