title: Assessing bacterial burden in wounds: comparing clinical observation and wound swabs.
abstract: A randomised controlled trial (RCT) was conducted to compare the efficacy of nanocrystalline silver and cadexomer iodine dressings in healing chronic lower leg ulcers. The relationships between wound swab culture results and nurses' clinical assessments of critical colonisation, and between bacterial burden and healing rate, were also examined. There were 281 individuals with leg ulcers recruited. The bacterial burden of wounds was assessed using semi-quantitative wound swabs collected at baseline and intervals during the study. The study found no relationship between the nurses' clinical assessments and bacterial burden as identified from wound swabs in the wounds. A significant difference in wound healing was found with the use of nanocrystalline silver as compared to cadexomer iodine in the first 2 weeks of treatment when nil or low levels of leukocytes, gram positive bacilli, gram positive cocci or gram negative cocci were reported. This study has raised a number of questions regarding the need for further investigation into methods of assessing wound bacterial burden as well as the impact of wound biofilms on wound assessment and treatment.
authors.affiliation: Royal District Nursing Service, Helen Macpherson Smith Institute of Community Health, Melbourne, Victoria, Australia. cmiller@rdns.com.au
authors.forename: Charne Nicole
authors.initials: CN
authors.lastname: Miller
authors.forename: Keryln
authors.initials: K
authors.lastname: Carville
authors.forename: Nelly
authors.initials: N
authors.lastname: Newall
authors.forename: Suzanne
authors.initials: S
authors.lastname: Kapp
authors.forename: Gill
authors.initials: G
authors.lastname: Lewin
authors.forename: Leila
authors.initials: L
authors.lastname: Karimi
authors.forename: Nick
authors.initials: N
authors.lastname: Santamaria
mesh_terms: D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local / Q000008:administration & dosage; D001419:Bacteria / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000188:drug therapy / Q000382:microbiology*; D001458:Bandages; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018030:Silver Compounds; D014647:Varicose Ulcer / Q000188:drug therapy / Q000382:microbiology*; D014945:Wound Healing / Q000502:physiology*
chemical_list: D000891:Anti-Infective Agents, Local; D018030:Silver Compounds