How to take a wound swab13.07.2020
Taking a wound swab
Jun 19, †Ј Dip swab in transport media included in swab container or moisten with sterile saline (do not use tap water) (Figures ). Rotate the swab over the area to be swabbed using a zig zag motion, ensuring you make contact with the area of the wound showing signs of infection . Preparation of the wound Before taking a wound swab, gently cleanse wound with water, either by irrigating or using sterile gauze. Do not use an antimicrobial cleansing solution as this may result in a false negative result Cleansing the wound prior to swabbing: Reduce contamination of swab .
A wound swab is required if there is a clinical suspicion that infection is present. If a discharge is present from the wound the following should be recorded:. Wound swabs should be collected and sent to the laboratory in a timely way for culture and sensitivity testing. Indications include infected surgical wounds, for example perineum, umbilicus, and invasive device insertion site e. Infected chicken pox pustules would also meet the definition of a wound.
Once the swab has been obtained it should be placed in a plastic specimen bag together with the laboratory form in line with local policies and procedures. Specimens should be sent to the laboratory as soon as possible and should not be left for long periods at ambient temperatures as this may how to relocate to alaska in overgrowth of commensal bacteria, which can impact on the accuracy of the laboratory result.
If transport to the laboratory will be how to make alchol at home the specimen should be refrigerated not in a food fridge until the next available laboratory collection. Note: this procedure requires an aseptic technique to avoid contamination of the swab or wound, which could lead to incorrect laboratory analysis due to contamination of equipment or the specimen.
It comprises dead leucocytes, which are produced by the body in response to the presence of infection. Large wounds may include chronic wounds. In the maternity setting chronic wounds may include pressure ulcers or diabetic foot wounds.
Large wounds may include areas of debridement for example following breakdown of a caesarean section wound or burns. Swabs should only be taken if the presence of infection is suspected. If a sample of the wound is required, a tissue biopsy rather a wound swab is the preferred microbiological sample.
Taking a wound swab. If a discharge is present from the wound the how to take a wound swab should be recorded: Colour Smell Consistency Presence of pus. The midwife should: Correctly complete the laboratory request form. Gain patient consent to take the specimen and inform the patient of the rationale for it. Ensure the patient is comfortable, and their privacy and dignity is maintained. Collect the specimen in a way that avoids contamination Ч see Chapter 5 Asepsis and sepsis.
Use the correct transport medium. Arrange transportation to the laboratory in a timely way or store appropriately if necessary.
Check and act on results once they are available. Document collection of the specimen and the results together with any resulting actions. Storing specimens Once the swab has been obtained it should be placed in a plastic specimen bag together with the laboratory form in line with local policies and procedures. The swabbing procedure Note: this procedure requires an aseptic technique to avoid contamination of the swab or wound, which could lead to incorrect laboratory analysis due to contamination of equipment or the specimen.
Positively identify the patient. Ensure all necessary equipment is available including correct swab how to crochet around corners laboratory form. Explain the procedure to the patient. Obtain patient consent. Obtain the swab before antibiotics are commenced wherever possible.
Perform hand hygiene before patient contact. Remove old wound dressing if present how to hook up a gfci outlet use personal protective equipment PPE Ч gloves and apron if required. Dip swab in transport media included in swab container or moisten with sterile saline do not use tap water Figures Rotate the swab over the area to be swabbed using a zig zag motion, ensuring you make contact with the area of the wound showing signs of infection Figure If a wound sinus is suspected or present do not probe the tract as exploration of the sinus should only be undertaken with a dedicated sinus probe.
Swabbing of the sinus, if requested, should be undertaken by or with the support of tissue viability or surgical specialists. If pus is present swab pus. Replace swab in the container Figure Redress wound if necessary. Remove PPE and perform hand hygiene. Make the woman comfortable. Complete patient identification labels and send to laboratory. Document in patient records. Swabbing large wounds Large wounds may include chronic wounds.
Remove any slough and necrotic tissue if easily dislodged. Swab viable wound tissue only do not take swabs from necrotic areas on the edge of the wound or from areas showing signs of infection. For complex wounds the expertise of tissue viability specialists should be sought.
Only gold members can continue reading. Log In or Register to continue. You may also need Infection prevention and control Use of a vaginal speculum and taking a vaginal swab Specimen collection Ч stool specimen Care of the perineum in labour including episiotomy and suturing Transfusion of blood and blood products Care of the deceased Wound assessment Supporting and caring for women in labour. Tags: Midwifery Skills at a Glance.
Fastest Nurse Insight Engine
Nov 26, †Ј This video takes a student through the correct techniques for taking a wound swab. The video was produced by Enrolled Nuring Staff and Students at the Tasman. 2. The following are appropriate situations in which to take a quantitative wound swab: a. When an acute or chronic wound exhibits signs of spreading or systemic infection (see: УDefinitions of acterial urden in Chronic WoundsФ) b. When a chronic wound fails to respond to or is deteriorating despite topical antimicrobial treatment c. When to collect a wound swab Х Wounds should only be cultured when signs and symptoms of a deep infection are present Х If an open wound or broken skin Цswabs can be taken from the infected area ХIf a closed wound or abscess present Цpus in syringe is preferable to a swab.
Initially, quizzes are posted out with journals and GPs are invited to submit their answers for CME credits. Register or Log in to take part in quizzes. Don't have an account? Register to use all the features of this website, including selecting clinical areas of interest, taking part in quizzes and much more.
This item is 7 years and 10 months old; some content may no longer be current. Identifying and managing infection in wounds is an important aspect of primary care practice. However, many issues relating to the aetiology of infection and the sampling of wounds remain controversial, with limited expert consensus. Most wound infection is diagnosed clinically, with laboratory testing used to provide further information to guide management.
It is only necessary to swab a wound if there are clinical signs of infection and the wound is deteriorating, increasing in size or failing to heal. Swabbing a wound that is not infected results in the unnecessary identification and analysis of organisms which are colonising the wound, rather than causing an infection. A wound is defined as any injury that damages the skin and therefore compromises its protective function. An acute wound is generally caused by external damage to the skin, including abrasions, minor cuts, lacerations, puncture wounds, bites, burns heat, cold, friction, chemical and surgical incisions.
A wound is defined as being chronic if it has failed to heal i. The aim of good wound care is to promote healing, prevent infection and ideally to achieve a good cosmetic result for the patient. The focus of this article is on identifying wound infection and interpreting the results of microbiological analysis of a wound swab.
Wounds heal by either primary closure, as in the case of a clean, fresh wound, with well-approximated edges which are sutured together, or by contraction and epithelialisation, such as for a wound left open due to loss of skin or contamination. A delay in healing can be caused by a number of factors, both local related to the wound itself and systemic related to the patient and their clinical condition.
Many of these factors not only delay healing but increase the likelihood of infection developing in the wound. All open skin wounds are colonised by bacteria, however, this does not mean that all wounds are infected. Inflammation occurs in all wounds during healing, regardless of whether they are infected, and a certain level of swelling, erythema and increased warmth at the site is normal and should not be confused with clinical infection.
When skin is broken, its protective defence mechanisms are impaired, and the environment becomes more conducive for bacteria, which increase in number. These bacteria come from three main sources; the environment e. Wound infection can be classified on a spectrum of five progressively more severe stages: 1, 5. Colonisation occurs when the bacteria begin replicating and adhere to the wound site, but do not cause tissue damage.
The healing process of the wound is not delayed by colonisation alone, and in some cases, colonisation can enhance the healing process. Local infection or critical colonisation occurs when the number of bacteria is greatly increased and begins to overwhelm the host immune system. The wound does not heal, but tissue invasion has not yet occurred. During this stage, the granulation bed in the wound appears unhealthy, e.
Delayed healing may be the only clinical sign. Signs and symptoms of infection occur, such as erythema, pain and purulent discharge. Septicaemia occurs when the infection spreads throughout the body via the blood stream and causes systemic symptoms such as fever, chills and tachycardia.
Specific wound features or patient factors greatly increase the risk of infection or other complications. Referral for hospital assessment should be considered if a patient presents with high risk features, such as: 7, 8, 9.
There should be a lower threshold for both referral and treatment in patients with co-morbidities such as diabetes or vascular disease, or if psychosocial factors are present that may increase the risk of infection, e.
Tetanus immunisation status should be established in all patients who present with a wound, and vaccination given where necessary. Several factors determine the progression of a wound from contamination to infection, including the bacterial load, the types of bacteria present and their synergistic action and virulence. If the wound does not heal, over time it will be colonised by different pathogenic species.
The polymicrobial populations then interact synergistically, making it difficult to isolate a particular causative organism for a wound infection. Biofilms are communities of bacteria, embedded in an extracellular polysaccharide matrix.
A biofilm forms when bacteria attach to a wound and form a micro-colony over time. Bacteria within a biofilm are physically protected from the host environment and can communicate with each other quorum sensing. This leads to bacteria changing their phenotypes, resulting in increased virulence and greater likelihood of causing infection. The biofilm becomes an impediment to the healing of chronic wounds, and bacteria in a biofilm are 50 Ч times more resistant to conventional antimicrobial treatment than unattached bacteria.
Microbiological assessment can be important in the management of infected wounds. Information on the microbiological species present in the wound is useful for determining antibiotic choice and predicting response to treatment. However, these results are only significant if interpreted in the context of a wound that is infected, as non-pathogenic, colonising bacteria will also be detected.
A wound should only be swabbed if there are clinical signs of infection and the wound is deteriorating, increasing in size or failing to heal. The classic clinical signs of infection in an acute wound include: Signs of spread of a localised wound infection include extension of erythema and development of cellulitis , abscess formation, lymphangitis, crepitus in the soft tissues and breakdown or dehiscence splitting open of the wound.
In people with diabetes or with other conditions where perfusion and immune response are diminished, classical clinical signs of infection are not always present, 9 so the threshold for suspecting infection should be lower. In addition, the classical clinical signs of infection in acute wounds may not always be obvious in patients with chronic wounds, and more subtle signs of infection can help indicate whether a chronic wound is infected.
In primary care, a swab is the most common method used for sampling a wound. If the wound is not purulent it should be cleaned prior to swabbing. Wounds should be washed with sterile saline and then superficially debrided with a cotton, alginate or rayon-tipped swab. Once the sample has been collected it should be labelled with the patient identification details, date and time of the sample and wound site. On the request form record relevant clinical information such as the site and type of wound, the indication for taking a swab and any medication that the patient is taking that may affect the result, e.
It is also important to make it clear on the request form that the sample is from a wound rather than a superficial skin lesion this will alert the laboratory to select the appropriate culture media. The sample should be transported as quickly as possible to the laboratory; ideally it should be processed within 48 hours. The swab should be stored at room temperature if same-day processing is not possible. Immediate treatment with empiric antibiotics is usually necessary for patients with acute wounds, where the risk of infection and complications is increased, e.
Depending on the patient and clinical circumstances, a wound swab may still be required in addition to empiric antibiotics and the antibiotic choice altered if necessary once the results become available.
In some situations, antibiotics should not be prescribed to a patient with a suspected infected wound until the results of the laboratory assessment are available so that the appropriate antibiotic can be prescribed, e.
Most laboratories will provide information on the bacteria cultured from a wound swab, the number of organisms grown either quantitatively or semi-quantitatively , and the antibiotic susceptibility of the grown organisms, which should guide treatment.
Approximately half of all infections in soft-tissue, community-acquired wounds are polymicrobial, and approximately one-quarter of infections in these type of wounds are caused by Staphylococcus aureu s. The presence of an organism in an infected wound does not necessarily mean that it has caused the infection, and in practice it is not possible to differentiate between pathogenic and non-pathogenic organisms.
Superficial burns do not usually become infected, unless other systemic factors are present. When infection does occur, the most commonly reported microbes from a burn wound in the days immediately following the injury are S. Later, Gram-negative organisms such as Pseudomonas aeruginosa or coliforms, e.
Bite wounds often contain more exotic flora, reflecting the source of the bite. Staphylococcus spp , Peptostreptococcus spp and Bacteroides spp are the most common microorganisms in wounds from human and animal bites. However, when infection does occur, antibiotic-resistant organisms, such as methicillin resistant Staphylococcus aureus MRSA and vancomycin resistant enterococci, are more commonly encountered, reflecting hospital-acquired flora. Diabetic foot infections are frequently associated with S.
However, the clinical significance of the type of microorganism present is reduced if there are limited signs of infection, which is common in people with infected diabetic ulcers. Deeper penetrating wounds are associated with a wider range of bacteria, representing the increased likelihood of foreign bodies in the wound.
Referral is often necessary for exploration of the wound if it fails to heal. There is some debate as to whether the type of bacteria or the overall density of the bacteria affects healing rates more significantly. It is likely that both factors play a role, however, the more widespread opinion is that organism type has the greater effect on wound healing.
It is thought that aerobic or facultative pathogens in particular, such as S. Laboratories may provide either a quantitative or semi-quantitative result for bacterial load. A quantitative result gives the estimated number of organisms per gram of tissue or per mm 3. Organism load above per gram of tissue or per mm 3 is considered significant, and is likely to reduce healing times significantly.
Susceptibility testing is performed for all of the potential pathogens isolated from the swab. This may not always be the case, e. When an organism is reported as resistant to a particular antibiotic it is important to assess the clinical response, if treatment has already commenced, with consideration given to changing the antibiotic if necessary.
In slower-developing infections or wounds that have failed to resolve over time, antibiotic choice should be directed by the relevant susceptibilities provided by the laboratory analysis. If empiric antibiotic treatment is prescribed, i. Susceptibility differs by geographical area, as well as in different rest homes or long-term care facilities, e. MRSA is more common in some locations. For information on nationwide susceptibilities and resistance, see: www.
In addition to antibiotic treatment, wound cleansing, surgical debridement and correct dressing is essential to reduce the microbial load, and likelihood of infection. Its frequent use led to increased bacterial resistance to mupirocin, and as a result, mupirocin became a prescription-only medicine.
Mupirocin remains active against some MRSA strains and as such, it is recommended that it should be reserved for use only when susceptibility testing shows MRSA to be present. If signs of infection are not reduced 48 Ч 72 hours after initiation of antibiotic treatment for an acute wound, a swab should be taken to reassess the wound flora and relevant susceptibilities.
If a wound fails to heal within four to six weeks following treatment, particularly if antibiotics were used, discussion with a wound specialist is recommended.
In some cases, a non-healing wound may raise the suspicion of malignancy and this should be investigated. Chronic wounds can degenerate into malignancy, and conversely a malignancy may present as, or be mistaken for, a chronic wound. Primary malignancy should be considered in a patient with an ulcer which has developed over a relatively short time.
A pearly, shiny nodule with prominent capillary networks is also common. A basal cell carcinoma may also present as an eczema-like patch.