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A Clinical Minute: Battling Opportunistic Pathogens and Infection
Infection rates are staggering, continue to challenge the healthcare system, and have been shown to increase mortality, hospital readmission rates, length of stay (LOS), and overall healthcare expenditures. The Centers for Disease Control and Prevention reports one out of 25 hospitalized patients has at least one healthcare-associated infection (HAI)1; an estimated 722,000 to potentially 1.7 million HAIs occurred in United States’ hospitals2; about 50% of patients with HAIs died during their hospitalizations, and more than half of these occurred outside the ICU setting, with associated costs as high as $45 billion.1,2 In 2007, methicillin-resistant Staphylococcus aureus (MRSA) was found in 2.4% of all patients, which totals 880,000 victims per year.
How can these infections happen, and why are bacteria so easily spread? First, there has been a worldwide increase of antibiotic-resistant organisms. Additionally, we often don’t consider the opportunity for bacteria to become airborne or prevalent within the environment. MRSA has been found in up to 4.6% of healthcare workers involved in direct patient care; as a result, workers can spread it to coworkers and to patients and patients to other patients.
Breaking down opportunistic infection potential, 40% of air samples and 50% of surface areas have been found to be positive for bacteria after dressing changes; for MRSA patients, 12% to 44% of their rooms were found to be contaminated; and during a moderately dry traditional gauze dressing change, approximately 350 colony-forming units (CFUs) of S. aureus per liter of air were found to be aerosolized at 2 minutes’ post dressing change,3 substantially increasing the potential for cross contamination (see Figure 1).
For healthcare professionals, it is important to keep in mind that bacteria are present on traditional dressings and easily transmitted from the dressing to the environment. One way to help minimize the spread of the bacteria is to use a dressing that acts as a true barrier by killing bacteria within the dressing substrate. BIOGUARD® Barrier Dressings (Derma Sciences, Inc, Princeton, NJ), with their advanced cationic biocide bound to the base dressing, provide >5 log-kill within the dressing substrate against a broad spectrum of pathogens, including MRSA. PolyDADMAC, the biocide in the BIOGUARD dressings, has an active mechanism of action that attracts the bacteria, disrupts and destroys their cell structure (see Figures 2 and 3), and kills the bacteria within the dressing, reducing the potential for aerosolization of the bacteria and cross-contamination.
As one example, a donor site was treated with standard gauze dressings (see Figure 4a); within 24 hours, the dressing was metallic green in color and had a strong odor. Figure 4b shows the same donor site after 24 hours of treatment with BIOGUARD gauze bandages. Exudate, color, and odor were markedly reduced with the BIOGUARD dressing.4
The primary goal in wound care is to protect a wound site from bacterial colonization as a result of cross-contamination or bacteria already found in the wound. It makes sense to use a dressing that has an impact on killing opportunistic pathogens without irritation or cell toxicity and keep the wound on track toward healthy healing.
A Clinical Minute is made possible through the support of Derma Sciences, Inc, Princeton, NJ. The opinions and statements provided in A Clinical Minute are specific to the respective authors and not necessarily those of OWM or HMP Communications. This article was not subject to the Ostomy Wound Management peer-review process.
1. Centers for Disease Control and Prevention (2014). Hospital-Associated Infections (HAI). Available at: www.cdc.gov/HAI/surveillance/index.html. Accessed August 8, 2014.
2. Committee to Reduce Infection Deaths (RID). The Cost of Infection (2014). Available at: www.hospitalinfection.org/cost_of_infection.shtml. Accessed August 8, 2014.
3. Sergent AP, Slekovec C, Pauchot J, Jeunet L, Bertrand X, Hocquet D, et al. Bacterial contamination of the hospital environment during wound dressing change. Orthop Traumatol Surg Res. 2002;98(4):441–445.
4. Youngblood L, Nappo R, Popp J, Mikhaylova A, Liesenfeld B, Moore D, et al. Gauze Bandages with a Bound Antimicrobial Polymer Suppresses Bacterial Growth in Patients with Heavily Exuding Wounds. Presentation at the Symposium on Advanced Wound Care. Dallas, TX. April 14–17, 2011.
