Diagnostics · 2021
Guidelines for Point-of-Care Fluorescence Imaging for Detection of Wound Bacterial Burden Based on Delphi Consensus
Oropallo, A.R., Andersen, C., Abdo, R., Hurlow, J., Kelso, M., Melin, M., & Serena, T.E.
Diagnostics (MDPI), Vol 11, 1219 (Guidelines)
In brief
This consensus paper used a two-round Delphi process with a multidisciplinary panel of 32 wound care experts, all experienced with point-of-care fluorescence imaging for bacteria, to produce guidelines on its use. The panel set out the training competencies needed, a clinical workflow, and the patient history, signs of infection and procedures (such as debridement, skin substitute application and wound sampling) that may warrant imaging. It recommends that imaging be performed no more than weekly unless medically indicated, and the authors state the guidelines are meant to standardize use of the technology among wound care providers.
Co-authored by Dr. Thomas Serena of the SerenaGroup Research Foundation.
Plain-language summary by SerenaGroup. See the full text for complete methods and results.
Abstract
Excessive levels of bacteria impede wound healing and can lead to infectious complications. Unfortunately, clinical signs and symptoms of elevated bacterial burden are often unreliable. As a result, point–of–care fluorescence imaging, used to detect critical bacterial burden in wounds, is becoming widely recognized and adopted by clinicians across the globe as an accepted and added component of wound assessment protocol. A Delphi method was employed to establish consensus guidelines describing fluorescence imaging use. A multidisciplinary panel of 32 wound experts (56% MD, 22% podiatrist, 12.5% nurses/nurse practitioners) representing multiple sites of service (e.g., hospital outpatient, inpatient, private office, long-term care) completed two rounds of online questionnaires. The Delphi included key topics, including competencies required to perform imaging, clinical indications for imaging (e.g., signs/symptoms present, procedures warranting imaging), frequency of imaging, and a clinical workflow algorithm. Describing their clinical experiences of imaging impact, >80% reported changes in treatment plans, 96% reported that imaging-informed treatment plans led to improved wound healing, 78% reported reduced rates of amputations, and 83% reported reduced rates of microbiological sampling. The guidelines provided here will help to standardize use of fluorescence imaging among wound care providers and enhance the quality of patient care.
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