An Evidence-based Decision Tree Using Fluorescence Imaging to Address Bacterial Load Per International Guidelines

Abstract Body: International wound infection guidelines1 mandate that reduction of bacterial load is essential for effective wound infection management, done through cleaning, debridement and antimicrobial agents. Point-of-care fluorescence imaging* allows clinicians to visualize in real-time the distribution of potentially harmful bacterial loads ( >104 CFU/g)2. Clinical studies indicate that bacterial fluorescence (FL+) information improves accuracy of cleansing, guides targeted debridement, and facilitates evidence-based changes in treatment plans1-3.  Guidelines recommend re-evaluating the wound; this is now possible in real-time, at each step and without weeks of delay, with fluorescence imaging. Here we present a clinical workflow to demonstrate how FL+ information is used to guide evidence-based decisions and facilitate monitoring of wound bed preparation by initiating a positive feedback loop of targeted cleansing and debridement. When fluorescence imaging is used as part of routine clinical assessment of wounds, FL+ prompts wound cleaning. Persistence of FL+ triggers additional cleansing, perhaps with a stronger cleanser. If FL+ remains, clinicians may consider debridement, iteratively to a deeper level, larger region, and/or targeted location to reduce bacterial burden. Persistence of red or cyan fluorescence despite cleansing and aggressive debridement indicates subsurface bacteria, which may prompt clinicians to employ antimicrobials, antibiotics or other methods to manage bacterial burden. Elimination of FL+ indicates that the wound is ready for advanced treatments (i.e. grafting, hyperbaric oxygen therapy) that are typically contraindicated when infection is present. This clinical decision tree serves as a wound treatment protocol with suggested clinical actions for wound care based on fluorescence information.