Transcript

Kara S. Couch, MS, CRNP, CWCN-AP, FAAWC:

Hello everyone. My name is Kara Couch. I am a nurse practitioner, and I'm also the director of Wound Care Services at the George Washington University Hospital in Washington, DC. Additionally, I hold a role as an Associate Research Professor of Surgery at the School of Medicine and Health Sciences at George Washington University. 

I think the easiest thing is being aware of the concept of wound hygiene, that we truly have to scrub these wounds with soap and water, if you're at home, that's what you have. If you're in a healthcare environment or even home health agencies, they can sometimes get antiseptics to the home as well. But certainly if you're in a clinic or a hospital or acute care setting, you should be using antiseptic agents, which help to reduce the bacteria on the surface of the wound and get the wound into a healable state where it's not trending towards any sort of overt or covert infection that can turn into sepsis and lead to broad spectrum antibiotic use. 

Well, there are some antiseptics that are available broadly where you can get them over the counter. You can get them in pharmacies such as Walgreens or CVS. You can buy products on Amazon. But just knowing that you need to select something that is gentle enough that it's not going to harm the normal skin or the normal flora that you need, but also has enough cidal activity that it's going to treat the bacteria that you're trying to reduce. So, there's plenty on the market that are broad spectrum enough that can meet those needs. And then, as I said, if the patient is at home simply using soap and water to scrub the area, certainly also in more austere environments where people have lower resources that that certainly works quite well to help disrupt any sort of microbial colonies. 

Oh, I see things all the time. My number 1 pet peeve is ordering wound cultures that don't have the ability to be or are not properly obtained, meaning the wound was not debrided first, and therefore, you are swabbing the contaminants on the surface of the wound, which leads to an inability to narrow down the pathogen that you're actually trying to treat and can lead to overuse of broad spectrum antibiotics. So for example, I don't allow for wound cultures to be taken in the home, because they don't have the ability to appropriately debride the wound and get rid of the slough and get to the tissue underneath, because what you want is what lies underneath, not what's on the surface there. Some other things that I think can also lead to antibiotic resistance is what I call overdosing patients on common antimicrobials, such as Keflex and Silvadene, when the wounds were not infected at all, and they didn't need that. Rather, there was an underappreciation of the fact that the patient had dependent rubor, and that's what was causing their erythema. So for the most part, chronic wounds, Keflex just doesn't simply treat them. It's not strong enough, so you might as well be giving patients Tic Tacs at that point. Those are just three common things that I see all the time. 

They have to understand that bugs are smarter than we are, and we are rapidly running out of our tools and weapons to treat the bugs. And if we don't continue to be more careful with our choices and obtaining, again, appropriate cultures to give pathogen-directed antibiotics to, then we're going to run into real trouble. We can't just keep dosing people with antibiotics without understanding what it is that we're trying to treat. That is a huge issue, and I would really love people to understand that we do have the tools available to get the correct information as far as what bacteria is actually causing the problem, and that we must treat it very specifically so we don't keep having this issue with a broad overuse and then having antibiotic resistance and a whole host of antimicrobial resistant organisms. 

Actually, yes, I would like to add that this is something that needs to be taught in all levels of healthcare, from medical nursing, physical therapy students, people who are working with nutrition. Everybody needs to have an understanding of this because wound care touches every specialty, and it's incumbent upon us to get this very basic yet incredibly important information widely disseminated.