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Arch Phys Med Rehabil. 2009 Oct;90(10):1723-6. doi: 10.1016/j.apmr.2009.04.009.

Is the use of low-pressure pulsatile lavage for pressure ulcer management associated with environmental contamination with Acinetobacter baumannii?

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  • 1Spinal Cord Injury/Disorders Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA. chester.ho@va.gov

Abstract

Ho CH, Johnson T, Miklacic J, Donskey CJ. Is the use of low-pressure pulsatile lavage for pressure ulcer management associated with environmental contamination with Acinetobacter baumannii?

OBJECTIVE:

To determine the extent of environmental contamination associated with low-pressure pulsatile lavage of stage III or IV pressure ulcers in patients with spinal cord injury (SCI) when routine infection control precautions are used for wounds colonized or infected with Acinetobacter baumannii.

DESIGN:

Prospective investigation in which pressure ulcer cultures and environmental cultures were obtained before and after low-pressure pulsatile lavage treatment, and before and after regular dressing changes. Environmental cultures included the patient's bedrail and settle plates placed 0.6, 1.5, and 2.4m from the wound to assess airborne spread of A. baumannii.

SETTING:

SCI inpatient unit in a Department of Veterans Affairs Medical Center.

PARTICIPANTS:

Inpatients (N=15) with SCI receiving daily low-pressure pulsatile lavage treatment for stage III or IV pressure ulcers with standard dressing change, as well as regular dressing changes without low-pressure pulsatile lavage at other times of the day.

INTERVENTIONS:

Standard, regular dressing changes and dressing changes with low-pressure pulsatile lavage.

MAIN OUTCOME MEASURES:

Comparison of frequency of environmental contamination with A. baumannii associated with low-pressure pulsatile lavage versus regular dressing changes.

RESULTS:

Of the 15 SCI inpatients meeting inclusion criteria, 9 (60%) grew A. baumannii from their wounds. Of the 9 patients with wound cultures positive for A. baumannii, only 1 (11%) had environmental contamination with this organism after performance of low-pressure pulsatile lavage, and the same patient had environmental contamination after a standard dressing change. The antibiotic susceptibility patterns of the wound and environmental A. baumannii isolates were identical.

CONCLUSIONS:

Low-pressure pulsatile lavage using the infection control methods described is not associated with an increased rate of environmental contamination of A. baumannii in comparison with standard dressing changes.

PMID:
19801062
[PubMed - indexed for MEDLINE]
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