Wound infection
Wound infection is a major challenge not only for the individual and their families, affecting quality of life, but also has a significant impact on healthcare professionals, the health services, and creates economic implications.
Infection. If left unmanaged it can lead to chronic/ non-healing wounds, with involvement of bone, spreading and / or systemic infection, long term incapacities and even death1.
Wound infection is the invasion of a wound by proliferating microorganisms to a level that invokes a local and/or systemic response in the host. The presence of microorganisms within the wound causes local tissue damage and impedes wound healing2.
A simpler definition is impairment of wound healing by bacteria.
All wounds are contaminated, and every type of wound has the potential to develop an infection. Having said that, not every wound will proceed down that route, and will not undergo a delay in healing.
Early detection/recognition, along with the appropriate and effective intervention, is essential to reduce the consequences, both health-wise and financially.
Prevention
Ideally prevention of wound infection is preferable, but not always possible. Prevention should be focused on introducing and applying strategies to reduce the individual's risk factors and establishing clinical goals. Where appropriate, working in conjunction the individual their family and or caregivers2.
For the Health Care Professionals, the foundation of preventing infection is in a back-to-basics approach that include the following:
Infection risk factors
The risk of developing a wound infection is influenced by an individual’s characteristics, their wound and the environment. The factors that can affect the development of an infection are often multifactorial and encompass many variables, including the factors in the diagram below and those that incapacitate the individual, impact on the cardiovascular and immune system.
There are also environmental factors to take into account that include:
Other factors to include for consideration would be, radiation and chemotherapy, peripheral neuropathy, neuroarthropathy, connective tissue disorder e.g., Elhers-Danlos syndrome and corticosteroid use2.
When reviewing the infection risk, the type of wound can have an influence. Although there are those factors that affect both types of wounds, an acute wound will have different risk factors compared to a chronic wound.
For example, a surgical wounds risk is influenced by the type and length of surgery combined with the individual's and environmental factors2.
Infection signs and symptoms
Those caring for patients with, or at risk of, developing a wound need to be able to recognise the signs and symptoms of wound infection.
?In Acute wounds infection can typically manifest clinically as clear and obvious signs and symptoms, with diagnosis most frequently made by Health Care Professionals. This is based on classic signs such as warmth, pain, swelling and redness.
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These signs can be mistaken for the general inflammation phase of wound healing, therefore attention to the individuals risk factors, wound type, environment and other less classic symptoms for example exudate/ discharge and its amount and colour should be considered.
Clinical signs and symptoms in chronic wound infections tend to be less obvious than in acute wound infections. They tend to be more subtle such as delay in wound healing, delicate bleeding tissue, evidence of hyper-granulation pocketing of the wound bed and bridging2.
If local infection and risk factors are unable to be managed and the bioburden of the wound increases the wound can progress to a spreading infection and / or with systemic involvement. Acute/ hospital intervention is often required at these stages to prevent serious health implications.
Red flags
Acute deterioration or sepsis is rare, but it is a potentially fatal condition. Recognising and treating infection early, before sepsis develops, is vital.
Within the UK there is the National Early Warning Score? that covers changes in:
or there are signs of infection – then the patient should be screened for sepsis.
Sepsis organisations also have the following pneumonic to assist with recognising symptoms?.
With regards to level to confusion, the patient has new-onset confusion, disorientation and/or agitation, where previously their mental state was normal – this may be subtle.
If any of these are being experienced this is a medical emergency and should be treated as such.
For further information on products that support infection management please reach out to us at [email protected].
References
1.Sharland M and Wilson P. NICE impact antimicrobial resistance, 2018. NICE, London, UK. Available from: https://www.nice.org.uk/Media/Default/About/what-we-do/Into-practice/measuring-uptake/NICEimpact-antimicrobial-resistance.pdf (accessed on 18 December 2019).
2.International Wound Infection Institute (IWII) Wound Infection in Clinical Practice. Wounds International. 2022.
3. Wounds UK (2020) Best Practice Statement: Antimicrobial stewardship strategies for wound management.
Wounds UK, London.
4. Royal College of Physicians. National Early Warning Score (NEWS2). December 2017. https://www.rcplondon.ac.uk/projects/outputs/national-early-warning-score-news-2
5.Sepsis Trust. https://sepsistrust.org/ accessed April 2023
Principle CEO Ai-Wound Inc
1 年Yes critical colonization has its markers but a semi quantitative swab or punch biopsy is the only valid way to Dx infection.