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Obtaining a Wound Culture

Wound Culture Test Overview

A wound culture is a test to find germs (such as bacteria or a fungus) that can cause an infection. A sample of skin, tissue, or fluid is added to a substance that promotes the growth of germs. If no germs grow, the culture is negative. If germs that can cause an infection grow, the culture is positive. The type of germ may be identified with a microscope or chemical tests. Sometimes other tests are done to find the right medicine for treating the infection. This is called sensitivity testing.

Most bacteria can grow in oxygen. They are called aerobic bacteria and usually are found in wounds close to the skin surface (superficial). Bacteria that cannot grow in the presence of oxygen (anaerobic) usually are found in deeper wounds and abscesses. A wound culture can find out whether bacteria are aerobic or anaerobic.

A fungal culture is done to find out if an infection is caused by a fungus. A viral culture can be done to find out whether an infection is caused by a virus.



Goal:
Identify organisms colonized within a wound so that antibiotics sensitive to the microorganisms can be prescribed, as needed.
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Procedure:

1. Identify the patient using two separate identifiers.
2. Close door or bed curtains and explain the procedure to the patient, if possible.
3. Verify order for culture noting site and type of culture. Label the specimen container and make sure the information includes the patient’s name, medical record number, date and time specimen is obtained, and site of the culture.
4. Perform hand hygiene and don gloves.
5. Remove soiled dressing. Observe drainage for amount, odor, and color.
6. Clear and remove exudate from around wound and cleanse with normal saline.
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Obtaining Aerobic Culture

1. Perform steps 1 through 6 above.
2. Using sterile swab from culture tube, insert swab deep into area of active drainage. Rotate swab to absorb as much drainage as possible.
3. Insert swab into culture tube, taking care not to touch the top or outside of the tube.
4. Crush ampule of medium and close container securely.
5. Continue with step 4 below.



Obtaining Anaerobic Culture

1. Perform steps 1 through 6 at beginning of procedure.
2. Using sterile swab from special anaerobic culture tube, insert swab deeply into draining body cavity.
3. a. Rotate swab gently and remove. Quickly place swab into inner tube of collection container.
b. Alternative method: Insert tip of syringe with needle removed into wound and aspirate 1 to 5 mL of exudate. Attach 21-gauge needle to syringe, expel all air, and inject exudate into inner tube of the culture container.
4. Send specimens in the pre-labeled containers with appropriate requisition immediately to the laboratory. Some agencies require that specimens be transported in clean plastic bags to further prevent transfer of microorganisms.
5. Clean and apply sterile dressings to the wound, as ordered.
6. Remove and discard gloves. Perform hand hygiene.
7. Document all relevant information on the patient’s chart. Include the location the specimen was taken from and the date and time. Record the wound’s appearance and the color, odor, amount, and consistency of drainage. Record
how the patient tolerated the procedure and any discomfort that he or she experienced.

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Wood’s Light Examination

Wood’s Light Examination

The Wood’s Light Examination is a useful and inexpensive tool in clinical practice. It is powered by alternating or direct current that converts ultraviolet light into visible light, and it usually has an accompanying magnification lens. It provides a simple diagnostic method in the evaluation of
● Many dermatological problems
Fluorescein-staining evaluation of eye injuries



OVERVIEW
● Most common dermatological lesions that fluoresce are listed on the table below.
● Detection of chemicals applied to the skin. Affected areas are a different color from that of the surrounding skin.
● Prior cleansing of the area to be examined causes false-negative result.
● Certain skin lesions do not fluoresce.
● Systemic antibiotic therapy, such as with tetracyclines, can cause fluorescence in some lesions.
● Cosmetics present on the skin interfere with fluorescence.
● Detection of eye injuries with fluorescein. When applied to the eye, fluorescein has a higher concentration of uptake in areas in which there has been disruption of the cornea or sclera. Under a Wood’s light, the injured area fluoresces as a bright yellow-green.
● Detection of porphyrins in the urine. These appear bright red.
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Fluorescence of Lesions and Parasites With the Wood’s Light

LESION FLUORESCENCE
Erythrasma
Corynebacterium minutissimum Varying shades of pink to coral red
Tinea Capitis (Three Varieties)
Microsporum audouinii Brilliant green
M. canis Brilliant green
Trichophyton schoenleinii Pale green
Tinea Versicolor Yellow to deep green
Pseudomonas aeruginosa Blue green to green
Pigmentation Alterations
Albinism Cold bright white
Ash-leaf spot of tuberous sclerosis Blue-white
Depigmentation Cold bright white
Hypopigmentation Blue-white
Hyperpigmentation Purple-brown
Leprosy Blue-white
Vitiligo Blue-white
Squamous cell carcinoma* Bright red
Common Parasitic Infestations
Scabies Magnification of track and/or mite
Pediculosis (capitis, corporis, pubis) Visualization of louse

* The diagnosis of this dermatological disorder should be made by pathological assessment.

RATIONALE
● Skin—To allow the clinician to differentiate dermatological presentation of types of bacterial, fungal, and pigmented lesions found on the skin
● Eye—To allow the visual assessment of injuries to the cornea and conjunctiva with fluorescein staining
● Urine—To screen for porphyria—a rare metabolic disorder
● Clinical evaluation of dermatitis, the eye, or urine by the unaided eye alone may result in an inappropriate assessment and render an unsuccessful treatment regimen.



INDICATIONS
● Skin or hair lesions
● Corneal abrasion
● Suspicion of porphyria

CONTRAINDICATIONS
● None

PROCEDURE
Wood’s Light—Skin
Equipment
● Wood’s light
● Darkened room

Procedure
● Have the client position himself or herself comfortably.
● Explain to the client that the Wood’s light has the same characteristics as a typical black light; the room will be darkened, and the black light will be turned on to examine for fluorescence of the lesion in question.
● Have all lights turned off.
● Hold the Wood’s light approximately 6 to 8 inches from the lesion in question, and observe the characteristics of the fluorescence of the lesion.



BIBLIOGRAPHY
Driscoll C, Bope ET. The Family Practice Desk Reference. 4th ed. St. Louis, MO: Mosby; 2002.
Habif T. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. 5th ed. St. Louis, MO: Mosby; 2011.
Murtagh J. Practice Tips. 5th ed. New York, NY: McGraw-Hill; 2008.
Pfenninger JL, Fowler GC. Procedures for Primary Care Physicians. St. Louis, MO: Mosby; 2011.

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