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Page last updated:
24 December 2019
Diagnosing wound infection is a clinical judgement. Micro-organisms are contained in all wounds however the majority do not become infected.
An increased level of suspicion for the likelihood of wound infection should be maintained in patients with:
Wound management strategies must aim to provide optimal wound healing conditions
Topical antibiotic preparations are used to reduce levels of bacteria within the wound bed and in burns to prevent infection. They are frequent sensitisers, can encourage the development of resistant bacteria and have no effect on healing. Therefore, their use should be carefully restricted.
Please see 13.10.1 Antibacterial preparations
Wound swabs should be taken following wound cleansing (and debridement if appropriate) from wounds which are critically colonised or clinically infected. The following wound types should be swabbed:
The swab result is to confirm that the antibiotic regime is the appropriate one. If indicated, change antibiotics in response to swab.
For suspected critically colonised wounds a two-week anti-microbial dressing challenge without microbiological swabbing is appropriate.
Systemic antibiotics should be used in the presence of systemic and spreading infection.
Antibiotics should be prescribed in line with local antibiotic prescribing policies. A swab should also be sent, and antibiotic changed if indicated by result.
Anti-microbial dressings should be considered to reduce bio burden in acute and chronic wounds that are infected or are being prevented from healing by microorganisms
The products available to combat infection and promote healing work in particular ways:
Please see 17.3 Antimicrobial dressings
NHS England useful tools and key resources - Sepsis
If a wound is malodorous:
Effective infection control interventions should include the minimising of contamination of wounds from pathogenic organisms. The use of dressings capable of providing a bacterial barrier should be encouraged particularly in the management of "at risk" patient groups. Semi-permeable films, hydrocolloids and foam dressings prevent the ingress of bacteria into the wound and help to prevent cross-infection to other individuals where wound contamination, colonisation and infection has occurred. Non-occlusive dressings must be changed as soon as strike-through has occurred.
The use of occlusive dressings on patients with diabetic/ischaemic foot ulceration is not recommended.
If transmission of bacterial burden, including MRSA, poses a risk to the patient or those in close contact, use a topical agent or dressing. A combination with systemic therapy maybe indicated. For further information see the Infection Control policy or contact a microbiologist.
The effective management of wounds relies on the preparation of an optimal wound healing environment. The presence of high levels of necrotic tissue in the wound presents an ideal environment for bacterial colonisation and proliferation. It also reduces the therapeutic effect of systemic antibiotic therapy. The effective treatment of wound infection and colonisation must include the management of the necrotic burden. Necrotic material can be removed from the wound by autolysis, enzymatic, sharp debridement or larval therapy, by a trained healthcare professional.
The choice of the most appropriate debridement method depends on individual patient circumstances, wound status, therapy availability, clinician expertise and the healthcare environment. Expert advice is available and should be sought.
The prevention of spreading wound contaminants from the environment to the patient, or between patients is everyone's responsibility. Good hand hygiene and adherence to infection control guidelines is essential.
The use of sterile dressing packs and aseptic dressing techniques is not essential for all types of dressing, see 17.7 Wound care accessories
Clinically clean procedures may be adopted to manage chronic, colonised wounds (such as the treatment of venous ulceration) or in the first aid of traumatic injuries.
Procedures vary within clinical environments. It is the responsibility of the healthcare practitioner to seek out, and adhere to, those protocols that are available.
A wound will not heal unless it is red and clean, and therefore it must be moist and warm with adequate supplies of nutrition and oxygen. Some patients experience delayed healing or develop chronic wounds and the cause of this may be either patient related (intrinsic) or wound-related (extrinsic).
If a leg ulcer fails to heal with conventional therapy within 12 weeks, specialist and/or vascular opinion should be sought.