Fungal Dressing Procedure
For fungal infections at gastrostomy or tube sites, apply an antimicrobial ointment or dressing with sustained-release antimicrobial properties (containing silver, iodine, or polyhexamethylene biguanide) to the affected area, and if necessary, combine with systemic antifungal treatment. 1
Assessment and Identification
- Inspect the site for signs of fungal infection including loss of skin integrity, erythema, purulent and/or malodorous exudate, fever, and pain 1
- Swab the area for both bacterial and fungal culture to confirm infection type before treatment 1
- Check for risk factors that predispose to fungal infections including diabetes, obesity, poor nutritional status, chronic corticosteroid therapy, or other immunosuppressive therapy 1
- Assess for hyper-hydrated or inflamed skin due to leakage, which can promote growth of microorganisms 1
Preparation
- Gather necessary supplies: antimicrobial agent (ointment or dressing), clean gloves, sterile water, cleaning solution, and disposal bag 1
- Ensure the external bolster is not too tight, causing excessive pressure between internal and external bolster which can contribute to infection 1
- For established stoma sites, clean twice weekly with soap and water of drinking quality 1
- For newer sites (less than one week old), use aseptic technique for wound care 1
Application Procedure
- Clean the affected area thoroughly with soap and water and dry completely 1
- Apply a topical antifungal agent to the entry site of the tube and surrounding tissue 1
- For sustained release, use antimicrobial dressings that get their activity from silver, iodine or polyhexamethylene biguanide, available in different forms (foams, hydrocolloids or alginates) 1
- Be aware of potential allergies to product components and note that silver dressings cannot be used during MRI procedures 1
- For silicone tubes with fungal infection, tube removal and/or replacement may be necessary 1
Special Considerations
- If using a foam dressing rather than gauze, this can reduce local skin irritation as foam lifts drainage away from the skin, whereas gauze can contribute to more skin maceration 1
- Apply a barrier film or cream to protect surrounding skin if the area is exuding 1
- For balloon-type tubes, check the water volume weekly to prevent spontaneous balloon deflation due to water leakage 1
- For persistent fungal infections, especially with silicone tubes, removal and replacement of the gastrostomy tube may be necessary 1
Follow-up Care
- Monitor the site daily for improvement or worsening of infection 1
- If the fungal infection cannot be resolved with topical antimicrobial treatment combined with systemic antifungal agents, tube removal should be considered 1
- For fungal infections that persist despite appropriate treatment, consider stoma tract disruption, peristomal infection, or skin excoriation as potential complications requiring tube replacement 1
- Maintain good hygiene practices after treatment to prevent recurrence 1
Common Pitfalls and Caveats
- Avoid using topical antibiotics for fungal infections as they are ineffective and may promote resistance 1
- Do not use saline in balloon-type tubes; use sterile water instead 1
- Ensure dressings are changed when they become damp, loose, soiled, or non-adherent 1
- Be vigilant about fungal infections in patients with diabetes, obesity, poor nutritional status and those on chronic corticosteroid therapy or other immunosuppressive therapy 1
- For fungal infections of the skin, treatment duration is typically 1-2 weeks, but may need to be extended based on clinical response 2, 3