Do you have difficulty managing wound infections? Is there a single definitive test to diagnose a wound infection? When should a wound culture swab be taken? Wound care is a core function of Nursing and managing wound infections is challenging . Whilst workplaces provide access to Nursing Education and Nursing resources I thought the enclosed article contains really good points for Nurses to note. The reference for this article is Swanson T, Grothier L, Schultz G. Wound Infection Made Easy. Wounds International 2014. www.woundsinternational.co2014.www.woundsinternational.com A copy is enclosed for your information.m A copy is enclosed for your information.
In regards to Wound Infections the following points are of interest!
- There is no single test to definitively diagnose infection; wound infection is diagnosed by clinical assessment of the wound and the whole patient
- It is recommended that systemic antibiotics are used cautiously. Potential triggers for systemic antibiotic use may include:
- Abnormal/absent granulation or necrosis
- Pocketing, tunnelling, maceration
- Static or enlarged wound size
- Erythema spreading>2cm around the wound
- Appearance of or changes in nature of the pain
- Wound deepening to involve structures under the skin and subcutaneous tissues
- Increased body temperature
- Heart rate> 90 beats per minute
- A wound swab culture might not capture bacteria protected within a biofilm, nor will it detect biofilm, so the result is often inconclusive
- Initiate a wound swab;
- Initial presentation of the wound
- Wound not progressing with healing after 2 weeks of treatment
- Per protocol to screen for resistant microbes
- Upon treatment completion to confirm clearance of microbes
- If a swab is needed…, the wound should first be irrigated with normal saline, to remove surface debris and avoid detection of only surface contaminants
- Chronic wounds may not always show the classic signs of wound infection including inflammation, new or increasing pain, local heat, swelling, advancing redness and purulence.
- Take note of malodour, friable/bleeding tissues, breakdown/increase in size of the wound, discolouration, spreading erythema, change in the nature of the pain, bridging of the wound, pocketing at the base of the wound, increased or purulent exudate
- It is reported that most wounds should heal within about 4 weeks
- Burns [email protected] 2% per day have positive indications for healing and patient survival
- Commonly used topical antimicrobials include:
- Enzyme alginogel
- Iodine (povidone,cadexomer)
- Medical-grade honey
- Octenidine dihydrocholoride
- Polyhexamethylene biguanide (PHMB)
- Silver (meltallic,nanocrystalline,ionic)
- Silver sulfadiazine
As Nurses we understand the importance of adhering to your organisations policies and procedures- however you may find this content of interest and the document could be used as a catalyst for discussion in your workplace regarding current wound management Nursing Practice .
The Nurses for Nurses Network has a great range of Nursing Education and Nursing activities related to wound care. 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!