Download Sensitivity and Specificity of NERDS and STONEES for the

F R E E
P A P E R S
BY David Haligowski, BSc, MD AND Anne LeMesurier, RN, BScN, IIWCC
which can be ever-present in a
some conditions may reach
Sensitivity and Specificity
Wound Infection:
of NERDS and STONEES
A Nursing Perspective
wound. When bacterial counts
critical levels and progress to
for the Diagnosis of
Presenter: Hiromi Sanada
reach >106 CFU/g of tissue, or
covert or overt infection.
Increased Bacterial Burden
Lack of typical clinical signs of
when there is a tissue presence
The study examined the heal-
in Chronic Wounds
infection may be one reason for a
of beta hemolytic Streptococci,
ing rate associated with the use
Speaker: Kevin Woo
delay in diagnosis of infection in
the equilibrium favours bacteria,
of two commonly used antimi-
The diagnosis of infection in a
chronic wounds. Because of this
and infection can occur.
crobial dressings (cadexomer
chronic wound is best confirmed
difficulty, thermography and ultra-
Treatment of chronic wounds
iodine and nanocrystalline silver)
and supported by documenting
sonography were used to improve
attempts to restore the equilibri-
in the treatment of infected
clinical signs and symptoms.
earlier diagnosis of infection.
um, favouring health. Guidelines
leg ulcers. Delayed healing (no
Sibbald et al. developed the
Once infection was diagnosed,
for the treatment of chronic
improvement two weeks after
mnemonic NERDS and STONEES
the wound was cleansed with
wounds with evidence of infec-
optimal treatment) is the most
to help assess levels of bacterial
saline, and the peri-wound skin
tion were published in Wound
common sign seen with critical
damage in chronic wounds.
was washed with a cleanser or
Repair and Regeneration in
colonization. New slough or
NERDS stands for: non-healing,
normal saline. Healing of the ulcers
December 2006. These guide-
wound breakdown is the second
tissue,
was better with the peri-wound
lines recommend quantitative
most frequent sign seen with
debris (discoloration) and smell.
cleanser, with a hazard ratio of 1.79.
swabs or tissue biopsy if a wound
critically colonized infection. This
STONEES stands for: size increas-
The wound clinic also looked
is not progressing as expected.
study confirmed that changes
ing, temperature elevation, os
at Quorum sensing to assess the
If >106 CFU/g are found on
in wound characteristics could
(probes to bone), new break-
biofilm in wounds inoculated
culture, the guidelines recom-
be used as clinical predictors
down, erythema/edema, exudate
with Pseudomonas aeruginosa.
mend topical antibacterials be
for determining the presence
and smell. The signs identified
Quorum sensing is the communi-
applied. If deeper infection,
of covert infection in chronic
in NERDS are suggestive of super-
cation between bacteria using
such as cellulitis, is found, then
leg ulcers. Statistical analysis
exudate,
red
friable
ficial wound infection that can be
signaling molecules that can lead
systemic antibiotics, covering
revealed a significant association
treated topically. The signs associ-
to increased bacterial virulence.
gram-positive bacteria, should
between Staphylococcus on swab
ated with STONEES could be
The investigators found that
be used.
culture and malodorous or painful
treated with antibiotics systemi-
Quorum sensing could be detected
cally. Finding three clinical signs
in the inoculated group, but not
Predicting Covert and Overt
increased the specificity of NERDS
in the control group. At the same
Infection in Leg Ulcers:
wounds with increased exudate.
to 80.5 per cent and STONEES to
time, wound swabs measuring
A Randomized Controlled Trial
69.4 per cent. Similarly the sensi-
bacterial counts did not correlate
Speaker: Kerlyn Carville
tivities improved to 73.3 per cent
with critical colonization.
and 90 per cent, respectively. It is
This trial examined the clinical
characteristics of wounds and
the hope that if these mnemonics
Wound Infection:
associated wound-swab results
were used in our practices when
A Medical Perspective
to determine the effectiveness of
assessing for infection, we would
Presenter: Martin Robson
topical antimicrobial dressings for
diagnose infection earlier and
Health is a balance or equilibrium
the treatment of wound infection.
reduce the inappropriate use of
between the factors of host resist-
Chronic leg ulcers are colonized
systemic antibiotics.
ance and a myriad of bacteria,
by micro-organisms, which under
For more free papers, please visit the CAWC web site at www.cawc.net.
26
Wo u n d C a re C a n a d a
Vo l u m e 6 , N u m b e r 2 , 2 0 0 8