Fluorescence imaging positively predicts bacterial presence and guides wound cleaning and patient education in a series of pilonidal sinus patients
•Wound care following surgical removal of a pilonidal sinus is challenging due to proximity to the anus and the warm, moist, dark environment where bacteria can thrive.
•Two of the most common challenges in post excision pilonidal sinus wound care are: (1) unrecognized superficial critical bacterial colonization and (2) inadequate personal skin cleansing (secondary contamination), which can lead to infection and delay healing.
•Detecting bacterial presence based on clinical signs and symptoms is difficult as bacteria are invisible to the naked eye. To address this problem, fluorescence imaging has recently been used to visualize pathogenic bacteria, which fluoresce red in real-time at the bedside using a non-contact hand-held device.
•Herein, we report the positive predictive value (PPV) of this device and its use to: (1) detect and monitor the presence of bacteria in pilonidal sinus patients and (2) guide clinician and patient wound cleaning regimes.
Pilonidal sinus patients (n=5) were imaged pre- and post wound cleaning during routine wound care to monitor the presence of bacteria, guide wound cleaning, and educate patients on home care cleaning practices.
Pilonidal sinus wounds that fluoresced red (4 of 5 patients) were considered positive for bacteria and received additional cleaning.
•Real-time fluorescence imaging positively predicts the presence of potentially harmful bacteria in wounds at clinically significant levels, irrespective of sampling method or of microbiological analysis technique.
•In the series of pilonidal sinus patients, fluorescence images guided the extent and location of clinician cleaning and prompted an instance of early suture removal.
•Visualizing bacteria, which the patient otherwise could not have seen, provided enhanced awareness of their infection risk.
•Bright and simple colours (green = tissue, red = bacteria) on fluorescence images made it easy for patients to understand when and where bacteria was present. An improvement in patient adherence was observed.
•Results highlight the potential of this imaging device to guide clinician treatment in cases where bacterial contamination could impede wound healing and to improve patient understanding and adherence
to home cleaning and hygiene protocols.