All open wounds have bacteria. The amount of bacteria can be minimized through adequate cleaning of the wound, absorption of drainage and debridement if necessary.
Odor often indicates a need for change in cleaning frequency, change in dressing to increase absorption, or debridement.
Use of topical antibiotic creams is controversial. Some clinicians believe they are effective in the short term especially if the wound is heavily exudative.
Use of infection control measures should be standard with any open wound
Clean gloves for each patient
Wash hands between patients
Body substance isolation precautions
In a patient with multiple ulcers, dress most contaminated ulcer last
Sterile instruments for debridement.
Wound Infection
All chronic wounds are colonized with microorganism. When the bacteria overwhelms the host, infection occurs. The diagnosis of wound infection is based on the clinical signs and symptoms of the patient, and culture and colony count of the wound.
Local Signs of Infection
Erythema
or skin discoloration
Edema
Warmth
Induration
Increased
pain
Purulent
wound exudate with or without foul odor
Systemic Signs of Infection
Elevated
temperature
Elevated
white blood cell count
Confusion
or agitation in older adults
Red
streaks from wound
A tissue biopsy, needle aspiration or a quantitative swab technique are the most frequently used methods to determine bacteria counts in wound tissue. They can detect aerobic and anaerobic organisms.
! This technique has been criticized as a method that produces information about colonization of the wound surface rather than in tissue infection.
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Cleanse wound with a non antiseptic solution
Rotate a sterile cotton-tipped applicator stick in a -2
cm area of open wound for 5 seconds
Apply pressure to swab tip in the sterile tube and transport
to lab
Lab results are expressed as organisms per swab or CFU per
swab or in a semiquantitative manner, such as scant, small, moderate,
large (1+-4+) bacterial growths
Use 10cc
syringe with a 22-gauge needle
Insert needle
through intact skin
Withdraw
the plunge to the 10 ml mark
Move the
needle backward and forward at different angles for 2-4 explorations
Return the
plunge gently back to the 0.5 ml mark and withdraw the needle.
Transport
the specimen to the laboratory
Data are
expressed in colony-forming units (CFU) per volume of fluid
Tissue Biopsy
Remove a piece (3-4mm)
of tissue by dermal punch biopsy or a scalpel
Clean area with sterile
solution, no aseptic
Perform tissue biopsy
and apply pressure to area to control bleeding
Promptly transport
biopsy tissue to laboratory
Tissue findings are
expressed in number of organisms per gram of tissue