- 1 Skin and Wound Cultures
- 2 Why It Is Done
- 3 How To Prepare
- 4 How It Is Done
- 5 How It Feels
- 6 Risks
- 7 Results
- 8 Credits
- 9 Bacterial Wound Culture
- 10 How to Culture a Wound
- 11 Local Signs and Symptoms of Wound Infection
- 12 Types of Wound Cultures
- 13 Recommended for You
- 14 Bacterial Wound Culture: Reference Range, Interpretation, Collection and Panels
- 15 Reference Range
- 16 Interpretation
- 17 Collection and Panels
- 18 Background
- 19 When and How to Perform Cultures on Chronic Wounds?
- 20 Similar articles
- 21 Wound Culture
- 22 Purpose
- 23 Preparation
- 24 Description
- 25 Results
- 26 Complications
- 27 KEY TERMS
- 28 Health care team roles
- 29 Resources
- 30 20.9 Checklist for Wound Culture – Nursing Skills
- 31 WOUND CULTURES **
Skin and Wound Cultures
A skin or wound culture is a test that is used to identify microorganisms (such as bacteria or fungus) that are capable of causing an infection to develop. It is necessary to add a sample of skin, tissue, or fluid to a material that encourages the development of germs. If no germs appear to be growing, the culture is considered negative. If microorganisms that might cause illness proliferate in the culture, the culture is considered positive. A microscope or chemical tests can be used to determine what sort of germ is present.
Sensitivity testing is the term used to describe this process.
They are referred to as aerobic bacteria, and they are typically found in wounds that are near to the skin’s surface (superficial).
An aerobic or anaerobic bacteria culture can be used to determine whether bacteria are aerobic or anaerobic.
- It is possible to do an aviral culture to determine whether an infection is caused by a virus.
- However, if E.
- Additionally, culture samples can be obtained from the ear or eye, from open or closed wounds, as well as from the nails and hair.
Why It Is Done
A skin or wound culture is performed for the following reasons:
- Locate the source of an infection in a sore, burn, surgical wound, or other type of lesion. Among the types of injuries that might occur are animal bites, human bites, sea stings or scrapes, cuts, and puncture wounds that are more prone to infection. Make judgments on the most effective therapy for an infection if one exists. This is referred to as sensitivity testing.
How To Prepare
In general, you don’t need to do anything before this test unless your doctor specifically instructs you to do so. Inform your doctor if you are currently taking or have recently taken antibiotics.
How It Is Done
For the purpose of collecting tissue or fluid samples from wounds, an inserted sterile gauze swab is used. The health care worker who is taking the sample may gently spin the swab around the area to gather as much tissue or fluid as feasible. Based on the type of organism suspected, the swab is then inserted into an aerobic culture tube, an anaerobic culture tube, or both an aerobic and anaerobic culture tubes. In order to collect fluid from a wound that has been covered (scabbed over) or from an abscess, a needle is utilized.
It is possible that your doctor will need to take a sample of skin or tissue (biopsy) for testing purposes.
The sample is placed in a container containing a material (referred to as growth media or culture medium) that aids in the development of bacteria, fungi, or viruses after it has been collected.
- A sterile swab is put into a wound in order to gather a sample of tissue or fluid from it. To gather as much tissue or fluid as possible, the health care worker collecting the sample may gently push around the area and spin the swab. According to the kind of organism suspected, the swab is then inserted into an aerobic culture tube, an anaerobic culture tube, or both an aerobic and anaerobic culture tubes. The use of a needle to collect fluid from a wound that has been covered (scabbed over) or from an abscess is common. After that, the fluid is deposited in the culture tube for further processing and analysis. Depending on the results of the tests, your doctor may recommend that you have a biopsy of your skin or tissue taken. It is possible that you will be given a shot to numb the region before the sample is collected if the collection is likely to be painful. The sample is placed in a container containing a material (referred to as growth media or culture medium) that aids in the development of bacteria, fungi, or viruses after it has been collected.
Bacteria, fungi, and viruses that develop will be recognized using a microscope, chemical testing, or a combination of the two methods. If sensitivity testing is performed to aid in the decision-making process regarding therapy, additional time will be required.
How It Feels
A sample of fluid or tissue taken from a wound may cause you to experience discomfort during the collection of the sample. If you are given an injection of anesthetic to numb the place where the culture sample will be collected, you may experience a quick, acute sting.
If a biopsy is required to obtain the sample, there is a very tiny chance of the infection spreading to other parts of the body.
Various bacteria, fungi, and viruses grow at different rates in culture, while some grow at a slower rate. Depending on the type of illness suspected, findings might take anywhere from one day to several weeks to come back.
|Normal:||No large numbers of harmful germs are found on the skin or in the wound. Normal culture results arenegative.|
|Abnormal:||Harmful germs are found on the skin or in the wound. Abnormal culture results arepositive.|
If the findings of the test are positive, sensitivity testing may be performed to aid in the decision-making process regarding therapy.
As of September 23, 2020, the information is current. Author:Healthwise StaffMedical Review: E. Gregory Thompson, MD – Internal MedicineE. Gregory Thompson, MD – Internal Medicine Dr. Adam Husney is a Family Medicine specialist. Dr. Elizabeth T. Russo specializes in Internal Medicine. As of September 23, 2020, the information is current. Written by a member of the Healthwise teamMedical Review: E. Gregory Thompson, MD, Internal Medicine Dr. Adam Husney is a Family Medicine specialist. Dr. Elizabeth T.
Bacterial Wound Culture
Sources consulted for the current review Non, L., and Kosmin, A. (in press) (2014 April 16 Updated). Culture of Bacterial Wounds. Medscape Drugs and Diseases is an online resource for medical information. Accessible online at (accessed on June 19, 2016). (Revised in June 2016) . Necrotizing Soft Tissue Infections – Infections of the Skin That Are Complicated ARUP Consult is a consulting firm. Accessible online at (accessed on June 19, 2016). E. Ben-Joseph, et al (2013 March Reviewed). Culture for Wound Drainage.
- Accessible online at (accessed on June 19, 2016).
- Bacterial Identification in Chronic Wounds: A Comparison of Culture and Molecular Identification Int J Mol Sci, vol.
- 3, pp.
- Accessible online at (accessed on June 19, 2016).
- Bacterial Culture in an Aerobic Environment Mayo Clinic is a medical center in Rochester, Minnesota.
- Accessible online at (accessed on June 19, 2016).
- Kallstrom’s et al (2014 August).
In August 2014, the Journal of Clinical Microbiology published issue number 8 (2753-2756).
Sources that have been used in previous reviews (2007, 2007).
and Pagana, Timothy J.
in Saint Louis, Missouri, pp.
Forbes, B., and colleagues (2007a).
891-903 in BaileyScott’s Diagnostic Microbiology, 12th Edition, published by Mosby Elsevier Press in St.
Tietz Clinical Guide to Laboratory Tests, Fourth Edition is a clinical guide to laboratory tests written by Tietz.
Louis, Missouri: Saunders Elsevier Publishing Company.
Thomas is the editor of this work (1997).
EMedicine’s Wound Infection page.
Infections of the Burn Wound.
Available on the internet at It was accessed on the 10th of May, 2008.
(in press) (2008 April 16, Updated).
Culturing Practices of Wound Care Professionals in the United States: Current Diagnosis of Wound Infections The journal Medscape fromWounds14(9):314-327.
An acronym for the American Academy of Orthopaedic Surgeons.
Skin and Wound Infections: A Review of the Literature AFP.
Klevens and colleagues (2007 October 17).
V 298 of the Journal of the American Medical Association (15).
Davis, K., and colleagues (2005 August).
Emerging Infectious Diseases, Centers for Disease Control and Prevention, V11 (8).
Healing Wounds, Skin Care, eMedicine Available on the internet at This page was last updated on May 18, 2008.
In this fact sheet you will find information on trauma, shock, burn, and injury as well as links to other resources.
Available on the internet at This page was last updated on May 18, 2008.
The Journal of the American Medical Association, volume 294 (16), number 2122, was published in 2005.
Eppes (Reviewed 2011 April).
TeensHealth is provided by Nemours.
Fisher, M., et al (Reviewed 2012 January).
ARUP Consult is a consulting firm.
Lipsky are co-authors of the paper (2011 February 8).
Expert Review Anti Infect Ther.
Available on the internet at the time of publication (February 2012).
(in press) (2012 February 17).
Murray, C., and Hospenthal, D.
Burn Wound Infections, according to Medscape Reference, which may be found online at The information was accessed in February 2012.
Wound Infection, according to Medscape Reference, which may be found online at The information was accessed in February 2012.
Bartlett, et al (2011 April 29).
Expert Reviews and Commentary on HIV/AIDS published on Medscape.
Pagaa, K. D., and Pagana-Jones, T. J. (2011). Pages 1052-1053 in Mosby’s Diagnostic and Laboratory Test Reference 10th Edition: Mosby Inc., Saint Louis, MO. Mosby, Inc. is a medical publishing company based in Saint Louis, Missouri.
How to Culture a Wound
Version that is easy to print Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTCI, sees it all of the time in her practice. Wound care practitioners who conduct wound cultures poorly or who get cultures just because there is an open wound are both examples of malpractice. Having said that, there are certain health care settings where, according to procedure, swab cultures are collected on every wound, regardless of whether or not there are signs and symptoms of infection. However, I want you to constantly ask yourself the following questions while deciding whether or not a culture is warranted: Infections can manifest themselves in the form of signs and symptoms.
Has wound healing come to a halt?
Local Signs and Symptoms of Wound Infection
Version that can be printed. We at Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, and CLTCI witness it on a regular basis. Wound care professionals who conduct wound cultures poorly or who get cultures just because there is an open wound are both examples of this type of behavior. Having said that, there are some health-care settings where, according to procedure, swab cultures are collected on every wound, even if there are no signs or symptoms of infection. However, I want you to constantly ask yourself the following questions while deciding whether or not a culture is necessary: Infections can manifest themselves in a number of ways.
Is the healing of your wounds slowed or stopped entirely?
- Version that can be printed Cheryl Carver, LPN, WCC, CWCA, FACCWS, DAPWCA, CLTCI, sees it all of the time. Wound care professionals who erroneously conduct wound cultures or who get cultures just because there is an open wound. Having said that, there are certain health-care settings where, according to procedure, swab cultures are obtained on every wound, even if there are no signs or symptoms of infection present. In the meanwhile, I want you to always ask yourself the following questions when deciding whether or not a culture is warranted: Is there any evidence of an infection? Is there an odor left behind after the wound has been thoroughly cleansed? Is the healing of your wounds slowed? Is it possible that there is a biofilm present?
Most Common Pathogens Found in Wounds
- Peptostreptococcus aureus, Staphylococcus aureus, Streptococcus aureus, Candida albicans, Clostridium, Enterobacter, Enterococci, Escherichia coli, Fusobacterium, Klebsiella, Peptostreptococcus aureus, Staphylococcus aureus, Streptococcus aureus, Staphylococcus au
Types of Wound Cultures
Swab culture: A swab culture is the most commonly utilized technique since it is non-invasive and the most cost-effective of the available options. This sort of culture will almost always be able to identify the bacterial species causing the infection and will aid in the selection of an appropriate antibiotic therapy. Surface swabs will only reveal the colonizing bacterium and may not reveal the presence of a more serious infection in deeper tissue. The Levine quantitative swab approach is a viable alternative to quantitative tissue culture in the following situations: The Levine Quantitative Swab Technique is comprised of the following steps:
- Normal saline should be used to clean the wound. Using sterile gauze, pat the dry wound bed
- Culture the tissue that appears to be in the best condition, omitting exudate, purulent, and devitalized tissue
- At least 5 seconds should be spent spinning the end of the sterile applicator over a 1cmx1cm area. In order to get tissue fluid to be expressed, apply adequate pressure on the swab.
Using regular saline, clean the wound. Sterilized gauze should be used to pat dry wound bed. Remove any exudate, purulent or devitalized tissue from the culture tube; culture only the healthiest-looking tissue At least 5 seconds should be spent spinning the sterile applicator’s tip over a 1cmx1cm region. By applying adequate pressure to the swab, it will cause the expression of tissue fluid;
Recommended for You
- The date is February 13th, 2020. Written by the editors of WoundSource Wounds that have become necrotic are defined by the presence of devitalized, or dead, tissue. Infection, trauma, ischemia, inflammation, or exposure to toxins can all result in necrosis. Malignancy is the most common cause of necrosis. It can also be induced by inappropriate management of a wound that has already occurred. Devitalized
- The date is May 21st, 2020. Written by Holly Hovan MSN, RN-BC, APRN, ACNS-BC, CWOCN-AP, MSN, RN-BC, APRN, ACNS-BC The new coronavirus that is responsible for the COVID-19 sickness has undoubtedly had an influence on everyone of us in some way. There are consequences to working in a hospital environment, an outpatient clinic, a doctor’s office, or a specialist workplace when you are affected by this pandemic: The deadline for submissions is January 31, 2021. Continuity of care has long been at the heart of medical practice, and it is particularly crucial in the field of wound care. Continuity of treatment in wound management is associated with improved patient outcomes, cost-effectiveness, and patient satisfaction ratings, according to research. Wound care professionals are confronted with the following challenges while delivering continuity of treatment:
Bacterial Wound Culture: Reference Range, Interpretation, Collection and Panels
On the 13th of February in the next year, Submitted by the editors at WoundSource Wounds that have become necrotic are defined by the presence of devitalized or dead tissue. Crosis may be caused by a tumor, an infection, a traumatic injury, an ischemia-induced inflammatory response, or an exposure to chemicals. It can also be induced by inappropriate management of a wound that has already been established (see below). Devitalized; 21st of May in the next calendar year. Holly Hovan contributed to this article.
Every single one of us has been affected in some way by the unique coronavirus that causes COVID-19 sickness.
Better results, cost-effectiveness, and patient satisfaction are all associated with continuity of wound care in wound treatment. It is wound care providers who are confronted with the following challenges when delivering continuity of care.
- The 13th of February, 2020 By the editors of WoundSource Necrotic wounds are marked by the presence of devitalized or dead tissue. Infection, trauma, ischemia, inflammation, or exposure to toxins can all result in necrosis. It can also be induced by inappropriate management of a wound that has already been established. Devitalized
- The 21st of May, 2020 Submitted by Holly Hovan MSN, RN-BC, APRN, ACNS-BC, CWOCN-AP, MSN, RN-BC, APRN The new coronavirus that causes the COVID-19 illness has undoubtedly had an influence on everyone of us in some way. Whether you work in a hospital environment, an outpatient clinic, a doctor’s office, or a specialist setting, this pandemic has affected you. The deadline for submission is January 31, 2021. Continuity of care has long been at the heart of medical practice, and it is especially critical in the field of wound care. Continuity of treatment in wound management is associated with improved patient outcomes, cost-effectiveness, and patient satisfaction ratings. Wound care clinicians must contend with the following challenges while delivering continuity of treatment:
In order to establish the presence of infection in wounds, bacterial wound cultures are performed in conjunction with clinical evaluation. When a bacterial wound culture yields a negative result, the reference range varies depending on the technique used, as follows:
- To identify the presence of infection in wounds, bacterial wound cultures are utilized in conjunction with clinical evaluation. When a bacterial wound culture results in a negative result, the reference range varies depending on the technique, and is as follows:
Wound cultures are frequently used as an auxiliary to clinical examination, and as a result, both should be evaluated at the same time. Identifying whether an isolated organism is the source of an infection or a contamination/part of normal skin microflora is critical in the interpretation of qualitative bacteria wound cultures. In order to evaluate whether the isolated pathogen is a real infection, conventional cutoff values for wound bacterial load, as specified in the Reference Range, are employed in conjunction with semiquantitative and quantitative approaches to quantify the pathogen further.
There are several types of organisms that are regularly found in the natural skin flora and that are not typically harmful, including the following:
- Propionibacterium acnes
- Alpha or gamma streptococci
- Staphylococcus epidermidis or other coagulase-negative staphylococci
- Corynebacteriumspecies and other diphtheroids Corynebacteriumspecies and other diphtheroids Neisseriaspecies (exceptNeisseria meningitidis or Neisseria gonorrhoeae)
- Bacillusspecies (exceptBacillus cereusorBacillus anthracis)
- Neisseria meningitidis or Neisseria gonorrhoeae
- Neisseria gonorrhoeae
Growth of the aforementioned organisms is typically indicative of contamination, with the exception of coagulase-negative Staphylococcus species, which can be indicative of either contamination or actual infection. The following are the pathogenic bacteria that are most often identified from acute and chronic wound infections:
- Coliform bacteria, includingEscherichia coli, Enterobacterspecies, and Klebsiella pneumoniae
- Staphylococcus aureus, Pseudomonas aeruginosa, Enterococci, Beta-hemolytic streptococci, and Beta-hemolytic streptococci Staphylococci that do not produce coagulase
- Gram-negative anaerobes (primarilyBacteroides, Prevotella, andFusobacteriumspecies)
- Pigmented gram-negative anaerobes (Prevotella and Porphyromonasspecies)
- Nonpigmented gram-negative anaerobes (primarilyBacteroides, Prevotella, andFusobacteriumspecies)
Wound cultures acquired by biopsy are regarded to be the gold standard among wound culture procedures because of their quantitative nature. It is deemed positive for wound infection if the growth of more than 100,000 or 10 5organisms per gram of tissue or per milliliter of fluid aspirate is seen. Using a sterile loop for each quadrant, blood agar plates are streaked three times on one quadrant and then three times on each remaining quadrant in order to obtain semiquantitative culture results.
More than 30 colonies growing in a quadrant is classified as 4+ growth, which indicates the presence of an infectious organism.
Collection and Panels
Wound tissue biopsy, needle aspiration of fluid, and swab are the three most prevalent ways of obtaining specimens for wound culture, with the first two being the most common.
Wound tissue biopsy
Sterile tube or container is used as a delivery vehicle. 0.005-0.2 g of affected tissue or a 3-4 mm punch biopsy are considered normal volumes. Excision using a scalpel is used in conjunction with a punch biopsy device to get a tissue biopsy in an aseptic manner. In addition to curettage of superficial devitalized tissue, the most usually used indiabetic foot ulcers, and a dermabrasion method for deep tissues without being overly intrusive, other recognized procedures include The material should be delivered to the laboratory within 60 minutes of collection to ensure the best possible recovery.
Sterile tube or container is used as a storage container. 3-4 mm punch biopsy or 0.005-0.2 g of affected tissue is considered normal volume. Excision using a scalpel is used in conjunction with a punch biopsy device to acquire a tissue biopsy in an aseptic environment. The curettage of superficially devitalized tissue, the most widely used indiabetic foot ulcers, and a dermabrasion method for deep tissues that is not overly invasive are all acceptable procedures. The specimen should be delivered to the laboratory within 60 minutes of collection in order to ensure the best possible recovery.
Container: A sterile tube or container is required. 3-4 mm punch biopsy or 0.005-0.2 g of affected tissue is considered normal. Excision with a scalpel is used in conjunction with a punch biopsy device to achieve an aseptic tissue biopsy. In addition to curettage of superficial devitalized tissue, the most usually used Indiabetic foot ulcers, and a dermabrasion method for deep tissues without being overly intrusive, other acceptable procedures include The material should be delivered to the laboratory within 60 minutes of collection in order to maximize recovery.
In order to establish the presence of infection in wounds, bacterial wound cultures are performed in conjunction with clinical evaluation. Additionally, cultures are utilized to identify the exact organism or organisms that are being treated as well as to advise the precise antimicrobial medication being administered.
Bacterial wound culture is suggested for surgical and nonsurgical wounds that are suspected of being infected, whether they are acute or chronic. Furthermore, it is recommended for use in hospital or local monitoring programs to monitor drug-resistant bacteria. According to a research by Marchand-Senécal et al., when the Q-score quality metric was used to evaluate wound swab specimens, and those of low quality were later rejected for culture, the rate of antibiotic treatment for wound infection decreased in patients who had low-quality specimens collected.
When it comes to obtaining wound culture materials, tissue biopsy is regarded to be the gold standard. When possible, it is preferable to culture viable but potentially contaminated tissue rather than necrotic tissue. Swab cultures can be inaccurate since they often suggest contamination. Perform tissue biopsy or aspiration to gather specimens when it is necessary. In an ideal situation, specimens would be obtained prior to the administration of antibiotics. In all cases, a clinical assessment of the wound and how it is developing should be given greater weight than the results of the culture.
It is not recommended to perform serial wound cultures in order to evaluate response to therapy.
- S. Baranoski and E. Ayello Specimens and wound cultures are used in this study. Buchanan K, Heimbach DM, Minshew BH, Coyle MB. Wound Care Essentials, 3rd edition, 2011. 136–145
- Buchanan K, Heimbach DM, Minshew BH, Coyle MB. For burn biopsy, a comparison of quantitative and semiquantitative culture methods was conducted. J Rudensky B, Lipschits M, Isaacsohn M, Sonnenblick M. Clin Microbiol. 1986 Feb
- Rudensky B, Lipschits M, Isaacsohn M, Sonnenblick M. Clin Microbiol. 1986 Feb
- Rudensky B, Lipschits M, Isaacsohn M, Sonnenblick M. Pressure sores infected with bacteria: a comparison of approaches for bacterial identification. South Med J. 1992 Sep
- Mayhall CG. South Med J. 1992 Sep
- 85(9):901-3. The epidemiology of burn wound infections has changed throughout the years. Drinka P, Bonham P, Crnich CJ, et al. Clin Infect Dis. 2003 Aug 15
- Drinka P, Bonham P, Crnich CJ. Swab cultures of purulent skin infections are performed to determine whether the infection has been infected or colonized by antibiotic-resistant bacteria. Bowler PG, Duerden BI, Armstrong DG
- J Am Med Dir Assoc. 2012 Jan
- Bowler PG, Duerden BI, Armstrong DG. Wound microbiology and the techniques to wound treatment that are related with it. Ratliff C, Rodeheaver G, et al. Clin Microbiol Rev. 2001 Apr
- Ratliff C, Rodeheaver G, et al. Semi-quantitative swab cultures and quantitative swab cultures from chronic wounds are correlated | WOUNDS. Wounds was released in 2008. You may find it at: Angel DE, Lloyd P, Carville K, Santamaria N
- Angel DE, Lloyd P, Carville K, Santamaria N
- Accessed September 22, 2012. When it comes to identifying the organism(s) responsible for infected cutaneous wounds, the clinical effectiveness of two semi-quantitative wound-swabbing approaches has been studied. IWJ (International Wound Journal) April 2011
- Stallard Y. When and How to Perform Cultures on Chronic Wounds? The Journal of Wound, Ostomy, and Continence Nursing published a paper in March/April 2018 titled: The World Union of Wound Healing Societies is an international organization dedicated to the healing of wounds (WUWHS). Best practice guidelines are based on the following principles: Infection of the wound in clinical practice. There is an international agreement. MEP Ltd., London (England), 2008. Marchand-Senecal, X., Brasg, I.A., Kozak, R., and colleagues The Influence of Rejection of Low-Quality Wound Swabs on Antimicrobial Prescribing: A Controlled Before-After Study Open Forum Infect Dis. 2021 Jan. 8 (1):ofaa609
- Gardner S, Frantz R, Hillis S, Park H, Scherubel M. Open Forum Infect Dis. 2021 Jan. 8 (1):ofaa609
- Gardner S, Frantz R, Hillis S, Park H, Scherubel M. The diagnostic validity of semiquantitative swab cultures has been demonstrated. Wounds: A Compendium of Clinical Research and Practice is a compilation of clinical research and practice on wounds. The year 2007 is 19.2:31-38.
Author Non, Dr. Lemuel R., is a resident physician in the Department of Internal Medicine at the Albert Einstein Medical Center. In addition to being a member of the American Medical Association, Lemuel R Non, MD belongs to the following medical societies: The American College of Physicians is a professional organization dedicated to the advancement of medicine. Disclosure: There is nothing to reveal. Coauthor(s) Aaron R. Kosmin, MD, AAHIVS, FACPClinical Assistant Professor of Medicine at Jefferson Medical College of Thomas Jefferson University; Attending Physician at the Section of Infection Diseases, Department of Medicine, Albert Einstein Medical Center.
Kosmin received his medical degree from the Albert Einstein College of Medicine in Philadelphia.
Kosmin, MD, AAHIVS, FACP is a member of the following medical societies: American Academy of Humanitarian and Veterinary Societies The American College of Physicians, the American Society for Microbiology, the Infectious Diseases Society of America, the International Society for Infectious Diseases, and the HIV Medicine Association are among the organizations that support HIV medicine.
When and How to Perform Cultures on Chronic Wounds?
It was the goal of this Evidence-Based Report Card to analyze the most recent best evidence linked to when and how to run cultures on chronic wounds in order to assist physicians in identifying the most effective therapy for their patients. (1) When should cultures be conducted on chronic wounds, and how often? in addition to (2) What is the most effective method or procedure for taking a culture from a chronic wound? The following is the search strategy: A search of the literature was conducted, and the results revealed 45 papers that were related to the issue.
- The phrases “chronic wound,” “chronic infected wound,” “wound culture,” “specimen collection,” and “wound swab” were among the most often searched for.
- As a result of the search, seven papers were identified as being relevant to the issue of wound culture and satisfying inclusion criteria.
- Three investigations found that traditional indications of infection may not always be present, but that culture may be suggested when other indicators such as discomfort, necrotic tissue, extended or delayed healing, and wound bed degradation are present.
- For determining microbial load in the wound bed, two publications suggest that the Levine approach is more trustworthy than the Z-technique, according to the authors.
- The quality of the studies was determined using the Johns Hopkins technique, and they were classified as either high quality or good quality.
- A comprehensive study of the collection of samples for the culture of infected wounds. Copeland-Halperin LR, Kaminsky AJ, Bluefeld N, Miraliakbari R. Copeland-Halperin LR, Kaminsky AJ, Bluefeld N, Miraliakbari R. LR Copeland-Halperin and colleagues Interdisciplinary Journal of Wound Care. 2016 Apr
- 25(4):S4-6, S8-10. doi: 10.112968/jowc2016.25.Sup4S4.J Wound Care. 2016.PMID:27068349 Is the use of a clean or sterile dressing technique associated with a reduction in the incidence of wound infection? Kent DJ, Scardillo JN, Dale B, Pike C, and colleagues. Kent, DJ, and colleagues 2018 May/Jun
- Doi: 10.1097/WON.0000000000000425.PMID:29528884J Wound Ostomy Continence Nurs. 2018. PMID:29528884 An examination: Swabs vs biopsies for the identification of chronically infected wounds Rondas AA, Schols JM, Halfens RJ, Stobberingh EE.Rondas AA, et al. Rondas AA, et al. Rondas AA, et al. Adv Skin Wound Care. 2013 May
- 26(5):211-9. doi: 10.1097/01.ASW.0000428984.58483.aa.Adv Skin Wound Care. 2013.PMID:23591095. Adv Skin Wound Care. 2013.PMID:23591095 Review: The most effective strategy for getting wound cultures is discussed. Spear M. Spear M. Spear M. Spear M. Spear M. Spear M. Spear M. Plast Surg Nurs. 2012 Jan-Mar
- 32(1):34-6. doi: 10.1097/PSN.0b013e31824a7e53. Plast Surg Nurs. 2012.PMID:22395174
- Plast Surg Nurs. 2012.PMID:22395174
- Plast Surg Nurs. 2012. Is it important if a wound biopsy or a wound swab is used to get a culture result for the evaluation of wound infection? Haalboom M, Blokhuis-Arkes MHE, Beuk RJ, Meerwaldt R, Klont R, Schijffelen MJ, Bowler PB, Burnet M, Sigl E, van der Palen JAM. Haalboom M, Blokhuis-Arkes MHE, Beuk RJ, Meerwaldt R, Klont R, Schijffelen MJ, Bowler PB, Burnet M, Sigl E, M. Haalboom and colleagues On the 24th of August, the journal Clin Microbiol Infect published an article titled “Clinical Microbiol Infect.” The article is titled “Clinical Microbiol Infect.” Clin Microbiol Infect. 2019.PMID:30145403
- Clin Microbiol Infect.
When microorganisms from an infected wound are grown on media in the laboratory and identified, this is referred to as wound culture. In all cases, aerobic culture is included in the wound culture; however, direct smear assessment (Gram stain) and anaerobic culture are not usually conducted on every lesion. These tests are carried out when the physician deems them necessary or requests them.
An infected wound culture is a diagnostic laboratory test in which microorganisms from the infected wound are cultured in a laboratory environment on medium and then identified. Despite the fact that wound cultures usually contain aerobic culture, not every wound is evaluated with direct smear examination (Gram stain) or anaerobic culture. If a physician determines that these tests are necessary or requests them, they will be conducted.
A biopsy sample is normally chosen by physicians, but because it is a relatively intrusive operation, it may not always be practicable in all circumstances. Patient preparation begins with a thorough cleaning of the affected region using a sterile solution such as saline. It is not suggested to use antiseptics such as ethyl alcohol since they will kill the germs and cause the findings to be negative. A local anesthetic is administered to the patient, and the tissue is removed with the use of a cutting sheath.
- In wounds with limited skin loss, such as puncture wounds, needle aspiration is a less intrusive approach that can be used effectively.
- To extract fluid from different sections of the wound, the clinician should draw back on the plunger and then adjust the angle of the needle two or three times, depending on the size of the incision.
- Sterile saline should be used to clean the wound region, as well as to wet a clean sterile swab with the same solution.
- The pressure will result in a greater output of fluid from the wound that is deeper in the body.
- Following the completion of all three operations, the incision should be carefully cleansed and wrapped.
- In order to protect the anaerobic sample from contamination, it should be put in a gassed out vial that may include prereduced medium or a gassed out bag and sealed.
- The inoculation of an anaerobicblood culturebottle at the point of care is a frequent method for anaerobic culture in order to ensure that the sample does not come into contact with air.
When doing aerobic culture, one swab is placed in Stuart, Cary-Blair, or Amies transport medium, and another is placed in PRAS transport media for anaerobic culture. For direct smear examination, one sample is put in a clean, dry envelope or tube for storage.
A wound is a physical injury to the body’s tissues produced by physical trauma or disease processes. Examples of such injuries include surgery, diabetes, burns, punctures from firearms, lacerations, bites, bed sores, and fractured bones, among others. The following are examples of wounds:
- Abraded: Damaged as a result of abrasion, such as a fall on concrete. A bruise or contusion is a bruise or a contusion. Incised: Resulting from a clean incision, such as with a sharp tool
- To be lacerated means that one’s skin or tissues have been torn or lacerated. Nonpenetrating injury is defined as injury that occurs without causing disturbance to the surface of the body. Blown-trauma wounds are those that occur in the thorax or abdomen and are also known as blunt trauma wounds. An open wound is one in which the tissues are exposed to the elements. Disruption of the bodily surface and expansion into the underlying tissue are examples of penetration. As an example, consider a gunshot wound that has two points of entrance and one point of exit. Puncture is a wound that forms when something penetrates the skin and enters the body’s internal organs. Despite the fact that it has a little entrance, this incision may be quite deep.
This depends on the nature, size, and depth of the wound, as well as its proximity to and involvement of non-sterile areas such as the skin or gastrointestinal tract, the possibility of organisms from outside of the person’s body entering the wound, and the person’s overall health status, including his or her immunological and general health status. Many infections are prevented by skin and body compartmentalization. Acute wounds, as opposed to chronic wounds, are more susceptible to infection in general.
- Puncture wounds may allow the growth of microorganisms because there is a breach in the skin with minimal bleeding and because they are difficult to clean up afterward.
- An infection produced by anaerobic bacteria is characterized by a foul-smelling odor, gas production, and organgreneat production at the infection site.
- It might be difficult to determine whether a wound is infected.
- Most wounds will exhibit a discharge of fluid, known as an exudate, within a few hours after being injured.
- If it is evident 48-72 hours after an injury, it should be treated as an emergency.
- Clinicians will examine the color, consistency, and volume of exudate to determine whether or not an early infection has occurred.
- Wound infection interferes with the healing process, and the germs that cause it can spread from the wound to other regions of the body, including the bloodstream.
Fever and an increase in white blood cells are among the symptoms of a systemic infection, which can also cause disorientation and changes in mental state in the elderly.
Numerous bacteria, including both aerobic and anaerobic grampositive cocci and gram-negative bacilli and yeast, can infect wounds.
Staphylococcus aureus, Escherichia coli, Proteus, Klebsiella, Pseudomonas aeruginosa, Peptostreptococcus, Fusobacterium, and Aeromonas are the most prevalent pathogens identified from wounds.
It is necessary to do an initial Gram stain in order to evaluate the specimen’s suitability, estimate the quantity of bacteria, yeast, or fungal cells present, and determine whether or not a particular culture medium is required depending on the appearance of the organisms identified.
It is possible to get the tissue needed for the tests by three alternative methods: tissue biopsy, needle aspiration, or the swab approach.
When the bit of tissue has been delivered to the laboratory, it must be liquified before further processing.
With a sterile pipet, this is vortexed and poured onto solid medium and into broth, respectively.
Swab techniques are the most widely employed, although they contain the least quantity of specimen, and as a result, their recovery rates are lower than those obtained from biopsy tissues or aspirates.
Nonselective enriched media are used to cultivate wound specimens, as well as selective media.
It is recommended that you use sheep blood agar for general growth, chocolate agar for isolation of Haemophilus, MacConkey agar for the isolation of enteric gram negative bacteria, CNA or PEA blood agar for gram-positive cocci, and potato dextrose agar with antibiotics for the isolation of yeast in your aerobic culture.
Every day, the cultures are checked for growth, and any colonies that form are Gram stained and subcultured (i.e., moved) to the appropriate media for further development.
Antibiotic susceptibility testing is also performed on organisms using the microtube broth dilution method or the Kirby Bauer method. The selection of antibiotics for testing is dictated by the organism that has been identified (i.e., gram-negative versus gram-positive, aerobe versus anaerobe).
This depends on the nature, size, and depth of the wound, as well as its proximity to and involvement of non-sterile areas such as the skin or gastrointestinal tract, the possibility of organisms from outside of the person’s body entering the wound, and the person’s overall health status, including his or her immunological and general health. Skin and body compartmentalization are effective in preventing many types of diseases from spreading. Acute wounds, as opposed to chronic wounds, are more susceptible to infection.
- Puncture wounds may allow the growth of microorganisms because there is a breach in the skin with minimal bleeding and because they are difficult to clean up afterward, The development of an anaerobic infection is facilitated by deep wounds that are walled off from oxygen.
- When microorganisms are introduced into another bodily compartment through surgical incisions, they can cause an infection.
- Sluggish healing is one of the key indicators that the doctor is looking for.
- Despite the fact that this fluid is natural, it includes components that help in healing.
- When an infection is present, the exudate may be thicker than the original exudate and may also be purulent (contain pus) and foul-smelling.
- Additionally, skin discoloration, swelling, warmth to the touch, and an increase in discomfort may be present in infected wounds.
- Septicemia is a phrase used to describe an infection that has spread to the bloodstream and is potentially deadly.
If you have an infected wound, it is critical that you treat it right away with antibiotics to avoid future problems.
Grampositive cocci and gram-negative bacilli are the most commonly seen in wound infections.
It is necessary to do an initial Gram stain in order to evaluate the specimen’s suitability, estimate the quantity of bacteria, yeast, or fungal cells present, and determine whether or not a particular culture medium is required depending on the appearance of the organisms discovered.
It is possible to get the tissue needed for the tests by three distinct methods: tissue biopsy, needle aspiration, and the swab approach.
The bit of tissue is transferred to the laboratory, where it must be liquified before it can be processed.
With a sterile pipet, this is vortexed and poured onto solid medium and into broth.
Swab techniques are the most widely employed, however they include the least quantity of material, and as a result, their recovery is lower than that of biopsied tissues or aspirates.
Experiments with wound specimens have been conducted on both nonselective enriched and selected media.
Anaerobic media are inoculated either within a glove box or in an anaerobic (degassed) holding jar and incubated at 96.8 degrees Fahrenheit (36 degrees Celsius) in the absence of oxygen.
It takes 48 hours to incubate cultures at 96.8 degrees Fahrenheit (36 degrees Celsius) in humid air (except for chocolate agar which is incubated in 5-10 percent carbon dioxide).
A biochemical identification panel is used to determine which species is present in the isolates obtained via culturing.
The microtube broth dilution method and the Kirby Bauer method are also used to test for antibiotic resistance in organisms. Selection of antibiotics for testing is dependent on the organism that has been identified and cultured (i.e., gram-negative versus gram-positive, aerobe versus anaerobe).
This depends on the nature, size, and depth of the wound, as well as its proximity to and involvement of non-sterile areas such as the skin or gastrointestinal tract, the possibility of organisms from outside of the person’s body entering the wound, and the person’s overall health status, including his or her immune system and general health. Skin and body compartmentalization are effective in preventing many types of infections. Acute wounds, as opposed to chronic wounds, are more prone to infection in general.
- Puncture wounds may allow the growth of microorganisms since there is a breach in the skin with limited bleeding and they are difficult to clean.
- An infection produced by anaerobic bacteria is characterized by a foul-smelling odor, gas, and organgreneat at the infection site.
- It might be difficult to determine the presence of an infection in a wound.
- Most wounds will exhibit a discharge of fluid known as an exudate within a few hours after being injured.
- It should not be present for 48-72 hours after an injury has occurred.
- Clinicians will examine the color, consistency, and volume of exudate to determine whether or not an infection has occurred.
- Wound infection interferes with the healing process, and the germs that cause it can travel from the wound to other regions of the body, including the blood.
In the aged, symptoms of a systemic infection include a fever and an increase in white blood cells, as well as disorientation and changes in mental state.
Multi-organism wound infections are common, and include both aerobic and anaerobic grampositive cocci, gram-negative bacilli, and yeast.
A Gram stain is made by rolling a smear over the center of a glass slide or by dropping a liquid specimen into the center of a glass slide and allowing it to air dry.
For example, the Gram stain may reveal gram positive filamentous bacteria that are indicative of Norcardia and that require a particular growing medium.
This approach involves the removal of tissue from the incision with a cutting sheath, which is a type of needle biopsy.
This is accomplished by adding roughly 1 mL of liquid medium to the tissue and blending or grinding the mixture until it forms a thick homogenized mixture.
A syringe can be used to aspirate samples that can be injected straight into broth and distributed onto solid medium.
In order to transfer the suspension of transport media into broth and solid media, a sterile pipet is used to push the swab against the transport tube.
Anaerobic sheep blood agar supplemented with vitamin K and hemin for general isolation; kanomycin-vancomycin laked blood agar for Bacteroides spp.; phenylethyl alcohol (PEA) or colistin-nalidixic acid (CNA) anaerobic sheep blood agar to suppress gram-negative bacilli; and thioglycolate broth with hemin and vitamin K for For five to seven days, anaerobic media are infected either within a glove box or in an anaerobic (degassed) holding jar and incubated at 96.8 °F (36 °C) in the absence of oxygen.
Aerobic culture should include inoculation of sheep blood agar for general growth, chocolate agar for isolation of Haemophilus, MacConkey agar for isolation of enteric gram negative bacilli, CNA or PEA blood agar for isolation of gram-positive cocci, and potato dextrose agar with antibiotics for isolation of yeast.
Every day, the cultures are checked for development, and any colonies that form are Gram stained and subcultured (i.e., moved) to the appropriate medium.
Antibiotic susceptibility testing is also performed on organisms using the microtube broth dilution or the Kirby Bauer technique. The selection of antibiotics for testing is determined by the organism that has been identified (i.e., gram-negative versus gram-positive, aerobe versus anaerobe).
Aerobes are bacteria that require oxygen in order to survive. Bacterial digestion is inhibited by agar, a gelatinous substance derived from red algae. It is used to promote the development of organisms in plates. Anaerobes are bacteria that can only survive in environments where there is no oxygen. Antibiotics are medications that can be applied topically, eaten orally, administered intramuscularly, or administered intravenously to prevent germs from multiplying. In microbiology, an antimicrobial is a substance that inhibits the development of microorganisms such as bacteria, fungus, and viruses.
- Antiseptic (also known as bactericide) is a chemical substance that destroys all bacteria on contact.
- Different substances, such as sugars or amino acids, may be introduced to specific organisms in order to promote their development.
- Exudate is defined as any fluid that has been discharged by tissue or its capillaries as a result of damage or inflammation of the tissue or capillaries.
- If the organisms are gram-positive, they will remain purple, and if they are gram-negative, they will counterstain pink.
- The typical flora is a collection of microorganisms that is normally found at various bodily regions in a healthy person.
- When completing a wound culture collection, nurses must exercise extreme caution to ensure that the wound has been cleansed thoroughly and that it has been bandaged appropriately.
- In addition, individuals may have discomfort as a result of the manipulation, and pain relievers such as acetaminophen may be prescribed.
Health care team roles
Wound culture necessitates the participation of a diverse group of professionals, including nurses, physicians, and microbiologists. The wound culture is requested by a physician, who is also in charge of specimen collection as well as antibiotic selection. Nursing, nurse practitioner, and physician assistants are all options for assisting the physician. Nurses should tell the patient about the diagnostic technique as well as the level of discomfort that will be experienced. When they’re through, they should clean the wound carefully, bandage it properly, and keep an eye out for any indications or symptoms of additional infection.
Clinical laboratory scientists/medical technologists who specialize in clinical microbiology are responsible for performing culture procedures.
Elmer W. Koneman, et al., Color Color Atlas and Textbook of Diagnostic Microbiology, 5th ed. Philadelphia: J. B. Lippincott Company, 1997. Color Color Atlas and Textbook of Diagnostic Microbiology, 5th ed. Philadelphia: J. B. Lippincott Company, 1997. Kathleen D. Pagana and Timothy J. Pagana are co-authors of this work. Diagnostic and laboratory tests are described in detail in the Diagnostic and Laboratory Tests Manual. Mosby, St. Louis, Missouri, 1998. Standford T. Shulman and colleagues, eds.
- The W.
- Saunders Company published this book in 1997.
- Bates-Jensen are co-authors of this article.
- Aspen Publishers, Inc., Gaithersburg, MD, published in 1998.
COLOR COLOR ATLAS AND TEXTBOOK OF DIAGNOSIS MICROBIOLOGY, 5TH EDITION (Philadelphia: J B Lippincott Company, 1997) Elmer W. Koneman and colleagues published Color Color Atlas and Textbook of Diagnostic Microbiology, 5th edition in 1997. Kathleen D. Pagana and Timothy J. Pagana are the authors of this article. Diagnostic and laboratory tests are covered in detail in this manual. Mosby Publishing Company, St. Louis, Missouri, 1998 Standford T. Shulman and colleagues (eds.) The Fifth Edition of The Biologic and Clinical Basis of Infectious Diseases The W.
Saunders Company published this book in Philadelphia in 1997.
Bates-Jensen have published a paper in which they discuss their research on adolescent girls’ sexual health.
20.9 Checklist for Wound Culture – Nursing Skills
A wound culture is a sample of bacteria taken from a wound that has been suspected of being infectious. Treatment choices are determined based on the results of the study. The findings of wound cultures provide information on the type and amount of bacteria present, as well as which antibiotics the bacteria are sensitive to. When administering a wound culture, it is critical for the nurse to minimize contamination and to employ evidence-based practices in order to produce a suitable specimen on which to base the patient’s treatment plan.
Disclaimer: Always evaluate and adhere to the agency’s policies and procedures before doing this specific skill.
- Assemble the following supplies: sterile wound swab, sterile normal saline, sterile irrigation kit with 30-60mL syringe, and sterile 2′′ x 2′′ gauze
- And Take the following precautions:
- Hand hygiene should be performed
- Check the room for transmission-based measures
- Introduction: Describe yourself and your job, as well as the reason for your visit and an estimate of how long it will take. Confirm patient identification by utilizing two patient identifiers (for example, the patient’s name and date of birth)
- Explain the procedure to the patient and inquire as to whether or not they have any queries
- Be structured and methodical
- Employ proper listening and questioning skills
- And be creative. Pay attention to and respond to the patient’s cues. Protect the patient’s privacy and dignity at all times. Examine the ABCs
- Prepare the setting, place the patient in the appropriate position, adjust the height of the bed, and turn the lights on. Ascertain good body mechanics for yourself, and arrange the patient in a comfortable posture for him or her. It is important to have adequate illumination so that the wound may be assessed with clear visibility. Provide pre- and post-operative pain relief if necessary and maintain the patient’s comfort before and during the process Clean, dry barrier on the bedside table or sterile field according to agency regulation should be established. Fill the irrigation tray halfway with sterile saline
- Hand hygiene should be performed, and nonsterile gloves should be worn. Remove the dressing from the patient’s wound and examine it. The dirty dressing should be disposed of in accordance with agency policy. Removing the gloves and performing hand hygiene are recommended. Inspect the patient’s condition and the kind, location, and depth of the wound before putting on a new pair of nonsterile or sterile gloves
- In order to remove surface debris or exudate from the wound and prevent specimen contamination, irrigate the wound with sterile normal saline solution. Alternative treatment is to use a commercial wound irrigation equipment to clean the wound. To remove surface pollutants from the wound, use a sterile gauze pad saturated with regular saline solution to wipe the surface of the wound. Blot the wound bed with a dry, sterile gauze pad to remove any extra normal saline solution that has accumulated. Removing the gloves and performing hand hygiene are recommended. Put on a fresh pair of nonsterile gloves
- To begin collecting and transporting swab specimens, turn on the system. As needed, prepare the ingredients according to the manufacturer’s instructions
- Collect the samples using the culture swab(s) in accordance with agency guidelines.
- It should be noted that some organizations employ swab collection and transport systems that contain particular swabs designed for anaerobic and aerobic specimen collection
- However, this is not the case for all agencies.
- It is necessary to wet the swab with regular saline solution when the wound bed seems dry. Locate a 1-cm2-area of viable wound tissue at or near the center of the wound
- Note: The culture must be collected from the cleanest tissue possible and not from pus, slough, eschar, or necrotic tissue
- Otherwise, the results will be negative.
- Apply appropriate pressure to the wound for 5 seconds while rotating the tip of the swab over the 1-cm2-area of the wound that has been identified. The swab should be removed from the wound. Insert the swab into the proper transport system as soon as possible, following the manufacturer’s directions for use. Precautions should be taken to avoid contaminating the swab when it is placed into the transit system:
- Clinical alert: It is important to note that the culture must be obtained from the cleanest possible tissue and not from pus, slough, eschar, or necrotic material. Keep exudate from the skin away from your eyes.
- Clinicians should be aware that the culture must be obtained from the cleanest tissue possible and not from pus, slough, eschar, or necrotic material. Clinical alert: Keep exudate from the skin away from your eyes
- On the laboratory request form, include a note of any recent or ongoing antibiotic therapy the patient is receiving because it may have an impact on test findings. Get a culture specimen as soon as feasible before commencing antimicrobial treatment
- CALL LIGHT: Easily accessible
- BED: LOW and LOCKED (in the lowest position with the brakes activated). SIDE RAILS: These have been secured. TABLE: Easily accessible
- ROOM: devoid of hazards that might cause a fall (search the room and remove any impediments)
- In a laboratory biohazard transport bag, place the specimen together with a completed laboratory request form and submit it to the lab as soon as possible In the patient’s chart, make a note of the operation and any relevant assessments. Any issues should be reported in accordance with agency policy.
WOUND CULTURES **
Policy:Its purpose and scope are as follows: Wound infections can be caused by a number of species, with S. aureus, beta-hemolytic streptococci, P. aeruginosa, and enteric Gram negative bacilli being the most often seen. Due to the presence of squamous epithelial cells, it’s possible that the specimen was only superficially examined, and the organisms recovered may not accurately represent the real cause of the illness. Reagents and supplies are required. 5 percent CNA agar plate/MacCONKEY agar bi-plate is used for this experiment.
Sterile loops that are disposable Incubator at 37 degrees Celsius Collection and transportation of specimens are the procedures to follow.
A sample of anaerobic culture must be taken and placed in an anaerobic transport tube if the request is for anaerobic culture.
If you get both an aerobic and anaerobic swab, both swabs should be maintained at room temperature until they are ready to be processed.
Quest Diagnostics receives and processes cultures sent on Fridays, as well as cultures that require additional workup on Fridays.
Culture: Incubation in the Media Blood Agar (BA), Colistin Nalidixic Acid Agar (CNA), and MacCONKEY Agar (MAC) are all types of agar.
Isolation plates made of disposable sterile loops are used in this procedure.
Cultures are being interpreted.
If there is no development after 24 hours, re-incubate.
aureus, beta-hemolytic streptococci, or Pseudomonas is noteworthy.
After a positive test for Staph aureus is performed, a fast test for Methicillin Resistant Staph Aureus (MRSA) will be performed.
Normal skin flora may include Coagulase negative staph, diptheroids, and lactobacillus bacteria, among other organisms.
Growth in all categories is many.
Textbook of Diagnostic Microbiology, MahonManuselis, 2nd edition, Chapter 27, pages 919-944; Chapter 33, pages 1045-1052; Chapter 35, pages 1083-1113; Textbook of Diagnostic Microbiology, MahonManuselis, 2nd edition, Chapter 27.
In BaileyScott’sDiagnostic Microbiology, Forbes, 11th edition, Chapter 59, pages 917-926, and Chapter 63, pages 972-984, the authors provide a method for diagnosing a bacterial infection. ” ” ” ” LIS PROCEDURES ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” ” “