Is the Use of Low-Pressure Pulsatile Lavage for Pressure Ulcer Management Associated With Environmental Contamination With Acinetobacter baumannii?

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.

Key Words: Hydrotherapy, Infection control, Irrigation, Pressure ulcer, Rehabilitation, Spinal cord injuries

List of Abbreviations: psi, pounds per square inch, SCI, spinal cord injury