Wearable fluorescence visualization systems in complex wound assessment

Introduction: Fluorescence guided wound care allows clinicians to visualize bacteria of the wound in real-time, is effective across skin tones, and in wounds where subjective clinical signs and symptoms of infection are undetected despite high bacterial loads. Utilization of this technology has been limited due to access including device cost and implementation issues.Methods:Providers at a hospital system in southeast Wisconsin utilized a wearable fluorescence visualization system including a headlight and observational glasses calibrated to the headlight. Specialists utilized the device in the assessment of a case exemplar of complex wounds across care settings including the hospital outpatient department, wound clinic, and inpatient environments. Photo documentation utilizing a clip-on emission filter was utilized to acquire imaging results on available smart phone technology. Traditional photo documentation in addition to fluorescence imaging was collected. All patients received standard of care including cleansing, debridement, advancement wound dressings, offloading, infection management, nutritional education, and vascular assessment.Results:The wearable fluorescence visualization systems emitted a safe violet light that enabled visualization of red (porphyrin) and cyan (pyoverdine) fluorescence produced by bacteria and tissues providing information on clinically relevant level of bacteria ( >104 CFU/g). Implementation of fluorescence imaging was used to determine real-time detection of bioburden allowing for targeted and thorough cleansing infectious materials. Debridement was augmented by real time bacterial burden assessment as tissue layers are removed. The device was found to be non-invasive, lightweight, portable, and of utility across the care continuum. Providers familiar with existing fluorescence imaging technology found device results comparable amongst devices.Discussion:   Wound infection determination is subjective, and thus appropriate dressing selection and antibiotic prescribing can be challenging. Utilizing blue light technology with specifically calibrated wavelengths and filtration, wearable fluorescence provides vibrant autofluorescence to enhance the visibility of microbes during assessment and treatment of infection.   Fluorescence imaging is associated with benefits including expedited healing, mitigation of assessment associated skin tone disparities, decreased costs, augmented treatment; however, these benefits are limited to those able to access the technology. Wearable fluorescence wound visualization is a more affordable option that was found to deliver results comparable to higher cost devices.References:1. Price N. Routine Fluorescence Imaging to Detect Wound Bacteria Reduces Antibiotic Use and Antimicrobial Dressing Expenditure While Improving Healing Rates: Retrospective Analysis of 229 Foot Ulcers. Diagnostics (Basel). 2020;10(11):927. Published 2020 Nov 10. doi:10.3390/diagnostics10110927 2. Johnson J, Johnson AR Jr, Andersen CA, Kelso MR, Oropallo AR, Serena TE. Skin Pigmentation Impacts the Clinical Diagnosis of Wound Infection: Imaging of Bacterial Burden to Overcome Diagnostic Limitations. J Racial Ethn Health Disparities. 2024;11(2):1045-1055. doi:10.1007/s40615-023-01584-8 3. DasGupta T, Rashleigh L, Zhou K, et al. Use of a fluorescence imaging device to detect elevated bacterial loads, enhance antimicrobial stewardship, and increase communication across inpatient complex wound care teams. Wounds. 2022;34(8):201-208. doi:10.25270/wnds/21076 4. Lopez AJ, Jones LM, Reynolds L, et al. Detection of bacterial fluorescence from in vivo wound biofilms using a point-of-care fluorescence imaging device. Int Wound J. 2021;18(5):626-638. doi:10.1111/iwj.13564