Prevention of Contamination During Pulsatile Lavage Irrigation (printer-friendly)

and Introduction Abstract Pulsatile lavage is a high-pressure irrigation treatment commonly used in the debridement of wounds. The risk of exposure to bloodborne pathogens and contaminants using high-pressure irrigation has been well documented in the literature. Projectile droplets and aerosolized fine droplets may form and spread, potentially contaminating the treatment facility and infecting personnel. A new device (Wound Irrigation Bag©, Pulse Care Medical LLC, North Andover, Mass) has been designed to decrease the dissemination of projectile and aerosolized particles. The wound irrigation bag (WIB) uses containment to decrease the amount of projectile and aerosolized pathogens spread during pulsatile lavage. This randomized prospective trial demonstrated that the WIB significantly decreased the amount of bacterial colony forming units disseminated during pulsatile lavage of infected wounds compared to standard wound irrigation techniques. The WIB is a useful new tool in the armamentarium of wound care that protects the debridement facility and the personnel who operate it by significantly reducing the dissemination of infectious particles.Pulsatile lavage is a high-pressure irrigation treatment commonly used in the debridement of wounds. The risk of exposure to bloodborne pathogens and contaminants using high-pressure irrigation has been well documented in the literature. Projectile droplets and aerosolized fine droplets may form and spread, potentially contaminating the treatment facility and infecting personnel. A new device (Wound Irrigation Bag©, Pulse Care Medical LLC, North Andover, Mass) has been designed to decrease the dissemination of projectile and aerosolized particles. The wound irrigation bag (WIB) uses containment to decrease the amount of projectile and aerosolized pathogens spread during pulsatile lavage. This randomized prospective trial demonstrated that the WIB significantly decreased the amount of bacterial colony forming units disseminated during pulsatile lavage of infected wounds compared to standard wound irrigation techniques. The WIB is a useful new tool in the armamentarium of wound care that protects the debridement facility and the personnel who operate it by significantly reducing the dissemination of infectious particles. Introduction Pulsatile lavage is a high-pressure wound irrigation system commonly used in operating rooms and wound care facilities. The system consists of a battery-powered device which delivers a pressurized sterile crystalloid solution to the wound bed at usually no greater than 15 psi. The device administers a fluid stream to the wound surface and has a built-in suction tube that concurrently removes the fluid as it is dispensed. A small circular shield is attached to the nozzle of the device, which serves to decrease gross splash when placed in contact with the wound bed. Tubing connects the device to a sterile irrigation fluid bag and a suction pump with a collection canister. Proper technique requires close proximity of the device's suction tip with the wound bed at all times during irrigation. This can be difficult to achieve when used on wounds with irregular contours. For example, sacral decubitis ulcers present a challenge with their jagged irregular surfaces. Often the vacuum seal is broken leading to splashing and contamination from fluid droplets. The risk of exposure to bloodborne pathogens for surgical personnel is well established in the literature.[1,2] The risk of percutaneous injury and contact via mucous membranes, conjunctiva, or non-intact skin has also been described.[3-6] High pressure irrigation is associated with a particularly high incidence of contamination from fluid dispersing around the wound.[4] Facial contamination of personnel resulting from droplets during pulse lavage irrigation has also been reported.[7] Adequate barrier protection during the course of the pulsatile lavage is important in decreasing the risk of human immunodeficiency virus (HIV), hepatitis B virus, and multi-drug resistant bacterial exposure.[8,9] The literature describes a few innovative methods of decreasing projectile and aerosolized emissions in the operating room.[1,4,8,10] Each of these methods requires the placement of holes in a bag in order to insert the pulse lavage device and suction tubing. The authors evaluated an easy and convenient method of decreasing projectile contamination in the operating room and protecting personnel from exposure while using pulse lavage. The Wound Irrigation Bag© (Pulse Care Medical LLC, North Andover, Mass) is a sterile plastic self-sealing system, which consists of a bag with 2 compartments connected by a conduit. The irrigation compartment has a 1-way valved sleeve that permits the pulsatile lavage device to enter but restricts any fluid or splatter from leaking out. Any fluid runoff from the irrigation compartment flows by gravity through the Prevention of Projectile and Aerosol Contamination During Pulsatile Lavage Irrigation Using a Wound Irrigation Bag J. Angobaldo, MD; C. Sanger, DO; M. Marks, MD Posted: 09/23/2008; Wounds. 2008;20(6):167-170. © 2008 HMP Communications 3/1/12 7:39 AM Prevention of Contamination During Pulsatile Lavage Irrigation (printer-friendly) Page 2 of 7 http://www.medscape.com/viewarticle/579992_print conduit into the collection compartment where it is contained for disposal (Figure 1). This study compared the amount of aerosol and projectile contamination that occurs during pulse lavage with and without the WIB. No previous study has shown objective evidence of decreased operating room contamination and reduced risk of exposure to personnel performing pulse lavage.