title: Wound swab use and misuse at a regional general hospital.
abstract: OBJECTIVE
  Guidelines for swab use at our centre cover lower-limb wounds, ulcers and postoperative wound infections but not all types of wound. The objective of this study was to assess current practices in wound management at Mater Dei Hospital and to identify areas for improvement.
  
  
  METHODS
  Wound swabs received at the microbiology department between February and April 2013 from adult inpatients departments were included. Wound swabs from the ophthalmology and paediatric departments were excluded. Patient comorbidities, detailed wound descriptions, acknowledgement of and documentation of culture and sensitivity results, and antibiotic changes during treatment were collected. Indictors of infection including white cell counts (WCCs) and C-reactive protein (CRP) were recorded.
  
  
  RESULTS
  The study included 134 patients. Diabetes mellitus (61.9%, n=83) was the most common underlying comorbidity. Postoperative wounds were the most common type of wounds swabbed (34.3%). The wound swab characteristics were not fully documented in 27 patients (20.1%). The CRP results were not recorded in 39.6% and WCCs were not taken in 10.4% of patients. Wound swab results were not acknowledged in the medical notes of 76% of cases.
  
  
  CONCLUSIONS
  Wound swabs that were not indicated, lack of documentation and untimely acknowledgement of results were evident. This suggests that a significant proportion of wound swabs may not have been justified and had no impact on wound management. Our study clearly underlines the need for a more comprehensive guideline.
  
  
  BACKGROUND
  There was no sponsorship of this study. The authors have no conflict of interest to declare.
authors.affiliation: Higher Specialist Trainee.
authors.forename: M
authors.initials: M
authors.lastname: Fenech
authors.forename: R
authors.initials: R
authors.lastname: Abela
authors.forename: S
authors.initials: S
authors.lastname: Chetcuti Zammit
authors.forename: L
authors.initials: L
authors.lastname: Mercieca
authors.forename: J
authors.initials: J
authors.lastname: Gauci
authors.forename: N
authors.initials: N
authors.lastname: Edwards
authors.forename: E
authors.initials: E
authors.lastname: Carachi
authors.forename: M
authors.initials: M
authors.lastname: Mifsud
authors.forename: T
authors.initials: T
authors.lastname: Piscopo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001431:Bacteriological Techniques / Q000379:methods*; D005260:Female; D006769:Hospitals, General / Q000458:organization & administration; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008485:Medical Audit; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D013048:Specimen Handling / Q000379:methods*; D013530:Surgical Wound Infection / Q000382:microbiology* / Q000517:prevention & control*; D014945:Wound Healing
keywords: antibiotics; documentation; guidelines; resources; wound swab form; wound swabs