(CS-154) 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 Center for Wound Healing and Hyperbaric Medicine

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 biobureden/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 preparatrion steps to be optimally enhanced using an imaging device that detects bacterial load and it's 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 remoal/reduction of bacteria. We have found that the judicious use of our HOCl cleansing agent confirms the effectiveness of the practice, validating that we can avoid the use caustic/toxic agents such as Dakin's solution or povidone iodine while still achieving reduction in surface bacteria.  We are able to confirm the reduction in bacterial load required to promote continued repair with the less cytotoxic HOCl based cleanser. We image for bacterial load pre- and post- wound cleansing and debridement.

Results: We present pre/post cleansing images on complex wounds with depth, mixed tissue types and periwound skin issues. Cleansing is typically done with irrigation of spaces/tracts, applying soaks with gauze followed by scrubbing 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 frequently in the periwound skin espcially if the skin has become macerated, or exhibits callus or scales. Effective mechanical cleansing and debridement with a safe antimicrobial agen that can be used throughout the wound healing process has dramatically aided in our bioburden control. Post debridement, rresidual bioburden on the surface and periwound is efficiently removed over time with a hypochlorous acid preserved cleanser. 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 bacterial 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 cleansing and/or scrubbing with each dressing change. The battle to couquer bacteria/biofilm in the wound requries constant dillagence via repetitive steps that gradual bring bacterial/fiofilm levels under control.

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References: Murphy C, Atkin L, Swanson T, Tachi M, Tan YK, Vega de Ceniga M, Weir D, Wolcott R. International consensus document. Defying hard-to-heal wounds with an early antibiofilm intervention strategy: wound hygiene. J Wound Care 2020; 29(Suppl 3b):S1–28.