Infection management
“The early diagnosis of infection is difficult in pressure ulcers and requires a high level of clinical suspicion.”1
Diagnosis Management
Infection risk in pressure ulcers is high due to the compromised immunological state of the elderly patient population who make up the majority of pressure ulcer cases.1
In addition grade III and IV pressure ulcers tend to occur in the lower part of the body and so have a higher risk of contamination from the corrosive nature of urine and feces.1
DIAGNOSIS
Diagnostic criteria have been identified and validated by an international multidisciplinary group of 54 experts using the Delphi approach. The following key criteria for the pressure ulcer have been highlighted in the 2005 European Wound Management Association position document on infection.1
Criteria for wound infection1
Change in nature of pain
Crepitus
Increase in exudate volume
Pus
Serous exudate with inflammation
Spreading erythema
Viable tissues become sloughy
Warmth in surrounding tissues
Wound stops healing despite relevant measures
Enlarging wound despite pressure relief
Erythema
Friable granulation tissue that bleeds easily
Malodor
Edema
MANAGEMENT
Systemic antibiotics should be used appropriately for patients with bacteremia, sepsis, advancing cellulitis or osteomyeltitis. But there is a debate over their use for local infections.2
According to the 2006 European Wound Management Association position document on “Management of wound infection” the principles of infection management are to:3
- “Provide an environment to promote rapid healing
- Minimize the use of antimicrobial agents that may adversely affect human cells
- Use antimicrobial agents appropriately
- 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
References [+]
- Sanada H, Nakagami G, Romanelli M. Identifying criteria for pressure ulcer infection. In: Moffatt CJ, K Cutting, B Gilchrist, F Gottrup, D Leaper, and P Vowden, eds. European Wound Management Association (EWMA). Position Document. Identifying criteria for wound infection. London: MEP Ltd; 2005:6-9.
- Dolynchuk K, Keast D, Campbell K, et al. Best practices for the prevention and treatment of pressure ulcers. Ostomy Wound Manage. 2000;46(11):38-52; quiz 53-34.
- 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 Management Association (EWMA). Position Document. Management of wound infection. London: MEP Ltd; 2006:2-6.