Handheld real-time fluorescence imaging of bacteria guides treatment selection and timing of dressing changes in inpatients undergoing negative pressure wound therapy

Rose Raizman RN-EC, MSc1, Ralph DaCosta, PhD2
1Rouge Valley Health System and 2University Health Network and MolecuLight Inc., Toronto, Canada

Poster presented at: Innovations in Wound Healing symposium, December 8-11, 2016, in Key Largo, FL.

ABSTRACT

Chronic wounds requiring hospitalization often harbor a high bacterial burden that negatively impacts tissue healing1. Knowledge of wound bioburden can help guide selection of optimal therapies, for example, negative pressure wound therapy devices (NPWT) with instillation of wound cleansers in a heavily contaminated wound. Recently, fluorescence imaging has been used to visualize red-fluorescing, pathogenic bacteria in real-time at the bedside using a non-contact hand held device2. Herein, we report the use of this imaging device to detect the presence of bacteria in three adult inpatients undergoing NPWT. Three wounds with diverse etiologies were imaged with the fluorescence imaging device at various stages of the wound healing process. Wounds that were positive for red fluorescence signal were considered to be contaminated with bacteria. Bacterial fluorescence was detected under sealed, optically-transparent (routine) adhesive prior to dressing changes (Figure), on foam dressings, within the wound bed, and on peri-wound tissues. Bacterial visualization in real-time helped to guide: (1) bioburden-based, personalized treatment regimens for each patient, (2) clinician selection of NPWT with or without instillation of wound cleansers and (3) the extent and location of wound cleaning during dressing changes. In addition, the ability to visualize bacteria in real-time prior to removal of adhesive and dressings led to expedited dressing changes when heavy bioburden was detected and postponement of dressing changes for 24 hours when red fluorescence was not observed, avoiding unnecessary disturbance of the wound bed. In summary, fluorescence imaging of bacteria helped guide timing of dressing changes, the extent of wound cleaning during dressing changes, and selection of the appropriate and most cost-effective NPWT (standard vs. instillation). These results highlight the ability of bacterial fluorescence imaging to provide invaluable real-time information on a wound’s bioburden, contributing to clinician treatment decisions in cases where bacterial contamination could impede wound healing.

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  1. Australian Wound Management Association. Bacterial impact on wound healing: from contamination to infection. 2011.
  2. DaCosta RS et al. PLoS One.2015 Mar 19;10(3):e0116623.