Bacterial Contamination Control with Sodium Hypochlorite and Jet Lavage Irrigation in a Severe Stage 4 Pelvic Pressure Injury: A Case Report

• Published in: Advances in skin & wound care Vol. 37; no. 5; p. 271
• Main Author: Stiehl, James B
• Format: Journal Article
• Language: English
• Published: United States 01.05.2024
• Subjects: Aged; Debridement - methods; Humans; Male; Pressure Ulcer - microbiology; Pressure Ulcer - therapy; Sodium Hypochlorite - administration & dosage; Sodium Hypochlorite - pharmacology; Sodium Hypochlorite - therapeutic use; Therapeutic Irrigation - methods; Treatment Outcome
• ISSN: 1538-8654
• DOI: 10.1097/ASW.0000000000000136

This case report reviews the effect of combining a 250-cc bottle of standard antimicrobial, buffered sodium hypochlorite with a surgical method, low-pressure jet lavage irrigation in the outpatient setting to control difficult wound contamination. A 73-year-old man had been in treatment for over 8 years, undergoing at least 18 surgical wound debridement procedures for an extensive undermined pelvic pressure injury involving the sacrum, ischium, and greater trochanter. Cultures and polymerase chain reaction diagnostics revealed a multibacterial presence. Autofluorescent imaging (AFI) was used in 21 examinations performed after a 72-hour delay over a long weekend. The AFI contamination exceeded log 4 colony-forming units/g of tissue in all pretreatment examinations and was reduced to less than log 2 colony-forming units in 6 of 21 examinations, with the remaining 15 showing an estimated 80% or higher removal of the bacterial porphyrin "red" appearance. A total of 54 AFI examinations were performed using the combination treatment, and no adverse reactions were encountered. Treatment paradigms can be improved with a multifactorial approach.