Question | Answer |
describe the signs and symptoms of infection in chronic wounds | inflammation(or not) delayed healing, friable wound bed, wound breakdown, foul odor, serous drainage, pocketing at base of wound |
define bioburden | the presence of microorganisms in a wound, colonization, critical col., biofilm, infection. includes quantity, virulence, and type of bacteria |
define contamination | presence of NON replicating organisms. No host response. all wound contaminated by skin flora doesn't impair healing |
define colonization | bacteria are on the wound bed, have begun to replicate and attach to surface. No host response Doesn't impair healing |
define critical colonization | considered present if wound not healing or not decreasing in size after 2weeks defined by response to treatment |
define infection | bacteria invade tissue and cause a host response. |
compare three techniques used to obtain a wound culture | tissue biopsy, needle aspiration, swab technique, Levine technique |
which of the following criteria is an indication to obtain a wound culture: decrease exudate and odor, lack of healing after 2wks in a clean wound, lack of healing after 4 wks in a clean wound, increase in wound size | lack of healing after 2wks in a clean wound |
true or false: all chronic wounds are colonized with bacterial organisms | true |
define the difference between colonization and contamination | colonization has bacteria that are replicating and adhere to wound surface contamination is with microorganisms that are non replicating, are ON surface but not attached |
true or false: wound contamination will contribute to delayed wound healing | false |
True or false: biofilm is best managed by frequent debridement | true |
identify the term NERDS and what it is used for | assessment for critical colonization Non healing wound Exudating (incr. in exud.) Red and/or bleeding wound (incr from baseline) Debris (necrotic tissue) Smell Topical anti-bx for 2weeks if no tissue invasion |
what is the most accurate swab method for a wound culture | Levine technique |
What is a less invasive technique to determine osteomyelitis | MRI |
What is the gold standard for wound culture | biopsy |
define biofilm | bacteria in a self secreted matrix that is permanently adhered to wound surface (or nonbiologic surf. like implant) |
treatment for biofilm | sharp debridement followed by moisture retentive dsg and wound irrigation, antimicrobial dsg, to prevent reformation, maintenance debridement (incl autolysis) |
define STONEES | to assess for deep tissue infection Size increased Temp inch's O- New Opening New breakdown Erythema/Edema Exudate Smell
requires systemic ABX |
when would sodium hypochlorite be used to irrigate a wound | local infection or critical contamination, MRSA, e coli present best at 0.0125% (1/4 strength) odor control use short term only |
when would acetic acid be used | if pseudomonas aeruginosa is present- green drainage, use 1/4 strength |
what is the goal of cleansing wounds | flush away exudate without damage to healthy and newly formed tissues dirty or necrotic wounds require 4-15 psi |
when is cytotoxic cleansing indicated, when is noncytotoxic indicated | cytotoxic- dirty, infected, heavily necrotic
noncytotoxic can irrigate dirty wounds but won't have bateriocidal action. |
what irrigation solution is effective against psuedomonas aeruginosa | acetic acid 0.25-0.5% |
what does cadexomer iodine do | eff. against MRSA, nontoxic to fibroblasts |
hydrofera blue | effective against MRSE, VRE, E COLI |
mupirocin 2% | effective against MRSA, beta-hemolytic strep, contraindicated for large burns, blocks activity of enzyme in bacteria that make proteins |
silver | off. against MRSA, VRE, do not use if there is a low bioburden, can delay epithelialization |
AMD, PHMB | broad spectrum |
strength of irrigation | 4-15 psi-35 ml syringe and 19 gauze IV catheter (7psi) |
what are the principles of topical therapy | obliterate dead space, identify and eliminate infection, remove necrotic tissue maintain moist wound, thermal insulation, protect wound |