Response to “ABCDEFGHI Systemic Approach to Wound Assessment and Management”

I believe a correction is needed to the article “ABCDEFGHI Systemic Approach to Wound Assessment and Management,” published in the July 2022 issue of Advances in Skin & Wound Care and the March 2023 edition of Nursing2023. In Table 4, “RECOMMENDED EXAMINATION AND INVESTIGATION OF WOUNDS,” in the graphic box under the heading Cultures, the authors recommend obtaining wound cultures with every dressing change. That is not the standard of care recommended by wound care associations. Some dressings are changed daily, and daily wound cultures do not make sense. Open wounds will always come back with some level of infection and frequent wound cultures will result in the overuse of antibiotics. A positive culture obliges the physician to treat. Cultures should only be done immediately following debridement of the wound to get a true culture of the wound bed and not the slough and biofilm on top. Wounds do not need systemic treatment unless the surrounding tissue shows signs of infection: red, hot, swollen. Otherwise, treat infection locally if there is a concern. There are many nonmedicated dressings that inhibit biofilm on the market and you do not need a culture to use them. —Tamara Kuhn, RN-BC, AMB, WCC Community Memorial Hospital, Camarillo, CA IN RESPONSE: We thank the reader for promoting further discussion surrounding the appropriate use of wound cultures. It is correct that a wound culture does not need to be completed with every dressing change if the wound appears to be healing appropriately, or if the frequency of dressing changes makes collecting a wound culture sample unrealistic. However, a wound that does not appear to be healing, even if it does not display the cardinal signs of infection that you have specified, may require collection of a repeat wound culture with dressing changes. For example, a wound that is simply not progressing as expected, or the presence of unhealthy granulation tissue, may indicate the presence of infection. Further, although the presence of a biofilm contributing to a non-healing wound may not be detected by wound culture, it is still prudent to perform a wound culture to rule out any other microorganisms that may have contributed to the nonhealing wound. This is especially true when we consider that wounds may be colonized by antibiotic-resistant microorganisms, or may be colonized by multiple microorganisms, some of which may not have been identified on wound culture previously. As physicians, these repeat wound cultures are helpful in guiding use of antibiotics to ensure that the patient is covered appropriately to allow for wound healing. We agree with the reviewer that perhaps our article should have stated that wound cultures could be ordered with dressing changes to ensure adequate infection control. — Sarah Hunt, MD, MSc — Sanjay Azad, MD, MS, FRCS (Ed) Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.