Infection management

Infection management

Assessing wound infection Management

ASSESSING WOUND INFECTION

Criteria for identifying wound infection have been identified and validated by an international multidisciplinary group of 54 experts using the Delphi approach. The following key criteria for ulcers have been highlighted in the 2005 European Wound Management Association position document on infection1.

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Criteria for wound infection 2

Arterial Leg Ulcers1

Cellulitis
Pus/abscess

Change in color/viscosity of exudate
Change in wound bed color*
Crepitus
Deterioration of wound
Dry necrosis turning wet
Increase in local skin temperature
Lymphangitis
Malodor
Necrosis – new or spreading

*Black for aerobes, bright red for Strepotcoccus, green for Pseudomonas

Erythema
Erythema in peri-ulcer tissue – persists with leg elevation
Fluctuation
Increase in exudate volume
Increase in size in a previously healing ulcer
Increased pain
Ulcer breakdown

 
 

Venous Leg Ulcers1

Cellulitis

Delayed healing despite appropriate compression therapy
Increase in local skin temperature
Increase in ulcer pain/change in nature of pain
Newly formed ulcers within inflamed margins of pre-existing ulcers
Wound bed extension within inflamed margins

Discoloration eg dull, dark brick red
Friable granulation tissue that bleeds easily
Increase in exudate viscosity
Increase in exudate volume
Malodor
New onset dusky wound hue
Sudden appearance/increase in amount of slough
Sudden appearance of necrotic black spots
Ulcer enlargement

 
 

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MANAGEMENT

According to the 2006 European Wound Management Association position document on “Management of wound infection” the principles of infection management are to:2

  • “Provide an environment to promote rapid healing
  • Minimize the use of antimicrobial agents that may adversely affect human cells
  • Use antimicrobial agents appropriately to reduce the selection of resistant strains
  • Restrict the use of systemic agents to when they are specifically indicated
  • Avoid topical sensitization or allergic reactions”

The choice of dressing to minimize the risk of infection is important. “Decisions need to be based on the ability of the dressing to:

  • Manage increased exudation
  • Remove necrotic tissue
  • Reduce malodor
  • Conform to the site and shape of the wound
  • Perform wound bed preparation functions
  • Satisfy patients’ expectations
  • And meet treatment goals”.2
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References [+]

  1. Cutting KF, White RJ, Mahoney P, Harding KG. Clinical identification of wound infection: a Delphi approach. In: Moffatt CJ, K Cutting, B Gilchrist, F Gottrup, D Leaper, and P Vowden, eds. EuropeanWound Management Association (EWMA). Position Document. Identifying criteria for wound infection. London: MEP Ltd; 2005:6-9
  2. Vowden P, Cooper RA. An integrated approach to managing wound infection. In: Moffatt CJ, R Cooper, B Gilchrist, F Gottrup, D Leaper, R Pratt, and P Vowden, eds. European Wound ManagementAssociation (EWMA). Position Document. Management of wound infection. London: MEP Ltd; 2006:2-6

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