(CS-138) Enhancing Wound Bed Preparation; Combining Bacterial Load Imaging Detection Technology with a Hypochlorous Acid Preserved Cleanser

Lee Ruotsi, MD, CWS-P, ABWMS, UHM – Medical Director, SARATOGA HOSPITAL WOUND HEALING

Introduction: Wound healing can be aided by utilizing the concept of “wound hygiene” at each and every dressing change. This consists of appropriate cleansing with non-cytotoxic agents that have evidence based bioburden/biofilm removal properties, appropriate debridement with attention to the wound edge, and management with dressings based on a thorough wound assessment.



Methods: We have found our wound bed preparation steps to be optimally enhanced using an imaging device that detects bacterial load and its locations. We use this guidance to help us to target our cleansing, ultrasound mechanical and sharp debridement procedures always utilizing a hypochlorous acid (HOCl) preserved cleanser, and observing serial images to confirm the removal of bacteria. We have found that this judicious use of our HOCl cleansing agent confirms the effectiveness of the practice, validating that we don’t need to use caustic/toxic agents such as Dakin’s solution or povidone iodine purely to achieve dramatic pre- and post- procedure images. We are able to confirm the reduction in bacterial load required to promote continued wound repair with the less cytotoxic HOCl based cleanser. We imaged for bacterial load pre and post wound cleansing.



Results: We present pre/post cleansing images on complex wounds with depth/crevices. Cleansing is typically done by irrigating wound spaces/tracts, soaking the wound bed with the cleanser on gauze, followed by vigorous scrubbing of the wound when needed and tolerated. No rinsing is necessary for HOCl based cleansers.

We have noted that chronic wounds invariably have a high bioburden often not only in the wound bed, but also the periwound skin especially if the skin has become macerated. Effective mechanical cleansing and debridement with a safe antimicrobial agent that can be used throughout the wound healing process has dramatically aided in our bioburden control. Post debridement, remnant bioburden and periwound bioburden is efficiently removed with a hypochlorous acid preserved cleanser, over time. Both soaking and mechanical scrubbing of the wound/periwound with gauze is essential to obtain optimal bacterial removal. Imaging of gauze used for cleansing reveals the high quantity of removed bacteria in the cleansing step.

Discussion: Wound healing is improved when effective wound hygiene is practiced. Imagery shows bacterial load removal with HOCl preserved cleanser is effective, but also that wound hygiene requires repetitive cleansing and/or mechanical scrubbing with each dressing change. The battle to conquer bacteria/biofilm in the wound requires constant diligence via repetitive steps that gradually bring bacterial/biofilm levels under control.