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CHAPTER 32 Skin Integrity & Wound Healing
b. Do not swab culture areas where slough or eschar is present. Areas of avascular or necrotic tissue are considered contaminated. c. Do not roll the swab in exuda- tive material. Pus is a collection of white blood cells that have already done their work as well as other wound debris. The cul- ture specimen must be wound tissue or wound fluid, not surface fluid or exudate. d. Do not swab multiple sites with the same culturette. Use more than one culturette if several areas need to be cultured.
on the type of wound and type of organism). Break the liquid capsule at the bottom of the culture tube. Be sure the culture medium sur- rounds the swab. 13.Label the tube with patient’s name, patient identifier, birthdate, source of specimen, and date and time of collection. 14. Apply a clean wound dressing if needed. 15.Arrange for the specimen to be immediately transported to the laboratory. What if . . . ■ I see another nursing student performing a Z stroke method of wound culture swab? Consult your nursing instructor regarding the need to recollect the specimen using the Levine technique. Since Levine technique is more accurate than the Z stroke method, it should be used to determine the type and number of bacteria in the wound (Angel et al., 2011; Copeland-Halperin, Kaminsky, Bluefield, & Miraliakbari, 2016).
■ I determined this wound requires sterile technique? After removal of soiled dressing, apply sterile gloves for irrigating, obtaining cul- ture, and applying new sterile dressing. Sterile technique is used for acute surgical wounds and for wounds that have under- gone recent sharp debridement, or when the healthcare provider prescribes it. ■ The culture tube is not sent to the laboratory within 72 hours? If the culture swab is not sent to the laboratory within 48 to 72 hours, it must be discarded. Be sure to check the policy within your institution. The swab culture needs to be exposed to ideal laboratory conditions to allow micro- bial growth. If the culture sits on the unit too long, the culture medium might not pro- duce reliable results. Most swab transport systems are validated for 48 to 72 hours after collection. However, if bacteria are sus- pected, the quicker the specimen is sent to the laboratory, the better. ■ The wound care and culture supplies are kept on a common treatment cart? Common treatment carts should be left in the hall and not taken into indi- vidual rooms. When a mobile cart is rolled into a room, it is a source for possible cross-contamination.
12. Carefully reinsert the swab back into the culturette tube (aero- bic or anaerobic culture, depending
Evaluation ■ Assess the patient’s pain level. Medicate as prescribed. ■ Monitor laboratory reports for results of the swab culture. Documentation Document the following information (some agencies use a wound/skin flow sheet): ■ Appearance and location of the wound and surrounding tissue. Note type, consistency and amount of exudate, and odor, if present, after irrigation. ■ Patient’s pain level before you obtained the culture. ■ If the patient has been medicated for pain, document the drug and dose used, time given, and patient response. ■ Method by which the wound was cleansed before you obtained the swab culture.
■ Description of the area where the culture was obtained. ■ Dressing reapplied to wound, if applicable. ■ Education provided to the patient. Practice Resources Angel et al. (2011,April); Baranoski & Ayello (2020); Copeland-Halperin et al. (2016); Gabriel & Schraga (2021,August 27, updated); Haalboom et al. (2018); Levine et al. (1976); Non & Kosmin (2021, May 21, updated); Stallard (2018).
Thinking About the Procedure
The video Obtaining a Wound by Swab, along with questions and suggested responses, is available on the Davis’s Nursing Skills Videos Web site on FADavis.com.
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