September 2, 2008

TREATMENT OF BACTERIAL INFECTION
WITH ELECTRICAL STIMULATION^©

Lyn Paul Taylor, A.A., B.A., M.A., R.P.T.

(Editing Assistant and Computer Consultant: Joanna Soon, B.S.)

Clinical research and experience have confirmed that low intensity, low frequency, electrical stimulation may facilitate the healing processes of damaged soft tissues, increasing the quality and rate of repair.  Electrical stimulation has been shown to be remarkably effective for precipitating the closure of healing-resistant incisions and pressure sores (decubiti).  It is thought that these effects are mainly due to its effects on bacteria.  In fact, electrical stimulation has been shown that monophasic (one direction) electrical stimulation has a bacteriostatic or antibiotic effect on some types of bacteria commonly associated with dermal lesions, including pseudomonas aeruginosus (in vivo).

Many types of electrical instrumentation provide current forms with the requisite amplitudes (0 to 100 microamperes, up to 90 volts), frequencies (1 to 10 hertz), and pulse width duration (100 to 200 milliseconds) necessary to inhibit bacterial infection and facilitate soft tissue healing.  Of all the current forms, the pulsed square wave has been shown to be the most effective and safest.

To utilize electrical stimulation to help fight bacterial infection the following steps should be taken:

• If necessary, the dermal lesion should be undressed and cleaned of any exudates or loose debris following sanitary debridement guidelines.

• A sterilized sponge electrode moistened with pure saline solution should be placed over the dermal lesion.  This electrode should be attached to the electrical stimulation device as the negative electrode.  The positive or dispersive electrode should be placed some distance away from the lesion.

• The electrical stimulator should be preset at zero amplitude, at a minimum frequency of 28 hertz and at the longest pulse width possible (from 100 to 200 milliseconds).

• The electrical stimulator should be turned on and the intensity slowly increased until the patient reports feeling the stimulation, usually occurring at 20 milliamperes or slightly less.  Higher currents are not thought to be advisable, and no involuntary muscle contraction or increased in muscle tonus should be allowed to occur.

• Stimulation should last for from 20 to 60 minutes.

• Ideally, this treatment should be applied three or four times a day, at equally spaced intervals.  Successful treatment has been noted to occur if stimulation is provided only once a day, or even as little as three times a week.  However, the speed of healing seems directly related to the number and frequency of treatment sessions.

• Following treatment, the electrodes should be removed.  If necessary, the dermal lesion should be redressed according to hygienic guidelines.

• The electrodes should be sanitized according to institutional hygienic guidelines (soaked in a bactericide solution or sterilized) before reuse.

References:

M. Brown, M.K. McDonnell, D.N. Menton, "Electrical Stimulation Effects on Cutaneous Wound Healing in Rabbits," Physical Therapy, 68:6, June 1988. Pp. 955-960

J.A. Feeder, L.C. Kloth, G.D. Gentzkow, "Chronic Dermal Ulcer Healing Enhanced with Monophasic Pulsed Electrical Stimulation," Physical Therapy, 71:9, September 1991. Pp. 639-649

J.W. Griffin, R.E. Tooms, R.A. Mendius, J.K. Clifft, R.V. Zwaag, F. El-Zeky, "Efficacy of High Voltage Pulsed Current for Healing of Pressure Ulcers in Patients with Spinal Cord Injury," Physical Therapy, 71:6, June 1991. Pp. 433-444

D.B. Harrington and R. Meyer, "Effects of Small Amounts of Electric Current at the Cellular Level," Annals of the N.Y. Academy of Science, vol. 238, October 11, 1974. Pp. 300-305

M.J. Im, W.P.A. Lee, J.E. Hoopes, "Effect of Electrical Stimulation on Survival of Skin Flaps in Pigs," Physical Therapy, 70:1, January 1990. Pp. 37-40

C.B. Kincaid, K.H. Lavoie, "Inhibition of Bacterial Growth In Vitro Following Stimulation with High Voltage, Monophasic, Pulsed Current, Physical Therapy, 69:8, August 1989. Pp. 651-655

L.C. Kloth, J.A. Feedar, "Acceleration of Wound Healing with High Voltage, Monophasic, Pulsed Current," Physical Therapy, 68:4, April 1988. Pp. 503-508

B.A. Rowley, J.M. McKenna and G.R. Chase, "The Influence of Electrical Current on an Infecting Microorganism in Wounds," Annals of the N.Y. Academy of Sciences, vol. 238, October 11, 1974. Pp. 543-551

L.P. Taylor, T. Hui, The Taylor Technique of Soft Tissue Management, Inflammation: Evaluation & Treatment, 2002.  Pp. 75-76

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