Wound Infection

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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.

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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.

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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.

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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.

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Of all the types of chronic wounds in lower extremities, venous leg ulcers are the most common, and they account for up to 70% of lower leg ulcers. Infection is a common complication in these wounds, however, and may contribute to chronicity. Biofilm is another common complicating factor. Preventing infection, removing unhealthy tissue from the wound, providing dressings that manage exudate, and using advanced modalities can help heal these chronic wound types and prevent a recurrence.

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The outer layer of the skin, the epidermis, is the body's physical barrier to the environment. This barrier is compromised when moisture or trauma damages the epidermis. Frequently, moisture or adhesives can damage the skin and cause painful injuries. The damaged area is then more susceptible to infection and delayed healing.

Overexposure to moisture can compromise the skin's integrity by disrupting the delicate molecular arrangement of intercellular lipids in the stratum corneum and the intercellular connections between epidermal cells or corneocytes. The term moisture-associated skin damage (MASD) encompasses a spectrum of injuries characterized by denudation (inflammation and erosion) of the epidermis resulting from prolonged exposure to various sources of moisture or irritants such as wound exudate, perspiration, urine, stool, or ostomy effluent.

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Pilonidal Cyst

By Cathy Wogamon, DNP, MSN, FNP-BC, CWON, CFCN

A pilonidal cyst is a pocket located at the top of the cleft of the buttocks that usually results from an embedded or stiff hair. This area may remain dormant for years and cause no major issues; however, often the embedded or stiff hair may cause the cyst to become inflamed and infected, resulting in an abscess that requires an incision to drain the infected material. These abscesses can recur, causing the patient to require surgical intervention to remove the cyst. After surgery, some patients tend not to heal well, and the result is a chronic, tracking wound in an area that is difficult to heal.

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Prevention and management of biofilm and infection in wounds can be supported by using antimicrobial and antibiofilm dressings. Internationally, there has been a rising prevalence of antibiotic-resistant organisms; this has resulted in increased incorporation of antimicrobial dressings in wound management. These dressings offer many advantages because they are easy to use, are readily available, have a decreased risk of resistance, and deliver sustained release of antimicrobial agents to the wound bed. This mode of action allows for a lower concentration of the agent and thereby lowers the possibility of toxicity to host cells.

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Delayed wound healing occurs in various wound types and in patients with significant comorbidities. Hard-to-heal wounds have proven to be a challenging and worldwide crisis resulting in high financial burdens.

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Biofilms are found in the majority of chronic wounds and pose a critical health threat, causing nearly 80% of refractory nosocomial infections. They also have a damaging virulence mechanism, which induces resistance to antimicrobials and evasion from the host’s immune system. Over 90% of chronic wounds contain bacteria and fungi living within a biofilm construct. Biofilms have been reported as major contributing factors to a multitude of chronic inflammatory diseases. Given the resistance of the bacteria, biofilms increase the risk of infection and cost the health care system millions of dollars annually. Clinicians should have practical knowledge of the role and impact that biofilms play in impeding chronic wounds, thus leading to risks of complications such as infection.