Managing and Treating Wound Infection: Taking a Holistic Approach

Wound sampling is used to identify the type and number of bacteria. Procedures for both aerobic and anaerobic microorganisms should be used. Wounds identified for sampling encompass those that are clinically infected, and those that are non-healing or deteriorating without clinical signs of infection. Wound sampling may involve surface samples, tissue biopsy during surgical debridement procedures, and closed space fluid such as enclosed abscesses.

With surface samples, semi-quantitative swabs may provide meaningless information with regard to wound care decisions. However, swabs can serve as an important adjunct in managing chronic wounds. (Ratliff and Rodeheaver, 2002) Although a swab will not diagnose an infection, it will reveal the type of organisms, numbers of organisms, and sensitivity and resistance. More meaningful information can be obtained from swab specimens that are quantitatively processed in the laboratory. (Gardner, 2007)

Wound infection varies by severity and should be classified according to symptoms. Signs of a superficial infection include a non-healing area, bright red granulation tissue, friable and exuberant granulation, new areas of breakdown or necrosis, increased exudate, bridging of soft tissue and the epithelium, and foul odor. A deep wound infection is identified by pain, induration, erythema greater than two centimeters, wound breakdown, increased size or satellite areas, undermining or tunneling of area, probing to bone, and flu-like symptoms. A systemic infection may be present if, in addition to the symptoms of a deep wound infection, the patient exhibits fever, rigors, chills, hypotension, and multi-organ failure.

Treatment modalities for infection control should involve a four-pronged approach: host support, medical asepsis, cleansing and debriding, and antimicrobial therapy.

Strategies for a superficial infection include support for the patient’s defenses, cleansing and debriding the wound, antimicrobials, and possibly oral/IV antibiotics, depending upon the patient risk. Evaluation based on clinical findings is ongoing, and patient education is essential.

For a deep wound infection, further steps in addition to those for a superficial infection include use of a polymicrobial, use of oral or IV antibiotics, possible surgical debridement, and potentially infectious disease consultation, as well. For a systemic infection, steps in addition to those described above include hospitalization and IV antibiotics.

In general, bacterial control host support should be the primary management strategy in preventing and treating wound infection. This includes: environment support to explore lifestyle choices that affect the patient’s vulnerability to infection (e.g., adequate rest); systemic support to review the person’s physical and emotional vulnerability to infection; (Segerstrom and Miller, 2004) and local support to remove necrotic tissue to decrease the risk of infection.