of Local Wound Bed Infection Julie Hewish Senior Tissue Viability - - PowerPoint PPT Presentation

Effective Diagnosis

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Local Wound Bed Infection

Julie Hewish Senior Tissue Viability Nurse Oxford Health NHS Foundation Trust

Localised Wound Bed Infection is the

Result of imbalance between patient’s immune system and the conditions within the wound (EWMA 2005)

“The Germ is nothing. It is the terrain in which it is found that is everything.”

Pasteur 1880

Trust Guidelines

Wound Infection is a clinical diagnosis Wound swabs are only indicated where systemic antibiotic therapy is required. Antibiotics should not be used in the absence of systemic/soft tissue infection.

All wound contain bacteria therefore the Challenge: recognising the signs of an increase in the numbers of bacteria – the bioburden, which may lead to infection. Timely intervention

Bacterial Balance

Presence of non-replicating micro-organisms Patient and Wound Bed currently stable. Routine wound management: Peri-wound cleansing Exudate management

Contamination

Presence of multiplying micro-organisms with no injury to the host Healing potentially compromised

Routine wound management: Peri-wound cleansing Exudate management Debridement Consider topical antimicrobial dressing

Colonisation

Proactive approach to wound management: Debridement Use of antimicrobials Exudate management Antibiotic therapy Yes / No

Micro-organisms are a burden Patient experience: Acute Increased pain Acute Increasing exudate levels

Local Wound Bed Infection

Consider:

Increased wound discharge Unexpected pain Non or delayed healing Wound breakdown Bridging of epithelium Pocketing in the wound bed Unhealthy granulation tissue:

bright red, often friable, bleeding brown Granulation tissue

Abscess formation Malodour

Assessment and Management

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Infected wounds Assessment and Management

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Consider possible systemic treatments for wound infection Consider topical treatments for wound infection

Wound Bed Contamination Patient’s immune system is maintaining bacteria at safe levels. Healing/patient not compromised LOCAL SIGNS & SYMPTOMS Wound Bed Wound surface area has reduced in size by 40% at 6 weeks. Positive granulation/epithelialisation Exudate Levels Normal exudate for patient / wound type Pain No change Erythema Erythema not usually present SYSTEMIC SIGNS & SYMPTOMS None MANAGEMENT Systemic Anttimicrobials (antibiotics) No High Risk Patient Wound Swabs for M, C & S No 2 Topical Antimicrobial dressing Standard formulary dressing Other Actions

• Treat / optimise co-existing morbidities
• Assess wound for critical

colonisation/infection at every dressing change

• Debride sloughy/necrotic tissue 3

Wound Bed Colonisation Multiplying bacteria has the ability to tip patient and wound defences Healing Compromised Healing has slowed / or stopped (non-progressing wound)). Sloughy/necrotic tissue may be present LOCAL SIGNS & SYMPTOMS Wound Bed Increased exudate (sometmes mild odour) Exudate Levels Increased/changed pain Pain Erythema not usually present Erythema None SYSTEMIC SIGNS & SYMPTOMS No MANAGEMEN T Systemic antibiotics Consider antibiotic in line with local prescribing protocols/guidelines Wound Swabs for M, C & S No Antimicrobial dressing 1st Line Honey-impregnated dressing 2nd Iodine-based dressing Other Actions

• Consider referral to Tissue Viability
• Treat / optimise co-existing morbidities
• Assess wound for infection at every

dressing change

• Debride sloughy/necrotic tissue 3

Wound Bed Colonisation

Local Wound Bed Infection Patient’s defences are overwhelmed Healing and patient compromised LOCAL SIGNS & SYMPTOMS Wound Bed Healing has stopped or Wound has deteriorated / extended Exudate levels Malodour/Copious/purulent exudate Pain Acute Pain/changed pain Erythema Local Wound Bed Infection Erythematous border <2cm Systemic Infection Erythematous border >2cm SYSTEMIC SIGNS & SYMPTOMS Abnormal /changed Odour Discoloured/friable Tissue pocketing Bridging /necrosis slough

• Pyrexia
• Tachycardia
• General malaise
• Raised WBC &

CRP Soft Tissue Infection MANAGEMENT Systemic Antimicrobials (antibiotics) No Yes High Risk Patient Yes Wound Swabs for M, C & S No 2 Yes Antimicrobial dressing 1st Line Honey-impregnated dressing 2nd Iodine-based dressing Other Actions

• Refer to Tissue Viability if support needed
• Treat / optimise co-existing morbidities

Local Wound Bed Infection

Conclusion:

Improve patient outcomes Need for early and accurate diagnosis of wound infection

Indiscriminate use of antibiotics Increasing cost of antimicrobial dressings

Careful, thorough assessment of the person with the infection Management of the symptoms of infection Reduce the risk of complications

Thank you for listening