Preclinical evaluation of a commercially available biofilm disrupting wound lavage for musculoskeletal trauma.

BACKGROUND: Treatment of open fractures remains a significant challenge in trauma care as these fractures are accompanied by extensive soft tissue damage, exposing the wound site to contaminants and increasing infection risk. Formation of biofilm, a capsule-like environment that acts as a barrier to treatment, is a primary mode by which infecting pathogens persist at the wound site. Therefore, a pressing need exists to identify irrigation methods that can disrupt biofilm and expose pathogens to treatment. This study aims to evaluate the antibiofilm wound lavage, Bactisure™, in comparison with saline for care of severe musculoskeletal wounds and elucidate potential effects on antibiotic treatment success. METHODS: UAMS-1 Staphylococcus aureus biofilms were formed in vitro and treated with Bactisure™ wound lavage or sterile normal saline, alone, or in combination with sub-biofilm inhibitory levels of vancomycin. Characterization methods included quantification of biofilm biomass, quantification of viable biofilm bacteria, and biofilm matrix imaging. For in vivo assessment, a delayed treatment model of contaminated open fracture was used wherein a critical-sized defect was created in a rat femur and wound site inoculated with UAMS-1. Following a 6 h delay, wounds were debrided, irrigated with lavage of interest, and antibiotic treatments administered. Bacterial enumeration was performed on bone and hardware samples after two weeks. RESULTS: An immediate reduction in biofilm biomass was observed in vitro following antibiofilm lavage treatment, with a subsequent 2- to 3- log reduction in viable bacteria achieved after 24 h. Furthermore, biofilms treated with antibiofilm lavage in combination with vancomycin exhibited a minor, but statistically significant, decrease in viable bacteria compared to irrigation alone. In vivo, a minor, not statistically significant, decrease in median bioburden was observed for the antibiofilm lavage compared to saline when used in combination with antibiotics. However, the percentage of bone and hardware samples with detectable bacteria was reduced from 50 to 38%. CONCLUSIONS: These results suggest that the antibiofilm wound lavage, Bactisure™, may hold promise in mitigating infection in contaminated musculoskeletal wounds and warrants further investigation. Here, we proposed multiple mechanisms in vitro by which this antibiofilm lavage may help mitigate infection, and demonstrate this treatment slightly outperforms saline in controlling bioburden in vivo.

The jornalero: perceptions of health care resources of immigrant day laborers.

Latino immigrant day laborers, also termed jornaleros or contingent workers, compose a significant segment of the millions of undocumented, temporary workers in our urban centers. These laborers largely work without benefit of health insurance in occupations that are unmonitored, unprotected, and often unsafe. This study utilized semi-structured interviews to explore the perceived health status and resources for health care in one group of 20 Latino day laborers in southern California. Results suggest a population that is largely in undocumented immigrant status with few health care resources other than emergency care centers and clinics provided for the homeless population. With close to 12 million undocumented workers currently residing in the US, this population bears additional scrutiny both for humanitarian reasons and for public health policy considerations.

Use of alternative folk medicine by Mexican American women.

Nontraditional health care resources available to Mexican Americans are many. The Mexican culture is rich with alternative health and illness beliefs and remedies which have their origins in ancient Mestizo/Indian folklore which viewed the causes of illness to include social, spiritual, and physical forces. This perception calls for culturally relevant folk practitioners who can treat all aspects of the perceived illness. This study of 70-Mexican American women explored their knowledge of and use of alternative Mexican folk medical practitioners in their own health maintenance. Results provided some evidence that, even among highly assimilated Mexican American women, there persist traditional, indigenous beliefs, and practices.

On growing old in America: perceptions of the Okinawan war bride.

The unique perceptions of aging of Okinawan war brides are presented through interviews with 15 subjects. They voiced their thoughts about a range of topics, including available support systems, effects of acculturation, and their sense of security as they approach old age. Pride in culture and fears of lost family connections are expressed as these women speculate about the demands of aging in America.