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wound infection
WOCN program
| Question | Answer |
|---|---|
| describe the signs and symptoms of infection in chronic wounds | not healing after 2 weeks of topical therapy, increase exudate, erythema, edema, odor, friable granulation tissue, new wound breakdown |
| bioburden | presence of microorganisms on a wound |
| contamination | NON replicating organisms on wound surface, non adherent, no host response |
| colonization | replicating organisms adhered to wound surface NO host response |
| critical colonization | sudden unexpected plateau, gran. tissue friable, new necrosis ^ exudate, no decrease in size or ^ in size replicating organisms ATTACHED to wound surface, no invasion of adjacent tissue |
| invasive infection | organisms invade tissue, cause host response (local or systemic) lack of healing after 2wks topical therapy, bioburden overwhelms body's defenses |
| list three techniques used to obtain a wound culture | tissue biopsy, needle aspiration, swab technique (Levine or Z tech.) |
| do contaminated wounds need to be treated with topical antibiotic? | contaminated wounds do not need to be treated with ABX |
| are all chronic wounds colonized with bacterial organisms | yes |
| what is the difference between colonization and contamination | contamination is from normal flora, doesn't require tx, non-replicating bacteria non-adherent to wound Colonization adherent to wound surface |
| does wound contamination contribute to delayed wound healing? | no |
| Is biofilm is best managed by frequent debridement | yes- mechanical debridement |
| what is NERDS for colonization | N non healing wound E exudate R red, bleeding wound D debris S smell |
| what is a less invasive technique to determine osteomyelitis | probe to bone/mri |
| what is the gold standard for wound culture? | tissue biopsy considered infected if 100,000 bacterial count, also if beta hemolytic strep present |
| treatment of biofilm | requires sharp debridement followed by moisture retentive dsg/antimicrobial dsg, continued debridement either mechanical or autolytic |
| S&S of wound infection | increased exudate, odor, erythema, edema, nonhealing, friable granulation tissue, pain, warmth, induration systemic: fever, chills, leukocytosis, BGL ^ in diabetics |
| diagnosis of infection | clinical signs, wound culture |
| what are S&S of infection if inflammatory response is impaired: | friable granulation tissue, failure to heal, discolored or friable gran. tissue, pocketing at base of wound, odor, wound breakdown |
| when should a wound culture be done | when clinical signs of infection are present OR when a clean wound doesn't heal within 2 weeks of topical therapy |
| treatment of systemic infection vs local infection | systemic- antibiotic, local: remove pathogens, topical antimicrobial |
| goal of treatment of critical colonization | reduce bioburden without causing tissue injury or causing antibiotic resistance |
| chronic vs acute osteomyelitis | acute- 1st episode, resolves within 6 weeks, chronic, recurrence after 1st episode OR lasts longer than 6 weeks |
| what is the gold standard for diagnosing osteomyelitis | bone biopsy, MRI is a good tool also |
| when should response to treatment be seen | withing 24-48 hours |
| if treatment doesn't produce response, what next | evaluate cofactors/underlying etiology/wound environment |
| biofilm | complex structure of bacteria in a self-secreting extracellular matrix that is permanently adhered to wound |
| antibacterial | antiseptic that inhibits the growth of bacteria |
| antimicrobial | general term for a substance that destroys or inhibits growth and replication of organisms |
| antiseptic/antibacterial | topical substance that inhibits growth and reproduction of organisms,can be used on open wounds and intact skin, little resistance developed, strong biocidal (acetic acid is one) |
| disinfectant | chemical that destroys neutralizes or inhibits growth of organisms, usually used on inanimate objects and intact skin |
| risk factors for wound infection | hx of prior wounds, family hx of chronic wounds, HIV, rheumatoid disease, malnutrition, diabetes, immunosuppression, hypoxic conditions:anemia, COPD, smoking, drug use, chemo, corticosteroids, antiinflamm drugs |
| discuss silver dressings and creams | broad spectrum, minimal allergic response, effective against MRSA and VRE,multiple modes of delivery and concentrations |
| discuss povidone-iodine | broad spectrum, no reported resistance don't use in open wound, or with iodine allergy |
| discuss honey | produces H2O2, contains antioxidants, releases anti-inflammatory products, reduces odor. produces lactic acid broad spectrum antimicrobial (including MRSA and VRE) is acidic decr'd protease activity, incr'd macrophage & fibroblast activity |
| hydrofera blue | effective against MRSA, VRE, e-coli, s aureus, s epidermis, reduces hypergranulation, epibole |
| mupirocin 2% | effective against MRSA, beta hemolytic strep, strep pyogenes, contraindicated for large burns, contains polyethylene glycol which could damage kidneys if absorbed through skin |
| signs of critical colonization | plateau in healing, increase in size or exudate, possible odor. development of friable bright red granulation tissue that bleeds easily |
| describe cadexomer iodine | broad spectrum delivery system of iodine in cadexomer starch beads. As exudate reaches beads it releases the iodine delivering -can penetrate most biofilms, nontoxic to good cells |
| procedure for Levine Technique | cleanse wound, identify 1cm area of clean wound, moisten swab with NS, apply pressure and rotate swab in clean area until saturated. |
| what dressing inactivates MMP's | promogran |
| the three principles of wound care are | control or eliminate causative factors, support the host to reduce cofactors, optimize the micro wound environment or physiologic wound environment |
| pathway for management is: | control or eliminate causative factors(biopsy prn, goals and adherence), support the host to reduce cofactors (systemic support), optimize the micro wound environment or physiologic wound environment(optimal wound care, active there. prn |
| active therapy | correct molecular imbalances in wound- like MMP inhibitors, matrix dsgs, skin sub., growth factors, NPWT, hyperbaric O2, ultrasonic mist, flaps & grafts |
Created by:
Beth Perry
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