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Wound Infection
Surgical wound infections are the second most frequent nosocomial infection in most hospitals and are an important cause of morbidity, mortality, and excess hospital costs.
Wound Infections in Two Health Institutions in Ile-Ife, Nigeria: Results of a Cohort Study
The control of wound infections is increasingly complicated, yet treatment is not always guided by microbiological diagnosis. To describe the distribution of wound infections and causative agents, a prospective, 6-month cohort study involving 102 outpatients was conducted at the University Teaching Hospital and the Health Center in Ile-Ife, Nigeria. Location and type of infected wounds were recorded and bacterial isolates were identified by standard microbiological techniques. Almost half (40%) of all infected wounds were attributed to trauma and, in most cases, located on the extremities. Of the 162 bacterial isolates obtained from wound cultures, 39 were monomicrobial and 55 were polymicrobial; no bacterial isolate was obtained in eight cases. Staphylococcus aureus was the predominant micro-organism (25%), followed by Escherichia coli (12%), Pseudomonas aeruginosa (9%), and Staphylococcus epidermidis (9%). The diversity of micro-organisms and the high incidence of polymicrobic flora in this study give credence to the value of identifying one or more bacterial pathogens from wound cultures. The recognition of causative agents of wound infections can assist wound care practitioners in taking appropriate measures. Continuous dialogue between the microbiology department and wound care practitioners is strongly advised in order to improve treatment outcomes and slow the development of antibiotic-resistant bacteria.
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Criteria for Identifying Wound Infection ? Revisited
The accurate identification of wound infection provides a clinical challenge to those involved in patient care and would appear to have not kept pace with other developments in the field of wound care. Attempts have been made to improve on the situation but diverse opinions together with lack of consensus prevail. The literature on infection criteria was reviewed and a set of criteria were collated; a number of criteria at the time were described as subtle in nature and have undergone validation studies. This article suggests a new perspective on the clinical identification of wound infection ? ie, the signs of infection are closely associated with the wound type. Infection criteria for six wound types are explored and presented. This approach is intended for consideration together with the results of an impending Delphi study that will raise awareness of this issue, promote discussion, and lead to validation of an accurate set of clinical criteria. KEYWORDS: clinical criteria, wound infection, Delphi, critical colonization, delayed healing
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Critical Colonization ? The Concept under Scrutiny
Infection in chronic wounds presents a major clinical challenge and is a cause of high morbidity rates. Much attention has been dedicated to identifying and managing this problem since the publication of the first article on chronic wound infection criteria in 1994. To illustrate how alteration in wound bioburden impacts pathology, the Wound Infection Continuum has been devised and subsequently modified. One stage in this continuum, critical colonization, is putatively described as a pivotal phase that occurs without inducing an overt host response. Critical colonization suggests that the concept is currently better explained from a microbiological than from a clinical perspective. The status of critically colonized wounds may change in one of several ways: 1) deteriorate to clinical infection, 2) remain in a critically colonized state, or 3) improve following appropriate intervention. Research to clearly define the term and clarify the role of bioburden in the chronic wound is needed to help clinicians recognize and implement appropriate treatment.
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The Wound Infection Continuum and its Application to Clinical Practice
Four basic conditions exist in open wounds resulting from the level of bioburden present (bacterial contamination - normal but short-lived state, colonization - normal state, critical colonization - abnormal state, and infection - abnormal state). The two abnormal states have the potential to disrupt the orderly healing sequence, which results in the development of a chronic wound. In addition, the impact of the wound's anatomical position, duration, shape, or presentation; the patient's level of health and control of underlying pathologies; the presence of infection-potentiating factors such as foreign bodies, hematoma, and necrotic tissue; the sources and frequency of exogenous contamination; the considered virulence of the individual micro-flora species; and the potential synergism between different species all require consideration. This article discusses the states of bioburden and other aspects of microbiology relating to wound infection and their application to clinical practice.
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Bacterial Swabs and the Chronic Wound: When, How, and What Do They Mean
Determining when is far more important than determining how to culture a wound. A wound should be cultured after wound infection has been clinically diagnosed. Wound infection by definition implies that replicating micro-organisms within a wound are having a detrimental effect on the host.
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Bacterial Growth Guideline: Reassessing its Clinical Relevance in Wound Healing
The microbiology of wounds is a key determinant in healing and clinicians generally accept that a level of microbial (ie, bacterial) growth greater than 100,000 viable organisms per gram of tissue can be used to diagnose infection. Although other factors that predispose a wound to infection are widely recognized, today's wound care practitioners are influenced primarily by the 10 5 guideline, with treatment being based on the microbial count in deep or superficial tissue. However, to appropriately manage microbially challenged wounds (eg, heavily colonized and clinically infected), a more balanced awareness of the broader issues relating to micro-organisms and wounds is needed. The types of micro-organisms, their interactions with each other and with the wound environment, the local conditions, and host resistance are all key factors that collectively influence healing. From a microbiological perspective, successful wound healing is dependent on maintaining a host-manageable bioburden. If local conditions favor microbial growth, a wound may fail to heal and become infected, requiring topical antiseptics or antibiotics to supplement the host inflammatory response and restore balance in favor of the host. This paper provides a critical examination of the 10 5 guideline to enhance clinician understanding and utilization of a commonly applied diagnostic consideration.
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Topical Antimicrobials in the Control of Wound Bioburden?Part 2
Part 2 - Commonly Used Antiseptics Iodine. Silver. A topical antiseptic sustained-delivery system (dressing, cream, or ointment) may be indicated if: • one or more overt signs of infection or any less obvious signs such as increased exudate levels are present • local pain is increased &...
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The Inter-rater Reliability of the Clinical Signs and Symptoms Checklist in Diabetic Foot Ulcers
The Clinical Signs and Symptoms Checklist is a tool designed to measure 12 clinical signs and symptoms of localized chronic wound infection. Since its initial development, this Checklist has been revised to include sanguineous drainage. To examine the inter-rater reliability of the revised Clinical Signs and Symptoms Checklist in diabetic foot ulcers, an observational, cross-sectional study was conducted in conjunction with a larger study examining the validity of each sign and symptom for identifying infection in diabetic foot ulcers. Two independent nurse observers assessed 64 diabetic foot ulcers in 64 patients using the Checklist. The reliability of each item was calculated using percent agreement and the Kappa coefficient. Total percent agreement ranged from 76% to 100%, and Kappa statistics ranged from .34 to 1.00. Study findings confirm that the Clinical Signs and Symptoms Checklist is a reliable tool for identifying the clinical signs and symptoms of localized infection in diabetic foot ulcers. KEYWORDS: wound infection, foot ulcer, diabetic foot, clinical signs and symptoms
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Progression toward Healing: Wound Infection and the Role of an Advanced Silver-containing Hydrofiber(R) Dressing
Progression toward Healing: Wound Infection and the Role of an Advanced Silver-containing Hydrofiber(R) Dressing Feature: Progression toward Healing: Wound Infection and the Role of an Advanced Silver-containing Hydrofiber(R) Dressing - Philip Bowler, MPhil The Microbiology of Wounds Wound microbiology and healing are unquestionably associated. Passive and Active Mechanisms of Infection Control Appropriate ...
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Topical Antimicrobials in the Control of Wound Bioburden?Part 1
Bacterial colonization and infection are important factors in compromised wound healing, particularly in chronic wounds. Although ?best practice? for controlling these factors currently is not defined, systemic antibiotics are generally accepted as the preferred choice for treating infection, provided ischemia does not reduce their bioavailability. However, widespread use of systemic and topical antibiotics is associated with the emergence of resistant bacterial strains such as methicillin-resistant Staphylococcus aureus. Colonization of wounds presents a double problem ? potentially delayed healing and a potential source for cross-contamination. The judicious use of dressings, notably those containing certain antiseptic agents, can be a valuable option to control infection and promote healing. A review of the literature underscores the importance of considering the antiseptic route as part of a concerted approach to wound management and infection control.
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