OBTAINING WOUND CULTURES

Why do we culture wounds? Systemic response can no longer defend against bacteria from normal skin flora and external environment and it enters the wound tissue Local or systemic infection is the result Cultures are obtained to determine type and levels of bacteria to determine sensitivity to antibiotics.

Method of wound culture Per CHSB Standardized Procedure for Wound and Pressure Ulcers the Levine technique or similar method is to be used to obtain wound cultures RCT (randomized control trial) of 50 patients compared Levine technique to Z method and found Levine technique detected more organisms in both chronic and acute wounds (P ≤ 0.001) RCT conclusion that Levine technique was superior due to expression of fluid from wound bed

Learning Objectives Assessment for wound infection How to obtain a wound culture Documentation

Colonization Bacteria adhere to wound surface and replicate Colonization does not impair wound healing Treatment with antibiotics are not required Signs and symptoms of infection are absent

Critical Colonization Number of bacteria has increased Bacteria has not entered wound tissue Non-healing wound Drainage has increased or become purulent Erythema around wound edge Easily bleeding wound Debris (yellow or black necrotic tissue) on wound surface Smell (unpleasant odor) Phew

Signs and Symptoms of Infection Suspect infection if 2 or more S/S are present with purulent exudate Bacteria have invaded the wound tissue Local infection Increased local warmth Increased erythema Induration or edema around wound edges Increased drainage or purulent drainage Odorous smell Increased pain in wound Systemic Infection Fever Chills Increased WBC count Phew Ow! It’s warm

Where to culture wounds When to culture wounds S/S of infection are present Before antibiotics are administered Per CHSB Wound Treatment Policy and Procedure you must have an MD order Where to culture wounds In the cleanest area of the wound Where not to culture wounds Over eschar or scabs In areas of slough or purulent exudate

Levine Technique for Wound Culture Supplies; swab specimen container, normal saline, package of 4 x 4 gauze, clean gloves, PPE (personal protection equipment) Wash hands, apply gloves and PPE Clean wound with normal saline Lightly pat wound dry Identify 1 cm of clean wound tissue Using sterile technique Moisten sterile swab with normal saline Apply firm pressure while rotating the swab in clean area of wound bed. Goal is to express fluid from wound bed Place swab applicator into specimen container

Risks to Clients from Improper Wound Culture Technique False positive- Culture obtained from eschar, purulence may indicate an organism from the wound surface, not the deep tissue. The client may receive unnecessary antibiotics increasing the risk for bacterial resistance to antibiotics. False negative- Culture obtained from the surface of the wound will not gather deep tissue organisms. The client will not receive necessary antibiotics, delaying wound healing and increasing the risk of systemic infection.

Documentation Obtain order for a wound culture and submit to lab electronically (there is a comment section to add previously administered antibiotics if needed) Perform wound culture Place patient label on specimen container Add date, time, initials of nurse obtaining specimen, initials of nurse verifying Note: A second nurse must verify the clients name, medical record number, and order at the bedside Document obtaining the wound culture in nursing notes

Summary Assessment and identification of wound infection is important to wound healing and the well being of the client Obtaining wound cultures using proper technique will enable client to receive necessary antibiotics for infection control and improve wound healing Correct documentation ensures client safety, accurate treatment, and provides continuity of care