Infected Wounds

Liping Tang's picture

By Liping Tang, PhD

Infection is the single most likely cause of delayed healing in chronic wounds. In most cases, identification of chronic wound infection (e.g., diabetic foot ulcers and venous leg ulcers) is not obvious because chronic wounds do not exhibit the same classic inflammatory signs of infection as those found in acute wounds. More arduously, those common signs of infection—pain, erythema, heat, and purulent exudate— vary as we age and occur differently in those with underlying diseases or weakened immune systems. Diagnosis is generally based on the doctors’ experience and could be confirmed with microbiological culture of tissue biopsy. However, culture could take a few days, and the results may not always be reliable because of sampling error. A fast and accurate diagnosis of wound infection would relieve the patient of significant discomfort and improve the treatment outcome.

Emily Greenstein's picture

By Emily Greenstein, APRN, CNP, CWON, FACCWS

After attending the Spring Symposium for Advanced Wound Care and hearing many great lectures, I got to thinking, “What are the pillars of chronic wound care?” We have all heard of the concept “look at the whole patient and not the hole in the patient.” Heck, I have even written about it. But we also need to have a good foundation for how to implement this phrase or where to even start. I did a quick Internet search and came up with some interesting articles that talked about the basics of wound care and management. I found discussions on everything from maintaining a moist wound environment to being financially responsible. All of this information leads me to the concept of developing easy-to-understand pillars or categories to consider when caring for a patient with a chronic wound.

WoundSource Practice Accelerator's picture

The incorporation of silver into wound dressings has been a breakthrough to combat the effects of antibiotic resistance, despite silver safety concerns. Regardless of its recent popularity, silver is not a new tool in health care.

WoundSource Practice Accelerator's picture

As a cost-effective alternative to topical antibiotics, silver is now widely available in wound dressings. However, what does silver really do within the wound bed? Silver uses a multifaceted approach to combating infection that attacks bacteria internally.

WoundSource Practice Accelerator's picture

Silver has become one of the most commonly used alternatives to topical antibiotics in recent years because of the growing concern over antibiotic resistance. Silver offers a multifaceted antimicrobial approach that makes it less likely for resistance to develop. With its limited and uncommon cytotoxicity, silver can be used to treat infected wounds over time and prevent further complications.

WoundSource Practice Accelerator's picture

Before the discovery of penicillin in 1928, silver was the primary antimicrobial agent available. Now, as antibiotic resistance plagues the health care field, silver has new value for wound care. Additionally, silver has demonstrated limited cytotoxicity when used topically, thus making it a suitable alternative to antibiotics.

Centuries ago, science took a back seat to superstition. Infectious diseases were seen as a sign of supernatural powers or the wrath of God. We now know that it was smallpox that led to the downfall of the Aztecs. We also know that bubonic plague was not a divine punishment, but it was caused by bacteria transmitted by fleas on rodents traveling on trading ships.

WoundSource Practice Accelerator's picture

Wounds typically heal in four sequential but overlapping phases — hemostasis, inflammatory, proliferative and remodeling — ultimately leading to tissue regeneration. Healing sometimes stalls for various reasons, a key one being extensive inflammation, which disrupts the normal cascade of healing and leads to chronic and hard-to-heal wounds. A vicious cycle of ongoing inflammation, pain and poor quality of life often follows. Understanding how to break this cycle is essential for wound care clinicians who want to optimize healing outcomes and patient quality of life.

WoundSource Practice Accelerator's picture

Wound healing can stall for a number of reasons. Wounds that have not healed or significantly reduced in size after four to six weeks are considered chronic. They are characterized by a multitude of impeding factors including biofilm, excess matrix metalloproteinases (MMPs) and extracellular matrix degradation, inflammation, fibrosis, unresponsive keratinocytes and fibroblasts, and atypical growth factor signaling.

WoundSource Practice Accelerator's picture

Biofilm: Colonies of multiphenotype, free-floating bacteria that secrete a polysaccharide matrix that protects the bacteria from immune response and antibiotics.

Chronic wounds: Wounds that stall in the inflammation phase and fail to progress toward healing within 3 months are considered chronic or hard to heal.

Continuous inflammation: When wound healing becomes stalled in the inflammatory phase because of the presence of bacteria and their endotoxins, the wound is unable to move out of the inflammatory phase and into the repair phase.