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Skin Flora
Staphylococcus aureus
Gram-negative bacteria
Staphylococcus epidermidis
Propionobacterium. Corynebacterium
Contamination
Colonization
O2 O2 O2
pH
pH O2 pH pH
Critical colonization
Infection
Definition
wound type depth Location quality of the tissues level of tissue perfusion host immune response.
Necrotic wounds
Probable aerobic bacteria S. aureus P. aeruginosa E. Coli / Klebsiella pneumoniae Streptococcus pyogenes
Type of wound
Burn wound
Probable aerobic bacteria P. aeruginosa / S. aureus / E. Coli / klebsiella spp, Enterococcus spp
Probable aerobic bacteria S. aureus Streptococcus spp Less common Pasturella multocida / Pasturella canis / Capnocytophaga canimorsus / B. Henselae / E. corrodens
Probable anaerobic bacteria Bacteroides spp Provotella spp Peptostreptococcus spp Clostridium perfringens
Probable aerobic bacteria S. aureus / Strep. Algalactae (GBS) / P. aeruginosa / Enterococcus spp / coliforms
Type of wound
Decubitous ulcer
Gregory Moran, M.D., from the Center for Disease Control and Prevention.
Greenish pus
New or increase swelling Local warmth Erythema or further extension of erythema New or increasing pain Purulent discharge or increase in the level of exudate Discoloration of surrounding skin Wound breakdown / dehiscence Lymphangitis Fever
2.Burns with skin graft rejection 3.Chronic wounds that have a long history of failure to heal
Clean wound
General Guidelines Quality of lab results proper collection and handling of the specimen as well as obtaining satisfactory material for examinations Actual infection site & minimum contamination from adjacent tissue, organs and secretions Sufficient quantity
Appropriate collection devices, specimen containers, & culture media must be used to ensure optimal recovery of microorganism
Specimen collected before the commencement of antibiotic therapy Specimen container must be properly labeled, place in the biohazard plastic bag and accompanied laboratory request form Specimen are best transported immediately to the laboratory
Triggers For Suspecting Wound Infection In Acute Wounds 1. New or increase 1.Discoloration of swelling surrounding skin 2. Local warmth 2.Wound breakdown / 3. Erythema or further dehiscence extension of erythema 4. New or increasing pain 3.Lymphangitis 5. Purulent discharge or 4.Fever increase in the level of exudate
Extensive burn wound (> 20%) Burns with skin graft rejection Chronic non-healing wounds
1. Wound swabbing Test request: Wound swab for culture and sensitivity Suitable for superficial wounds Requirements:
Specimen Collection
and lable the container Complete the request form( Per Pat 301). clinical information should be provided (e.g., type and site of wound, associated malodor, signs of infection, antibiotic therapy) in order to ensure that meaningful results can be provided in as short a time as possible 1. Place the specimen and request form into the Biohazard bag and sent straight to the laboratory 2. Wound swabs should be stored at room temperature
Tissue sampling
Test request : Tissue for culture and sensitivity and
gram stain
debridement and cleansing (with sterile saline or distilled water) of the wound The most useful method for determining the presence of invasive pathogens. Taken after initial debridement and cleansing of superficial debris and should be taken aseptically.
from the deep part of the wound or base of the lesion/wound/ulcer and placed into a sterile screw capped container with few drops of saline to keep it moist
Fluid sampling
Suitable
for wound with copious volume of fluid present either beneath the scab or any superficial debris. be done aseptically and try to avoid endogenous contamination. cavity wounds such as pressure sores, irrigation with saline and gentle massaging may be required to provide fluid for sampling.
Should
In
Fluid sampling
Test request: Fluids for C&S and gram stain Suitable for wound with cavity, sinus or pockets.
Should be done aseptically after cleansing (with sterile saline or distilled water)
areas. Wounds that are deep and contains devitalized tissues. Chronic nonhealing wounds with poor blood perfusion.
Anaerobic infection
sensitivity and gram stain Should be done aseptically Samples must be either aspirates or tissues only. Swabs are not suitable for anaerobic culture For large pieces of tissues ( 1 cm), sample can be placed in a screw capped bottle because the bigger the tissue, the higher is the yield for anaerobic culture. Smaller pieces should be placed in an aerobic transport media or Robertson cooked meat medium.
Anaerobic culture
Collection: 1. Abscess Clean site by wiping with sterile saline or water Aspirates the area containing fluid, pus or exudates by needle and syringe, expel air from the syringe and cap it or send in a screw capped bottle and send to the laboratory immediately
Storage and Transportation of Wound Specimens for anaerobic culture 1.Specimens should be sent immediately to the laboratory for processing 2.In hospitals where the laboratory does not accept specimens after office time or over the weekends, the specimen should be kept at room temperature and sent immediately on the next working day.
1. Blood cultures should be performed for a patient with a severe infection, especially if the patient is systemically ill.
Antibiotic Treatment
Antibiotics should only be given when there are
organisms as stated in the table above and should be changed according to the culture results
Sample for culture should never be send in Formalin & should not be left dry in the container
Formalin
Saline
Sterile water
Summary
Sample should be taken when indicated Correct sampling technique is pertinent for optimal yield Correct Transport material & container may determine
whether the bacteria is able to grow Never send samples in FORMALIN Bacteria isolated from any wound does not indicate infection clinical correlation is crucial No growth does not exclude infection Consider anaerobic infection in deep seated infection or when there is abundant of devitalized tissues Antibiotic treatment only when indicated and follow guideline