Infection management
"All wounds contain
micro-organisms, yet the
majority are not infected."1
All wounds, even postoperative wounds, are colonized by a variety of aerobic and anaerobic bacteria.2 However, the presence of bacteria in a wound is not inherently harmful – infection only occurs when the bioburden exceeds the level manageable by the host.3
Wound bioburden refers to the presence of bacteria in the wound competing for a limited supply of oxygen and nutrients, which creates a burden on the wound-healing process.
Bioburden is more than just a quantitative assessment of the number of bacteria present in the wound; diversity, virulence, and interaction of organisms are also key factors of the negative impact of micro-organisms on the wound.
Toxins released from certain bacteria, such as Pseudomonas aeruginosa, are known to affect progression toward healing.1
Delayed wound healing manifests as a prolonged or extended inflammatory response, an alteration in collagen synthesis and deposition, delayed epithelialization, and alteration in wound contraction.4
As wound infection results in an impeded wound-healing process, consideration of healing rate of the wound combined with assessment of the signs of infection can help with the decision to intervene.1
References [+]
- Vowden P, Cooper RA. An integrated approach to managing wound infection. In: Moffatt CJ, RCooper, 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.
- Bowler P (1998). The anaerobic and aerobic microbiology of wounds: a review. Wounds 10(6): 170–8.
- Bowler PG, 2003. Progression towards healing: Wound Infection and the Role of an Advanced Silver-Containing Hydrofiber® Dressing Ostomy Wound Management 49: (8) Suppl. 2-5.
- Bates-Jensen BM. Management of exudate and infection. In: Sussman C, Bates-Jensen BM, eds. Wound Care: A Collaborative Practice Manual for Physical Therapists and Nurses. Gaithersburg, Md: Aspen Publishers Inc; 1998:159-177.