At the end of this chapter, the learner will be able to:
Define terms describing the use of ultraviolet C including electromagnetic spectrum, ultraviolet radiation, minimal erythemal dose (MED), and the cosine law.
Explain how the application of ultraviolet C to a chronic wound generates a bactericidal effect.
Develop safe and appropriate application parameters for ultraviolet C in wound healing.
Select specific patient indications appropriate for the use of ultraviolet C in wound management.
Identify precautions and contraindications for the use of ultraviolet C.
Select safe and appropriate parameters for ultraviolet C application.
Develop and implement a care plan involving the use of ultraviolet C in the treatment of a chronic wound.
Although ultraviolet A (UVA) and ultraviolet B (UVB) have been used in health care for some time to treat dermatological conditions such as psoriasis and also have evidence to support the use of ultraviolet radiation to promote wound healing, ultraviolet C is the type of ultraviolet light that is most commonly utilized today in the treatment of chronic wounds.1,2 Specifically, ultraviolet C (UVC) is beneficial for the treatment of chronic wounds due to its bactericidal effects.3 As the number of drug-resistant organisms continues to increase, wound clinicians must consider treatment options that not only effectively destroy bacteria without damaging fibroblasts and other cells necessary for wound healing, but also avoid the development of resistance.4 UVC accomplishes both of these treatment goals and is a cost-effective, portable, and safe non-carcinogenic treatment modality.5,6
Understanding the types of ultraviolet light is important in order to choose a wavelength that will deliver the desired outcome (TABLE 19-1, FIGURE 19-1). This chapter focuses on UVC, which has the FDA approval for use on open wounds due to its bactericidal effects.7 TABLE 19-2 provides terminology and definitions utilized in the discussion of ultraviolet light. Handheld UVC devices consist of lamps that deliver ultraviolet light at a specific wavelength (254 nm), which falls within the optimal wavelength range for bacterial reduction.8,9 These devices contain filters specific to UVC that reduce the risk of skin cancer and skin burns often associated with UVA and UVB.10 Although studies have shown an increase in risk of skin cancer associated with the use of ultraviolet B, there has been no link reported between skin cancer and UVC.10,11
Mr D is a 70-year-old male referred to the wound center for a failed split-thickness skin graft (STSG) on the left anterior shin. The original full-thickness wound was caused by trauma approximately 8 months prior to referral. The most recent debridement and STSG surgery was performed approximately 2 weeks prior to evaluation at the wound center. The patient was instructed to leave the post-operative dressings in place for 1 week and return to his surgeon for ...