How to treat and assess infected wounds.
Did you know? All open wounds are contaminated or colonised with microorganisms; however, not all contaminated wounds become infected. The risk of wound infection depends on the individual, their wound and the environment.
1) A tool that covers different stages of the microbial presence in the wound.
The transition from non-infected to infected wounds is often gradual. It's generally agreed that continuous, accurate and holistic wound assessment is needed to determine the risk of infection. To help identify and assess infection in wounds, many healthcare professionals use the wound infection continuum during their holistic wound assessment. It's a well acknowledged educational tool created the IWII (International Wound Infection Institute). This tool helps you understand various stages of microbial presence within the wound. It can also support you in making the clinical assessment of wound infection. By understanding the signs and symptoms of each stage and closely following the wound progression, you can create or adjust your treatment plan.
2) Signs and symptoms of each stage.
IWII wound infection continuum represents various stages of microbial presence in a wound that increases in severity.
First stage: Contamination - Microorganisms are present within the wound but are not proliferating. This means that the microorganisms are not multiplying at a rapid pace. No delay in healing and no signs of infection are observed. In this stage, the person will not be affected by the microorganisms.
Second stage: Colonisation - Microorganisms are present within the wound and are undergoing limited proliferation. Still no delay in healing and no signs of infection are observed. In this stage, the person (host) will also not be affected by the microorganisms.
Third stage: Local wound infection - This stage is characterised by the presence and proliferation of microorganisms within the wound that often include a delay in wound healing. Local infection is contained within the wound and the immediate periwound region (less than 2cm). In this stage the microorganisms will invade the tissue and the person's immune system will respond to that.
Ask yourself? Do you see subtle (covert) or classic (overt) signs of local wound infection?
Remember that any two or more signs indicate local infection.
Subtle signs and symptoms:
- Hypergranulation
- Bleeding
- Pockets in the tissue
- Delayed wound healing beyond expectations
Classic signs and symptoms:
- Erythema
- Local warmth
- Swelling
- Purelent discharge
- Wound breakdown
- New or increased pain
- Malodour
Fourth stage: spreading infection - This stage is characterised by the invasion of the surrounding tissue by infective microorganisms that have spread from the wound beyond the wound border.
Signs and symptoms may include:
- Wound breakdown or breakdown of surrounding areas
- Inflammation or spreading erythema, more than two centimetres beyond the wound edge.
- Thickening and hardening of soft tissue
- Swelling of lymph glands
Remember: Any sign in combination with two or more signs of local infection indicates spreading infection
Fifth stage: systemic infection - This refers to the stage where microorganisms spread throughout the body via vascular or lymphatic systems, affecting the body as a whole.
Signs and symptoms may include:
Malaise
Lethargy
Loss of appetite
Fever
Severe sepsis
Septic shock
Organ failure
Death
3) How to manage the wound based on these stages.
You should suspect infection when there are multiple signs and symptoms rather than the presence of any signs and symptoms. Think about how to maximise the persons host defence against infection as part of your holistic wound assessment. Always prepare the wound to remove the barriers that may delay wound healing. In this way, you can reduce the bioburden and the risk of infection as non-viable tissue may serve as a source of nutrients for bacteria. The goal is to prevent new organisms from recolonising the wound. Use topical antimicrobial treatment to manage wounds showing signs and symptoms of local wound infection.
Consider the duration and choice of a topical antiseptic based on regular wound assessment and the goals of care for a particular person and their wound. At least two weeks are recommended before evaluating its efficacy in managing wound infection. Use topical antimicrobial treatments in combination with systemic antibiotics for wound showing signs and symptoms of spreading or systemic infections.
To wrap up: Continuous, accurate and holistic wound assessment is needed to determine the risk of infection. IWII wound infection continuum is a well-acknowledged educational tool. It can support you in making a clinical assessment of potential wound infection.
Closely monitor wound progression and remember to consult a wound care specialist if needed.