Using Synergy to Address Bioburden During Wound Bed Preparation: A Case Series

Clinical Problem: Routine sharp debridement has been an accepted modality to reduce bioburden1 but scope of practice barriers and site of care limit frequency. Recent evidence suggests normal saline is ineffective2 in impacting bacterial load. Newer products, including combination wound and skin cleansers for bioburden management3 and monofilament4 pads also positively impact wound bioburden but little is reported about the use of these modalities in tandem.

Clinical Approach: Ten patients with venous leg ulcers (VLUs) and specific inclusion/exclusion criteria were divided into 2 groups. Group A treated with a monofilament pad* moistened with 0.9% NS. Group B treated with a monofilament pad moistened with an antimicrobial wound cleanser**. Biofluorescence assessment of bioburden was performed using a standardized device *** before each treatment and 15 minutes after completion of treatment. All treatments were followed with a dressing appropriate to manage wound exudate and standard compression therapy. Patients were followed for 6 weeks. The patients were not receiving systemic or topical antibiotics nor antimicrobial agents within the wound dressing.

Outcomes: All patients had reduced biofluorescence in and around the wound bed, however Group B demonstrated greater reductions in bioburden. It also demonstrated greater wound reduction with 2 of the 5 patients demonstrating complete epithelialization and 3 patients with greater than 50% reduction in wound surface area. Group A had one patient with complete epithelialization, one patient with greater than 50% reduction in wound surface area and 3 patients with less than 50% wound surface area reduction.

Conclusion: This case study suggests that combining a monofilament pad with an antimicrobial wound cleanser reduces fluorescing bacteria located in and around the wound and may ultimately impact wound closure rates in patients with venous insufficiency. More study is needed.