RNAO BPG Pressure Ulcers Stage I to IV - Faculty of Health ...

Nursing Best Practice GuidelineKnox, Morgan, & Rodeheaver, 2001). Though there remains much debate surrounding approaches to woundculture sampling (Bowler, Duerden, & Armstrong, 2001), the panel supports the Levine method as it has recentlyemerged in the literature and current practice as the best approach for obtaining semi-quantitative woundculture swabs (Dow, Browne, & Sibbald, 1999; Sibbald, Woo, & Ayello, 2006). This represents a change from thepreviously recommended zig-zag method. Most wounds need some form of preparation prior to theculture in order to reduce the risk of introducing extraneous microorganisms into the specimen (Crow, 1990;Cuzzell, 1993). The exudate that accumulates on the surface of the wound and under dressings containsbacteria that are not the same as those causing infection in the wound. Irrigate wounds with normal salineuntil all visible debris has been washed away. Successful culturing also involves culturing viable tissue,therefore never swab eschar or yellow fibrous slough. Ensure that the swab is moist or alternatively, addnormal saline to the wound bed and/or swab. Rotate the swab tip in a 1 cm 2 area of the cleanest anddeepest part of the wound and/or area of granulation, using enough pressure to release tissue exudate fora period of five seconds. This may be painful so warn the patient of the possibility of pain. Ensure adequatepain management and pre-medicate (e.g., topical wound analgesia) if possible. For a diagram of swabbingtechnique for accurate wound culture results, refer to Appendix O – Wound Cultures: Swabbing Techniques.The AHCPR (1994) recommends that topical antiseptics should not be used to reduce bacteria in woundtissue. They report numerous studies that have documented the toxic effects of exposing wound-healingcells to antiseptics. Maklebust and Sieggreen (1996) describe antiseptics as highly reactive chemicals thatindiscriminately destroy cell function, and that the use of antiseptics to decrease the bacterial counts inopen wounds is contraindicated. However, in cases where a wound is non-healable and bacterial burdenis more important than tissue toxicity, antiseptics may be used to dry the wound surface and decrease localbacterial proliferation (Sibbald, Orsted et al., 2006).Protecting pressure ulcers from exogenous sources of bacteria e.g., fecal matter, will facilitate themanagement of bacterial contamination. Refer to the Discussion of Evidence related to dressing selectionand sacral dressings.Wound CleansingRecommendation 3.4aDo not use skin cleansers or antiseptic agents (e.g., povidine iodine, iodophor, sodium hypochloritesolution, hydrogen peroxide, acetic acid) to clean ulcer wounds.Level of Evidence – IIIRecommendation 3.4bUse normal saline, Ringer’s lactate, sterile water or non-cytoxic wound cleansers for woundcleansing.Level of Evidence – IVRecommendation 3.4cFluid used for cleansing should be warmed at least to room temperature.Level of Evidence – III39