Dr.T.V.Rao MD   1
Why Wound Swabs are            Important in Patient Care            Wound Swabs are one of the Important            Specim...
Events in Infected                    WoundsDr.T.V.Rao MD           3
Obtaining a Specimen            Methods of obtaining a specimen from            a wound include wound swabbing,           ...
Wound Culture Protocols            Soft skin and tissue infections with open or draining            lesions (Appearance of...
What are guideline to                          Follow for            The technique usually employed            transferrin...
Swabs should be collected                 with Suspected Infection            Swabs should            therefore be        ...
Are there are Standard Protocol           in Collection of Specimens            It should be noted that the best technique...
Cleaning the contaminating               materials is a priority      Before a representative      sample is collected, an...
Appropriate Specimen is                      Important                                Do not                              ...
Collecting the Optimal                  Specimen                           Sterile swabs with cotton or                   ...
Basic care in Collecting             the Specimen            Care should be            taken to ensure            that the...
Care in When Collecting the                      Swabs            1.Cleanse wound by removing excess debris from          ...
Practical Approach to                Collections of Swabs                               The swab should be                ...
Bigger Wounds Needs                   Multiple Specimens            A representative area of the            wound should b...
Devices and Collection of               SwabsDr.T.V.Rao MD     16
Collecting the Swabs            Open sterile culture collection/transport kit containing            Amies or Stuarts trans...
Steps in Collection in                          Specimen            Cleanse intact skin with antiseptic and allow to dry. ...
Transport the Swabs                     Promptly                              Immediately                              fol...
Label and Promptly                    Transport            Label culture            collection/transport            kit wi...
Swabs should be Transported               without delay            Swabs must be transferred to the laboratory            ...
Appropriate Culturing Yields               Precise Results            Apply sufficient            pressure to cause       ...
Clinicians should Support                 with Information            Any supporting documentation for the            labo...
Microbiological and Clinical        Correlation is the Best Option Antibiotic susceptibilities of anyorganisms present in ...
Limitation of Swab                    Techniques            To examine the diagnostic validity of swab            techniqu...
Programme Created By Dr.T.V.Rao MD                    for Medical and Paramedical                Professionals in the Deve...
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Wound Swabs basics

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Wound Swabs basics

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Wound Swabs basics

  1. 1. Dr.T.V.Rao MD 1
  2. 2. Why Wound Swabs are Important in Patient Care Wound Swabs are one of the Important Specimens sent to Microbiology Departments for Bacteriological and Fungal isolation and Antimicrobiologial Evaluation. However many basic lacuna in Collection, Laboratory identification and reporting makes the Deficit in Effective care of the Patients and increases the potentials for Morbidity and MortalityDr.T.V.Rao MD 2
  3. 3. Events in Infected WoundsDr.T.V.Rao MD 3
  4. 4. Obtaining a Specimen Methods of obtaining a specimen from a wound include wound swabbing, needle aspiration and wound tissue biopsy. Although wound swabbing is the most practical and widely used, it is important to use a technique that produces reliable samples for microbiological analysis.Dr.T.V.Rao MD 4
  5. 5. Wound Culture Protocols Soft skin and tissue infections with open or draining lesions (Appearance of) insect/spider bite with necrotizing centre, drainage & erythema • Abscess - ulcer • Infected laceration ⇒ Culture wound prior to initiation of antibiotics if signs or symptoms of infection are present. If Culture & Sensitivity is obtained after antibiotics have been started, list the drug on the laboratory C& S request.Dr.T.V.Rao MD 5
  6. 6. What are guideline to Follow for The technique usually employed transferring clinical samples from wounds to microbiology laboratories is the wound swab; however definitive guidelines for this relatively simple procedure have yet to be established. Uncertainty about when swabs should be taken, the correct collection procedure and the appropriate protocols for submitting swabs for investigation have led to a situation where clinicians regularly collect and process unsuitable sampleDr.T.V.Rao MD 6
  7. 7. Swabs should be collected with Suspected Infection Swabs should therefore be collected only when clinical criteria point to a wound infection and before any antimicrobial interventions have been initiatedDr.T.V.Rao MD 7
  8. 8. Are there are Standard Protocol in Collection of Specimens It should be noted that the best technique for swabbing wounds has not been identified and validated. The following recommendations can be used as a guide and should be used in conjunction with local protocols: When a swab is indicated, the patient should be given a concise explanation of the need for microbiological investigation and what the procedure involves, for example, that swabs are mainly used to recover species from the surface layers rather than from the deep tissues of a wound.Dr.T.V.Rao MD 8
  9. 9. Cleaning the contaminating materials is a priority Before a representative sample is collected, any contaminating materials such as slough, necrotic tissue, dried exudate and dressing residue should be removed by cleansing the wound with tap water, sterile saline or debridementDr.T.V.Rao MD 9
  10. 10. Appropriate Specimen is Important Do not culture purulent or necrotic debris or drainage over hard eschar.Dr.T.V.Rao MD 10
  11. 11. Collecting the Optimal Specimen Sterile swabs with cotton or rayon tips are usually used. If the wound is moist a swab can be used straight from the packaging - if the wound is dry, then the swab tip should be moistened with sterile saline to increase the chances of recovering organisms from the site . Swabs with a transport medium that incorporates charcoal enhance the survival of fastidious organismsDr.T.V.Rao MD 11
  12. 12. Basic care in Collecting the Specimen Care should be taken to ensure that the swab only comes into contact with the wound surface.Dr.T.V.Rao MD 12
  13. 13. Care in When Collecting the Swabs 1.Cleanse wound by removing excess debris from wound base with normal saline 2. Thoroughly flush wound with sterile saline. 3. Gently blot excess saline from wound bed with sterile gauze. 4. Remove soiled gloves; apply hand sanitizer. 5. Apply clean glovesDr.T.V.Rao MD 13
  14. 14. Practical Approach to Collections of Swabs The swab should be moved across the wound surface in a zigzag motion , at the same time as being rotated between the fingers . Downward pressure to release fluid from the wound surface has been advocated, but this may be painful for theDr.T.V.Rao MD 14 patient.
  15. 15. Bigger Wounds Needs Multiple Specimens A representative area of the wound should be sampled. If the wound is large, it may not be feasible to cover the entire surface, but at least 1cm² should be sampled and material from both the wound bed and wound margin should be collected. If pus is present, the clinician should ensure that a sample is sent to the laboratory.Dr.T.V.Rao MD 15
  16. 16. Devices and Collection of SwabsDr.T.V.Rao MD 16
  17. 17. Collecting the Swabs Open sterile culture collection/transport kit containing Amies or Stuarts transport medium and remove swab. If wound is dry, moisten tip of swab with transport fluid at the bottom of the transport sleeve or sterile preservative-free saline (pink saline fish or saline bullet). If wound is moist (weepy) after cleaning, this might not be necessary. Without touching swab to surrounding wound edges or skin, rotate tip of swab over a 1cm area of open wound for 5 seconds (preferred method), or rotate the swab while making a zigzag pattern across the wound at 10 pointsDr.T.V.Rao MD 17
  18. 18. Steps in Collection in Specimen Cleanse intact skin with antiseptic and allow to dry. Expel all air from a 10mL syringe with a 22 gauge needle prior to aspiration. Insert needle into intact skin and apply suction (aspirate). Aspirate approximately 0.5mL of wound fluid. Label syringe (see Swab Culture, above). . After labelling syringe, place in lab biohazard transport bag and transport to the LaboratoryDr.T.V.Rao MD 18
  19. 19. Transport the Swabs Promptly Immediately following collection, the swab should be returned to its container (placed into the transport medium) and accurately labelledDr.T.V.Rao MD 19
  20. 20. Label and Promptly Transport Label culture collection/transport kit with name, birth date, specimen source, date and time of culture. Place in lab biohazard transport containerDr.T.V.Rao MD 20
  21. 21. Swabs should be Transported without delay Swabs must be transferred to the laboratory as quickly as possible and ideally processed within four hours of collection The laboratory report should list the potential pathogens isolated and the amount of growth observed. The antibiotic susceptibilities of any organisms present in the wound may be included, but whether the isolates are of pathogenic and relevant to the Clinical Details furnishedDr.T.V.Rao MD 21
  22. 22. Appropriate Culturing Yields Precise Results Apply sufficient pressure to cause tissue fluid to be expressed. It is the bacteria in the tissue fluid that is desired for culture.Dr.T.V.Rao MD 22
  23. 23. Clinicians should Support with Information Any supporting documentation for the laboratory should immediately be completed and a note included in the patients records. It is important to provide information to the laboratory staff that will aid their use of the standard operating protocol, such as any underlying co-morbidities, the patients age, on-going treatment and wound locationDr.T.V.Rao MD 23
  24. 24. Microbiological and Clinical Correlation is the Best Option Antibiotic susceptibilities of anyorganisms present in the wound may beincluded, but whether the isolates are ofclinical significance or whether antibiotictherapy is required is a matter of clinicaljudgement. Spreading cellulitis andclinical infections will require systemicantibiotics.Dr.T.V.Rao MD 24
  25. 25. Limitation of Swab Techniques To examine the diagnostic validity of swab techniques, analyses of the accuracy as compared to tissue cultures in identifying microbial load provide insight into the utility of swab techniques used for this purpose. The accuracy of swab specimens based on Levines technique was significantly higher than those based on Z-technique and approached significance when compared to swabs based on wound exudatesDr.T.V.Rao MD 25
  26. 26. Programme Created By Dr.T.V.Rao MD for Medical and Paramedical Professionals in the Developing World Email doctortvrao@gmail.comDr.T.V.Rao MD 26
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