Wound infection

• Wound infection has a significant impact on economic and Patient outcomes (IWJ 2008), However it is often misdiagnosed and mistreated.

•

“Wound infection scares me on a daily basis. It is one of the most challenging aspects of wound management today - a major contributor to healthcare costs around the world, and the cause of significant distress to patients and carers.”

Professor Keith Harding

Statistics associated with HAIs

• 10% of patients get a HAI• 5000 patients every year die of HAI– 5000 patients die every year of “superbug”

infection• Deaths due to MRSA are increasing• Costs £1 billion per year• 15% of HAI are preventable

How does infection occur?

• This depends on the type of bacteria.• The number of bacteria • The host reaction (ie the patients ability to

fight infection).

• All individuals are covered with a range of bacteria known as normal body flora, these are usually not harmful.

• When a wound occurs bacteria enters the skin and may cause an infection.

The presence of bacteria

• Contamination– Presence of bacteria, without multiplication

• Colonisation– Multiplication, but no host reaction

• Infection– Deposition and multiplication of organisms in tissue, with an associated host

reaction( Ayton, 1985)

Bacteria Causing Wound Infection Prolong Healing

• By destroying cells by competing for available oxygen supplies

• By releasing toxins that damage tissue causing necrosis & pus formation

• By releasing toxins into the blood stream.

Why do wounds become infected?

Conditions for bacterial growth• time• temperature• food• moisture• A wonderful culture medium

Who is at risk of infection?

Is Patient at risk of Infection?• Reduced resistance• Malignancy• Medical condition -

Diabetes• Medication• Psychological• Position of Wound• Type of tissue

present• Chronic wound• Size of wound(Cutting et al 1994)• Reduced tissue

perfusion

Tissue typesNecrosis Slough

• How do we recognise of wound infection?

Signs of infection

•Erythema•Heat•Swelling•Pain•Loss of function•Patient may have a temperature or be generally unwell – these patients need fast assessment!!

Signs of infection•SUPERFICIAL BRIDGING

•FRIABLE TISSUE

•BLEEDS EASILY

•PAIN IN WOUND

•DELAY IN HEALING

•ODOUR

•Increase in exudate and colour

You may be asked to perform a wound swab

• Clean wound first to remove surface debris.• Using gentle pressure rub the swab in a zig zag

motion over the wound bed• This is known as the levine technique• Ensure that the form has been filled in with

correct clinical information

Prevention is better than cure

• How can we help in preventing wound infection?• Remember your patient is watching

you!!!

Infection control is paramount• Handwashing

Gloves and ApronsProtects you and your patient!!!

Infection control is paramount• Clean non touch technique for dressing

change =chronic wounds• or aseptic technique = acute wounds

What treatments might your patient be prescribed?

Using antimicrobialsAntimicrobials are agents that either kill or inhibit the growth and division of micro – organisms. They include antibiotics (which act on specific cellular target sites) antiseptics, disinfectants and other agents (which act on multiple cellular target sites).

Antibiotics act on ….

Antiseptics act on ...

Types of treatments available

• Systemic• Topical– Debridement (WBP)– Antibiotic– Antimicrobial

• Iodine• Silver• Honey• PHMB• Chlorhexidine

• Your patient may be displaying signs of infection

• If you have identified some of the above symptoms please get the patient assessed ASAP by a GP or Nurse in charge.

• Failure to identify and treat wound infection may have serious consequences for your patient.

Are these wound infections?