(CR-002) Bacterial load imaging of chronic wounds supports patient adherence, empowerment and may prevent negative outcomes

Katherine McLeod, RN – Madigan Army Medical Center; Rowena Stefan, RN – Madigan Army Medical Center

Introduction: Treatment adherence and patient empowerment are fundamental to chronic wound healing. They are dependent on patient understanding of their condition and the reasoning behind their care. Fluorescence (FL) imaging* for bacteria can improve treatment planning and outcomes. In diabetic patients, imaged bacterial load can indicate a foot fissure that can evolve into a DFU. Proactive foot-care can avoid this progression. Can FL-imaging improve patients' understanding of the importance of foot hygiene?

Methods: A two-part analysis was performed: (1) A 10-item questionnaire based on quality-of-care tools to n=19 hard-to-heal wound outpatients explored safety, patient-centered care, effectiveness, and treatment adherence. (2) 10 consecutive diabetic patients with lower extremity wounds not involving the feet received a new treatment algorithm: An initial FL-imaging* foot scan was performed. If negative, care centered on foot-care education (i.e. interdigital daily washing and lotion/cream between the toes avoidance). If positive for intertriginous bacteria, education and “toe flossing**” hygiene procedure was performed. Re-scanning typically demonstrated removal of the bacterial signal. Images were shown to patients reinforcing foot hygiene efficacy. When signal remained, patients were prescribed daily interdigital wash and silver alginate strip^. Follow-up visits assured bacterial removal and fissure healing.

Results: Patient questionnaire: all respondents agreed/strongly agreed that FL-imaging helped them better understand their wounds’ status and the purpose behind their treatments. As a result, most respondents (76%) agreed that they were more likely to carry out at-home care plans and return for future appointments (adherence). Perception of improved patientcare and wound-status was reported by 93% of the surveyed.

Of scanned diabetic non-wound patients, 50% had intertriginous bacteria. Of those, 2/5 had unexpected small fissures. With the hygiene protocol described no study patients developed DFUs.

Discussion: