How much do you really know about the diabetic foot and infections? Have you heard about the great work being done by the International Working Group on the Diabetic Foot? In 2015 they have released some really good documents which I think provide good information and are easy to use. Click on the title to access Guidance on the diagnosis and management of foot infections in persons with diabetes.
The document is very practical in its layout and includes the following topics:
Soft Tissue Infection
Treatment and Key Controversies
“Infection is best deﬁned as an invasion and multiplication of microorganisms in host tissues that induces a host inﬂammatory response, usually followed by tissue destruction. DFI is deﬁned clinically as manifestations of this process in soft tissue or bone anywhere below the malleoli in a person with diabetes. These infections usually begin with a break in the protective cutaneous envelope, typically in a site of trauma or ulceration . Peripheral neuropathy (mostly sensory, but also motor and autonomic) is the main factor leading to skin breaks; these open wounds then become colonised (usually with skin ﬂora) and, in many cases, ultimately infected. Foot ischemia, related to peripheral arterial disease, is also common in patients with a DFI”.
Here is an example of a recommentation: Recommendation 23
“Do not select a specific type of dressing for a diabetic foot infection with the aim of preventing an infection, or improving its outcome For treating DFIs, antibiotics (and often surgery) are necessary, but not sufﬁcient to overcome inadequate vascular supply, poor glycaemic control, persistent wound trauma or improper wound care .
In the hands of an experienced surgeon, most amputations can be foot sparing (i.e., below the malleoli), and long-term control of infection is achieved in over 80% of cases . The presence of limb or foot ischemia has an important adverse effect on the outcome, synergising with infection to worsen the prognosis .
Unfortunately, having had one foot infection is associated with an increased likelihood of another; foot infection recurs in 20% to 30% of diabetic patients, especially those with underlying osteomyelitis”.
The Nurses for Nurses Network has a great range of Nursing Education and Nursing activities related to wound care including the best practice management of leg ulcers. The sessions are focused on Nurses who need to know about managing wound care in the ‘real world’ where Nurses are often time poor and resource limited!