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Wound Infection

This information is intended for Healthcare Professionals only.

 
 
 
 

 

Wound Infection

 

The amount of bacteria in a wound can be used to determine whether or not it is considered infected. And this can vary from patient to patient.

 

Ayton summarises infection as ‘the deposition and multiplication of bacteria in tissue with an associated host reaction.'


That's to say, a wound is considered infected if bacteria are present and there are also other signs and symptoms in the patient to indicate it is causing an adverse response.

 

Below are some classic and secondary signs of infection that a patient may exhibit:

 

 

Infected Wound

Infected Wound

 

Classic clinical signs:
Pain
Redness
Heat
Swelling


Secondary signs:
Serous exudate
Delayed healing
Discoloration of granulation tissue
Pocketing at the base of the wound
Wound breakdown

 


While the response of the individual patient to infection can vary, there are some common causes and outcomes:

 

Factors that can increase the risk of a wound becoming infected:

  • The depth of bacterial tissue
  • The type and mixture of organisms
  • The patient's underlying disease
  • The quality and level of tissue perfusion
  • The ability of the patient's immune system to withstand the multiplication of organisms
  • The patient's environment

And specifically in surgical wounds:

  • The length of operating time
  • Site of the incision
  • The involvement of dirty organs

 

Some consequences of wound infection:

  • Delay of tissue repair
  • Increased odour
  • Increased anxiety, pain and misery for patients
  • Reduced quality of life
  • Increased bed-time
  • Increased cost of healthcare
  • Increased morbidity and mortality

And specifically in surgical wounds:

  • Prostheses rejection
  • Revision surgery
  • Vein graft rejection

 


Preventing infection
The best way to avoid infection is to identify risk factors and address them wherever possible, such as making sure that dead tissue is effectively removed from the wound (debridement).

 

It may also be possible to prevent wound infection by using dressings as physical or antimicrobial barriers, in order to protect a wound from bacterial invasion.

 

This would also help to reduce the risk of cross-contamination (the transfer of harmful bacteria from one host to another).


Prevention and treatment of infection with systemic antibiotics

Antibiotics are antimicrobial agents produced by microorganisms that kill or inhibit other microorganisms. Antibiotic agents can be classified under two main categories:

 

Bacteriostatic: will prevent the multiplication of active pathogens but do not affect those that are not replicating. Therefore, bacteriostatic agents must work with the immune system to remove the microorganisms from the body.

Bactericidal: will kill bacteria outright (whether it's resting or replicating).
It should be noted that high concentrations of most bacteriostatic agents will be bactericidal, while low concentrations of bactericidal agents are only bacteriostatic.

 

Antibiotic agents work by blocking/interfering with a single target in the bacteria necessary to its metabolism or growth.

 

The most common targets being:

  • the cell wall
  • protein synthesis
  • nucleic acid synthesis
  • folic acid synthesis

 

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