Department & Location Procedure Number

Nursing Cooperative Wide Wound Culture Page 1 of 5

PURPOSE: To define the nursing responsibilities for obtaining a

wound culture.

RESPONSIBILITY STATEMENT:
Licensed staff may obtain a wound culture with
physician order.
Licensed staff may perform a swab culture.
Aspiration cultures or tissue biopsies are performed
by individuals licensed as an ARNP, PA, or MD.

SUPPORTIVE DATA:

1. PERSONAL PROTECTIVE EQUIPMENT (PPE)

Wear gloves, and other appropriate PPE, for all wound care; i.e.,
when irrigating or using Dremel during wound care wear gloves,
gown, and mask with eye shield.

2. INFECTION CONTROL
Notify Infection Control when cluster or possible transmission of
MRSA/VRE is suspected. Adherence to Infection Control Wound
Care Procedure will prevent or minimize transmission of
organisms.

3. WOUND CLEANSING
Wound must be thoroughly cleaned prior to culturing. Do not
culture purulent or necrotic debris or drainage over hard eschar.
See Wound Debridement Procedure and Wound Irrigation
Procedure.
4. INDICATIONS FOR OBTAINING CULTURE AND SUSCEPTIBILITIES
a. Use blue top culturette for aerobic C&S. This includes MRSA.
b. Culture for signs/symptoms of infection
c. Signs of wound infection
 Drainage excess, change in color, odor, consistency
 Purulent (pus) drainage
 Warmth or redness around wound, swelling or induration
 Poor granulation tissue
 Increased pain or tenderness
 Suddenly high blood glucose level in diabetic patient

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Nursing Wound Culture Procedure #
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 Continued wound exudate (drainage after 2-3 weeks optimal
care)
 Non healing wound (lack of healing after 2 weeks in a clean
wound)
 Increased pain in an immunocompromised patient
 Signs of systemic infection (elevated neutrophil count, fever)
 Bone involvement-suspect osteomyelitis

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INDICATIONS FOR OBTAINING A MRSA SURVEILLACE SCREENING
CULTURE
a. Refer to Management of the Patient with a Multi-Resistant Organism
Protocol
http://incontext.ghc.org/clinical/infection_control/protocol/mro.pdf
b. Identify r/o MRSA when ordering surveillance screening culture.
c. Use blue top culturette for aerobic surveillance screening culture
d. Ambulatory Setting
WHO WHEN Body Site
Patients receiving First wound care  Draining or moist
ongoing cutaneous visit wounds, and open
wound care skin lesions
Patients scheduled By PCP, surgeon,  Nares and,
for outpatient pre-anesthesia  Draining or moist
surgery with known provider prior to wounds, if present
history of a MRO surgery date, if (open skin lesions,
feasible. and surgical sites,
percutaneous tube
sites)

e. Inpatient Setting
WHO WHEN Body Site
Patients admitted to Upon admission  Draining/moist
the hospital (any) wounds, open skin
who have lesions (include
 Cutaneous wounds pegs, trach, central
 Foley catheters line wound sites)
 Invasive devices  Urine, if Foley
(i.e., pegs, trach, catheter
central lines)
Patients with a prior Upon admission  Nares and,
history of MRSA
 Draining or moist
wounds, if present

EQUIPMENT LIST:
For Swab Culture For Aspiration Culture
 Supplies for cleaning/irrigating  10mL sterile syringe
wound
 Gloves  22gauge needle
 Biohazard plastic lab transport bag  Syringe end cap
 Culturette with gel Matkon 53976  Sterile gloves
 Culturette without gel Matkon 53999  Skin antiseptic (betadine,
(for gram stain) etc)
 Skin antiseptic (betadine,

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etc)

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CONTENT:

Procedure Steps Key Points

Rational:
 Culture wound prior to initiation
of antibiotics when signs or
symptoms of infection is present.
 Identification of MRSA
colonization or infection.
The purpose of culturing a
wound prior to starting
antibiotics is to serve as a
baseline for guiding treatment. If
C&S is obtained after antibiotics
have been started, identify
specific drug on the laboratory
C& S requisition.

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General Wound culture swab

technique (quantitative)
1. Cleanse wound with normal saline
(bullets/fish) by removing excess
debris from wound base.
2. Thoroughly rinse/flush/irrigate
wound with sterile saline.
3. Gently blot excess saline from
wound bed with sterile gauze.
4. Remove soiled gloves after
cleaning and apply hand sanitizer.
5. Apply clean gloves
Maintain aseptic environment
with hand hygiene and wearing
gloves.
When flushing/irrigating wound
wear gown and face protection.
Use hand sanitizer between
gloving to prevent
contamination.

Preferred Culture Method:

6. Open culturette with gel Matkon Cotton tip swabs are not
53976. recommended.
7. After cleaning, if wound is dry, Culturettes contain a synthetic
moisten tip of culturette swab swab (rayon, dacron).
with sterile preservative free
saline (pink saline fish or saline
bullet). If wound is moist (weepy)
after cleaning, this may not be Apply sufficient pressure to
necessary. cause tissue fluid to be
expressed. It is the bacteria in
8. Rotate end of sterile synthetic the tissue fluid that is desired
tipped swab while a 1cm area of for culture.
open wound is swabbed for 5
seconds, or
**
**Alternative Culture Method
9. Perform a 10-point culture (this
consists of rotating the swab
while making a zigzag pattern
across the wound base at 10
points).
10. Avoid touching swab to
surrounding wound edges or skin.

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Procedure Steps Continued Key Points

11. Place swab in culturette and Avoid contaminating outside of

break gel preservative. culturette.

12. Label culturette.

13. Place in lab biohazard transport

bag.

14. Gram Stain

Gram stain cannot be done from a
culturette with gel. Use a
culturette (non gel) Matkon
53999.

Tissue Aspiration Technique

1. MD, PA, ARNP responsibility Involves insertion of a needle
into the tissue adjacent to the
2. Perform hand hygiene and apply
wound to aspirate tissue fluid.
sterile gloves.
This is a sterile procedure.
3. Face shield and gown may be
necessary to avoid potential Intact skin next to the wound is
exposure to inadvertent wound disinfected and allowed to air
spray dry. Do not fan area to speed
drying as it allows the
4. Cleanse intact skin with
organisms in environment to
antiseptic and allow to dry.
settle on the skin surface.
5. Insert 10mL syringe with a 22
gauge needle, with 0.5 mL of air
in the syringe into the skin and The needle is moved backward
apply suction (aspirate). and forward at different angles
for 2-4 explorations.
6. Aspirate approximately 0.5mL of
wound fluid.
7. Remove needle and place end cap Remove needle with hemostat
on syringe. and place immediately in sharps
container. Place end cap on
8. After labeling syringe, place in
syringe to prevent leakage.
lab biohazard transport bag and
send aspirate immediately to lab
General Wound tissue biopsy
(gold standard)
Physician responsibility

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Procedure Steps Continued Key Points

Obtaining a Wound Culture from a
Diabetic Neuropathic Wound
Physician responsibility Confirm with radiographic
evaluation or biopsy.
If neuropathic wound is suspected to
involve bone (i.e., osteomyelitis),
assess by the blunt end of a sterile
probe into the wound to determine if
probe can scrape bone.

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DOCUMENTATION:
1. Label culturette or syringe
2. Record in the medical record:
 Date and time
 Note that wound was cleaned or irrigated
 Wound location (e.g., lower aspect of abd incision)
 Type of culture (aspiration, swab)

REFERENCES:
APIC Text of Infection Control and Epidemiology (2000), p 89-2.
US Department of Health and Human Services, Agency for Health
Care Policy and Research. Treatment of Pressure Ulcers. 1994
Publication No. 95-0653
Color Atlas and Textbook of Diagnostic Microbiology. (5 th ed.,
p152). (1997). Lippincott-Raven , Philadelphia, PA. pp152.
Bryant, R. A. (2000). Acute and chronic wounds: Nursing
management. (2nd ed.). St Louis: Mosby
Kosier,B. (2000). Fundamentals of nursing: Concepts, process,
and practice. (6th ed.) New Jersey: Prentice-Hall, Inc.

Written by: Gwenda Felizardo, BSN, CIC, RN, Infection Control

Original date: March 2002

Reviewed by: Jan Crosman, MN, ARNP, ONC, RN, Orthopedics

Barb Fugleberg, MN, RN, Puget Sound Regional Division

Administration

Ruth Gregersen, PhD, RN, Home and Community

Services

Peggy Rogers, Microbiology Laboratory

Arthur Harris, Wound Care Specialist

Karen Severson, MSN, RN, Hospital System Practice and

Process Improvement Carmen Suazo, MN, RN, Nursing
Operations

Reviewed/Revised date(s): 1/03, 1/05

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Administrative Approval:
______________________________________________

Director, Nursing Resources

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