1. OBTAINING WOUND CULTURES

2. 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.

3. 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

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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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

12. 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