Abstract
BackgroundThe purpose of this study was to assess the level of air contamination with bacteria after surgical hydrodebridement and to determine the effectiveness of hydro surgery on bacterial reduction of a simulated infected wound.MethodsFour porcine samples were scored then infected with a broth culture containing a variety of organisms and incubated at 37°C for 24 hours. The infected samples were then debrided with the hydro surgery tool (Versajet, Smith and Nephew, Largo, Florida, USA). Samples were taken for microbiology, histology and scanning electron microscopy pre-infection, post infection and post debridement. Air bacterial contamination was evaluated before, during and after debridement by using active and passive methods; for active sampling the SAS-Super 90 air sampler was used, for passive sampling settle plates were located at set distances around the clinic room.ResultsThere was no statistically significant reduction in bacterial contamination of the porcine samples post hydrodebridement. Analysis of the passive sampling showed a significant (p < 0.001) increase in microbial counts post hydrodebridement. Levels ranging from 950 colony forming units per meter cubed (CFUs/m3) to 16780 CFUs/m3 were observed with active sampling of the air whilst using hydro surgery equipment compared with a basal count of 582 CFUs/m3. During removal of the wound dressing, a significant increase was observed relative to basal counts (p < 0.05). Microbial load of the air samples was still significantly raised 1 hour post-therapy.ConclusionThe results suggest a significant increase in bacterial air contamination both by active sampling and passive sampling. We believe that action might be taken to mitigate fallout in the settings in which this technique is used.
Highlights
The purpose of this study was to assess the level of air contamination with bacteria after surgical hydrodebridement and to determine the effectiveness of hydro surgery on bacterial reduction of a simulated infected wound
By removing necrotic tissue and reducing the bacterial load on the wound surface, wound debridement may assist in healing [4,5]
Bacterial counts obtained from specimens before and after Versajet treatment showed no significant difference
Summary
The purpose of this study was to assess the level of air contamination with bacteria after surgical hydrodebridement and to determine the effectiveness of hydro surgery on bacterial reduction of a simulated infected wound. Surgical ( known as sharp) debridement using a scalpel or a biopsy is considered the optimal method for rapidly cleaning the ulcer and converting it to an acute wound; it can be painful and not all practitioners are trained or permitted to perform such procedures. Other mechanical forms of "sharp" debridement include pulsed lavage, ultrasound disruption of debris, and high-pressure water jet dissection of the wound surface [7]. These alternative techniques may possibly serve to reduce biofilm prevalence and local bacterial burden thereby stimulating the repair process. They may be better able to debride superficial slough than traditional biopsy or scalpels. Unaware of prior reports that have evaluated the potential for aerosolization of particulates, namely bacteria, into the peri-operative environment whist using these modalities
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