Guidelines for Point-of-Care Fluorescence Imaging for Detection of Wound Bacterial Burden Based on Delphi Consensus

Excessive levels of bacteria impede wound healing and can lead to infectious complications. Unfortunately, clinical signs and symptoms of elevated bacterial burden are often unreliable. As a result, point--of--care fluorescence imaging, used to detect critical bacterial burden in wounds, is becoming widely recognized and adopted by clinicians across the globe as an accepted and added component of wound assessment protocol. A Delphi method was employed to establish consensus guidelines describing fluorescence imaging use. A multidisciplinary panel of 32 wound experts (56% MD, 22% podiatrist, 12.5% nurses/nurse practitioners) representing multiple sites of service (e.g., hospital outpatient, inpatient, private office, long-term care) completed two rounds of online questionnaires. The Delphi included key topics, including competencies required to perform imaging, clinical indications for imaging (e.g., signs/symptoms present, procedures warranting imaging), frequency of imaging, and a clinical workflow algorithm. Describing their clinical experiences of imaging impact, >80% reported changes in treatment plans, 96% reported that imaging-informed treatment plans led to improved wound healing, 78% reported reduced rates of amputations, and 83% reported reduced rates of microbiological sampling. The guidelines provided here will help to standardize use of fluorescence imaging among wound care providers and enhance the quality of patient care.

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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 ◽

10.3390/diagnostics10110927 ◽

2020 ◽

Vol 10 (11) ◽

pp. 927

Author(s):

Nadine Price

Keyword(s):

Wound Healing ◽

Fluorescence Imaging ◽

Point Of Care ◽

Antibiotic Use ◽

Foot Ulcers ◽

Routine Practice ◽

Bacterial Burden ◽

Imaging Device ◽

Antibiotics Use ◽

Point Of Care Detection

Foot ulcers and their bacterial burden produce a significant strain on the National Healthcare System (NHS). Subjectivity of wound infection assessment makes appropriate dressing selection challenging. To aid point-of-care detection of bacterial burden, a fluorescence imaging device (MolecuLight i:X) was introduced to the Whipps Cross Hospital Podiatry clinic. This retrospective pre/post-analysis evaluated how implementation of fluorescence imaging impacted (1) antimicrobial dressings and antibiotics use and (2) wound healing rates. Over a 2-year period 229 lower extremity wounds were treated. Wound-related outcomes and antimicrobial dressing costs were quantified over 1-year before (2018/2019) and after (2019/2020) incorporating fluorescence imaging into routine practice. The period of fluorescence imaging saw a 27% increase in the number of wounds seen, yet annual antimicrobial dressing expenditure decreased by 33%. Implementation of fluorescence imaging was also associated with a 49% decrease in prescription of antimicrobial dressings, a 33% decrease in antibiotic prescriptions, and a 23% increase in wound healing rates within 12-weeks (48% vs. 39%), likely due to earlier bacterial detection and improved wound hygiene. This increased healing rate is projected to decrease annual wound costs by 10% (£762 per patient). Routine bacterial imaging appears to diminish clinical and economic burden to patients and the NHS.

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Utility of MolecuLight i:X for Managing Bacterial Burden in Pediatric Burns

Journal of Burn Care & Research ◽

10.1093/jbcr/irz167 ◽

2019 ◽

Cited By ~ 1

Author(s):

Nawras Farhan ◽

Steven Jeffery

Keyword(s):

Fluorescence Imaging ◽

Clinical Signs ◽

Diagnostic Algorithm ◽

Signs And Symptoms ◽

Bacterial Burden ◽

Burn Wound ◽

Imaging Device ◽

Burn Wounds ◽

Clinical Signs And Symptoms ◽

Clinically Significant

Abstract Pediatric burn injuries are vulnerable to severe complications, most often infection, making prompt and precise diagnosis of bacterial bioburden vital to preventing detrimental consequences and optimizing patients’ outcomes. Currently, burn wounds are assessed for infection via examining the clinical signs and symptoms of infection, which can be confirmed by swab culture analysis. While the former approach is subjective and experience-dependant, the latter technique is susceptible to missing subsurface, biofilm-associated colonization, and any peripheral bacterial burden, and also delays confirmation by up to 5 days. The MolecuLight i:X is a handheld, noncontact fluorescence imaging device, which can reveal real-time information about clinically significant levels of bacteria and their biodistribution in surface and subsurface burn wound tissues. We conducted a single-center observational study to assess the device efficacy in identifying critical bacterial levels in pediatric burn wounds and to test the children’s compliance and the overall feasibility of the device integration into the current diagnostic practice. Ten patients with 16 wounds were recruited and assessed for the presence or absence of clinical signs and symptoms of infection and the presence or absence of bacterial fluorescence on images, with swabs taken to confirm findings. Results demonstrate the device’s ability to visualize clinically significant bacterial burden and to localize distribution of pathogens. All clinicians agreed on the high compliance with the device and high feasibility of incorporating the device into routine wound assessments. The results of this study may pave the way toward including bacterial fluorescence imaging into the standard diagnostic algorithm for pediatric burn population.

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NP model of survivorship care: Lessons learned.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.26 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 26-26

Author(s):

Gretchen Dawson ◽

Stacy Wentworth

Keyword(s):

Cancer Survivors ◽

Nurse Practitioners ◽

Primary Care Providers ◽

Survivorship Care Plan ◽

Cancer Center ◽

Survivorship Care ◽

Care Providers ◽

Term Care ◽

Healthcare Needs

26 Background: The number of cancer survivors is expected to reach 20 million by 2026. As patient volumes increase, oncologists are tasked with seeing more patients, often allowing less time for survivorship-related concerns. In an effort to address this issue, nurse practitioners (NPs) are equipped to aid survivors by managing late/long-term side effects of treatment, monitor for recurrence, provide survivorship care plan (SCP), and promote overall health and wellness. Methods: When initiating a survivorship program, our community cancer center utilized survivorship nurse practitioners (SNP) to address increasing patient volumes and patients’ survivorship issues. By beginning with breast cancer survivors, we were able to meet patients prospectively at diagnosis to provide support and introduce survivorship. SNP later saw patients in designated Survivorship Clinic, after completing treatment and in long-term survivorship to address physical/psychosocial concerns, place appropriate referrals, and promote overall wellness. Collaboration with local Primary Care Providers (PCP) was integral for the long-term care of survivors. Results: In 9 months, prospective data collection surveys helped to better understand patients’ needs, allocation of appropriate resources, and measure patient empowerment. Collaboration with EMR team helped address patient volumes and workflow. Future collaboration of survivors’ healthcare needs with PCP was done by routing 162 completed SCPs to patient-designated PCP and mailing over 185 survivorship program introduction letters to community PCPs. Conclusions: Meeting patients prospectively aided in promoting the importance of survivorship helped provide evaluation of our survivorship program’s growth and development. However, patients introduced to survivorship at diagnosis required a formal referral at the completion of treatment, which disrupted workflow. Collaborating with EMR team to develop survivorship referrals, survivorship clinic templates, and SCP reports were important. Continued work with PCPs will be integral to future success. NPs provide survivorship-focused care in the oncology setting, while meeting continued demands of a growing cancer survivorship patient population.

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Diagnostic Accuracy of Point-of-Care Fluorescence Imaging for the Detection of Bacterial Burden in Wounds: Results from the 350-Patient Fluorescence Imaging Assessment and Guidance Trial

Advances in Wound Care ◽

10.1089/wound.2020.1272 ◽

2020 ◽

Cited By ~ 2

Author(s):

Lam Le ◽

Marc Baer ◽

Patrick Briggs ◽

Neal Bullock ◽

Windy Cole ◽

...

Keyword(s):

Diagnostic Accuracy ◽

Fluorescence Imaging ◽

Point Of Care ◽

Bacterial Burden

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The Impact of Nurse Practitioners on Hospitalizations and Discharges from Long-term Nursing Facilities: A Systematic Review

Healthcare ◽

10.3390/healthcare8020114 ◽

2020 ◽

Vol 8 (2) ◽

pp. 114 ◽

Cited By ~ 2

Author(s):

Michael Mileski ◽

Upwinder Pannu ◽

Bobbi Payne ◽

Erica Sterling ◽

Rebecca McClay

Keyword(s):

Nurse Practitioners ◽

Hospital Readmissions ◽

Primary Care Providers ◽

Scope Of Practice ◽

Nursing Facilities ◽

Care Providers ◽

Term Care ◽

Skilled Nursing ◽

The Impact

The objective of this study was to increase the understanding of the role a nurse practitioner (NP) has in reducing the risk of hospitalizations and improving quality outcomes among nursing facility residents. This was explored by the research team conducting a systematic literature review via Cumulative Index of Nursing and Allied Health Literature, PubMed (MEDLINE), and Academic Search Ultimate. This is of concern because of the increased rate of hospital readmissions from skilled nursing facilities. The study found that utilization of NPs as primary care providers resulted in decreased unnecessary hospitalizations, increased access to healthcare, and improved health outcomes. NPs are fundamental in building relationships with residents and families and providing them information for decision making. The utilization of NPs in a long-term care setting should be encouraged to improve access to care, decrease hospitalizations, and enhance quality of care. States with reduced or restrictive scope of practice for NPs should revisit the regulations to provide unrestricted scope of practice for NPs.

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Use of a bacterial fluorescence imaging system to target wound debridement and accelerate healing: a pilot study

Journal of Wound Care ◽

10.12968/jowc.2020.29.sup7.s44 ◽

2020 ◽

Vol 29 (Sup7) ◽

pp. S44-S52 ◽

Cited By ~ 1

Author(s):

Windy Cole ◽

Stacey Coe

Keyword(s):

Wound Healing ◽

Fluorescence Imaging ◽

Imaging System ◽

Wound Care ◽

Point Of Care ◽

Bacterial Load ◽

Case Series ◽

Wound Area ◽

Wound Debridement ◽

Wound Bed Preparation

Objective: Optimal wound-bed preparation consists of regular debridement to remove devitalised tissues, reduce bacterial load, and to establish an environment that promotes healing. However, lack of diagnostic information at point-of-care limits effectiveness of debridement. Method: This observational case series investigated use of point-of-care fluorescence imaging to detect bacteria (loads >104CFU/g) and guide wound bed preparation. Lower extremity hard-to-heal wounds were imaged over a 12-week period for bacterial fluorescence and wound area. Results: A total of 11 wounds were included in the study. Bacterial fluorescence was present in 10 wounds and persisted, on average, for 3.7 weeks over the course of the study. The presence of red or cyan fluorescent signatures from bacteria correlated with an average increase in wound area of 6.5% per week, indicating stalled or delayed wound healing. Fluorescence imaging information assisted in determining the location and extent of wound debridement, and the selection of dressings and/or antimicrobials. Elimination of bacterial fluorescence signature with targeted debridement and other treatments correlated with an average reduction in wound area of 27.7% per week (p<0.05), indicative of a healing trajectory. Conclusion: These results demonstrate that use of fluorescence imaging as part of routine wound care enhances assessment and treatment selection, thus facilitating improved wound healing.

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Uncovering the high prevalence of bacterial burden in surgical site wounds with point‐of‐care fluorescence imaging

International Wound Journal ◽

10.1111/iwj.13737 ◽

2021 ◽

Author(s):

Kylie Sandy‐Hodgetts ◽

Charles A. Andersen ◽

Omar Al‐Jalodi ◽

Laura Serena ◽

Christina Teimouri ◽

...

Keyword(s):

Fluorescence Imaging ◽

Point Of Care ◽

Bacterial Burden ◽

High Prevalence

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Relationship Between Type of Treatment and Degree of Wound Healing Among Institutionalized Geriatric Patients With Stage II Pressure Ulcers

Care Management Journals ◽

10.1891/cmaj.2004.5.4.213 ◽

2004 ◽

Vol 5 (4) ◽

pp. 213-218 ◽

Cited By ~ 11

Author(s):

Diane J. Yastrub

Keyword(s):

Wound Healing ◽

Geriatric Patients ◽

Pressure Ulcers ◽

Small Sample ◽

Stage Ii ◽

Polymeric Membrane ◽

Care Providers ◽

Term Care ◽

Convenience Sample ◽

Significant Difference

The prevention and treatment of pressure ulcers has always been of paramount concern to geriatric health care providers. The purpose of this study was to examine the relationship between two types of treatments and the degree of wound healing among status postcerebral vascular accident (CVA) institutionalized geriatric patients with stage II pressure ulcers. Wound dressings were evaluated according to the National Pressure Advisory Panels Pressure Ulcer Scale for Healing (NPUAP, 1997). Fifty long-term care residents were recruited for the study in Queens, New York. A convenience sample was randomly assigned to either of the treatment protocols: polymeric membrane dressing (polymem) or the antibiotic ointment and dry clean dressing (DCD). The findings from the study revealed a significant difference in wound healing scores in the polymeric membrane-dressing group. These findings are limited due to the small sample size and they cannot be generalized to other populations. As this is an initial study, further research is recommended.

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