Wound healing. The relationship of wound infections to non-infected wound complications.
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Humans↗
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[Wound healing--wound infection--wound management].
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Anti-Bacterial Agents↗
[Infections of the skin caused by gram-negative pathogens. Foot infections--wound infections--folliculitis].
Gram-negative bacilli are ubiquitous. They are found in 10-15% of the intertriginous bacterial flora and the most important one is Pseudomonas aeruginosa. Heat, moisture, mazeration, and reduction of the normal Gram-positive flora favor a rapid establishment of Gram-negative bacilli and the ensuing development of clinical infections. The diagnosis depends of the characteristic clinical features and localization, the patient's history, as well as the result of bacteriological investigation. The significance of the isolation of Gram-negative bacilli from non-specific lesions must be carefully evaluated. Cutaneous lesions respond well to therapy if they can be dried. Systemic antibiotics acting against Gram-negative bacilli have been found helpful. In patients with acne and Gram-negative folliculitis, isotretinoin has a good effect.
Bacterial Infections↗
Identifying and evaluating wound infection.
Wound infection is a serious problem in the home care patient. Early detection of infection, prompt treatment, and continuous surveillance are pivotal to elimination of the infection and prevention of complications. This article addresses identification of wound infection in postsurgical and chronic wounds based on data obtained from the patient's history, physical examination, and diagnostic tests. Appreciating the overt and subtle signs and symptoms of wound infection and acting on them is critical to timely diagnosis and treatment.
Acute Disease↗
Surgical wound infection.
Wound infections remain a major source of postoperative morbidity, accounting for about a quarter of the total number of nosocomial infections. Today, many of these infections are first recognized in the outpatient clinic or in the patient's home due to the large number of operations done in the outpatient setting. This leads to errors in establishing the true incidence of their occurrence but undoubtedly decreases the overall real cost and length of hospital stay. The pathogens implicated in the development of wound infections remain largely the human microorganisms from the exogenous environment and the endogenous organ microflora. Many perioperative factors have been identified that increase the incidence of the development of postoperative wound infection. Avoidance of these factors as well as the appropriate use of perioperative antibiotic prophylaxis has decreased the incidence of wound infection. During the last decade many studies have reported on the individual risk factors that favor the development of postoperative infectious complications in various surgical procedures. It is hoped that this knowledge may allow for prospective alterations in the preventative and therapeutic modalities in the high-risk patient in the studies designed in the 1990s. The use of effective infection surveillance both in the hospital and in the outpatient setting is mandatory in order to collect meaningful data. The use of computer technology will greatly facilitate the proper surveillance, analysis, and control of infections in the surgical patient.
Anti-Bacterial Agents↗
Prophylactic antibiotics in surgery and surgical wound infections.
Wound infection remains a considerable cause of morbidity and mortality among surgical patients, despite the relative success of prophylactic antibiotics. In modern efforts to control healthcare costs while improving the quality of patient care, we must not overlook the basic principles of wound infections and their appropriate treatment. Predisposing factors for the development of surgical wound infection include the creation of a surgical wound, the presence of bacteria, and a susceptible host. The selection of an appropriate antimicrobial drug depends on the identification of the most likely pathogens associated with a given procedure, as well as the expected antibiotic susceptibility of those pathogens. Ideally, a prophylactic antibiotic should achieve high peak tissue concentration at the site of the wound before the first incision and should be maintained until the time of closure. Currently, the administration of prophylactic antibiotics is indicated for contaminated and clean-contaminated wounds. Despite the proven effectiveness of antibiotic prophylaxis, many researchers would argue that contemporary dosing regimens should be reevaluated. The debates concerning the dosage and timing of ideal prophylactic administration are likely to continue.
Antibiotic Prophylaxis↗
Wound infections.
Wound infections continue to be an important entity in terms of use of time and medical resources. Currently, the following risk factors are known to strongly predispose to wound infection: pre-existing medical illness, prolonged operative time, wound contamination, and contaminated or dirty wounds. Tissue level factors, including the local microenvironment, white cells, and cellular products that mediate inflammation, are important, and their manipulation holds promise for future therapies. For now, the judicious use of antibiotic prophylaxis and organized systems of wound surveillance are the most effective means to reduce the wound infection rate to its pathophysiologically attainable minimum.
Anti-Bacterial Agents↗
Operative wound infection.
Wound infection is the commonest complication after operation and frequently gives rise to complex problems which may be very difficult to manage and prevention is most desired. For successful prevention, one must understand the pathogenesis of wound infection and follow strictly the regulations or precautions of aseptic and operative techniques to minimize contamination which consequently will reduce the incidence of post operative wound infection.
Adult↗
A combative healer with no ill-effect. Iodosorb in the treatment of infected wounds.
Infected wounds require an antiseptic agent which does not inhibit the healing process. In this trial, Iodosorb ointment and powder succeeded in combining these two qualities.
Cost-Benefit Analysis↗
The effect of differing ambient oxygen tensions on wound infection.
Wound infections were studied in rabbits using two standard inocula (approximately equal to 10-4 and approximately equal to 10-6) of Pseudomonas aeruginosa injected into subcutaneous wound dead space made by implantation of standard wire mesh cylinders. The inoculation was done on the fourth day after implantation of the cylinders in animals kept from the day of implantation in atmospheres of 12%, 21%, or 45% oxygen content. Samples of wound fluid (0.2 ml) were removed for quantitative culture just before inoculation and 3, 7, 14, and 21 days later. No positive cultures resulted from samples taken before inoculation. One uninoculated wound served as a control in each animal. None of these control wounds became infected. Culture counts were significantly highest in the anoxic group and lowest in the hyperoxic group. Established infections were significantly lowest in the hyperoxics and highest in the hypoxics. The percent of wounds showing a significant culture count showed a similar trend. The mechanisms of this effect is not known, but a possible mechanism lies in the relative inability of leucocytes to kill this bacterium under hypoxic conditions.
Animals↗
Urinary tract infection and wound infection in kidney transplant patients.
The frequency of urinary tract and wound infections was studied in 53 patients most of whom had received kidneys from donors without heart action. Urinary infection was demonstrated soon after the transplantation in 46 out of 47 with functioning kidneys. Recurrent infections took place during the first 3 months and still half of the patients were infected or under treatment 6 months after the operation. The urinary infection seems mainly to arise via indwelling catheters. Wound infections were demonstrated in 18 out of the 53 patients and in addition abscess formation took place in 9 of these. In the majority of the infected wounds previous infected drains were demonstrated. In all, 36 of the patients had infected drains, the use of which therefore is to be avoided.
Abscess↗
Post-operative urinary tract infection and wound infection in women undergoing caesarean section: a comparison of two study periods in 1985 and 1987.
In 1985 and 1987 women undergoing Caesarean section were studied for the development of post-catheterization bacteriuria, urinary tract infection and wound infection. In 1985, 34% developed bacteriuria compared to 25% in 1987. Post-catheterization bacteriuria within two days was reduced by improved catheterization techniques. Late urinary tract infection after 5 days occurred in 2% of women in 1985 and 6% in 1987. The commonest bacteria were Escherichia coli and enterococci. Post-catheterization bacteriuria was only confirmed in a second urine specimen in 53%. The incidence of wound infection was 20% in 1985 and 15.8% in 1987 but bacterial pathogens were only isolated from 12.5% and 5.1% respectively. Staphylococcus aureus was isolated in 60% of infected women. Antimicrobial usage was high in this group of women at 41% in 1985 and 27% in 1987. A significant reduction of usage from 37% to 16% was seen in bacteriologically confirmed infections where the laboratory reports were only issued after examination of a second specimen. However most symptomatic women received treatment. The incidence of post-operative infective complications is high in women having Caesarean section. Careful urethral catheterization techniques are necessary to prevent bacteriuria.
Adolescent↗
Infected wound management: advanced technologies, moisture-retentive dressings, and die-hard methods.
Wound infection is a significant problem for the complicated, critically ill patient. A critical care patient's plan of care can be challenging enough without complicating it with the additional comorbidity of a wound infection. Wound infection delays wound closure, disrupts wound tensile strength; increases hospital length of stay and costs; and escalates the patient's risk of bacteremia, sepsis, multisystem organ failure, and death. The goal is to reduce and eliminate the wound infection before it leads to such drastic consequences, especially in the age of antibiotic-resistant organisms. It is paramount to identify classic and not-so-obvious signs and symptoms of wound infections, correctly collect a wound specimen, and assist in appropriate systemic and topical wound management. Techniques to prevent wound infection and reduce bioburden include nontoxic wound cleansing, debridement of necrotic tissue, proper antibiotic management, and appropriate use of moisture-retentive dressings. Advanced technologies in moisture-retentive dressings include sustained-release silver and cadexomer iodine antimicrobial dressings and negative-pressure wound therapy. Accurate wound assessment, knowledge of new technologies, and applying current wound care standards to clinical practice will assist the critical care nurse in treating and preventing wound infections.
Bandages↗
[Toxic shock syndrome in 2 girls with pharyngeal infection and wound infection].
In 1981, a 13 year old girl died of her shock lung. She had been admitted with the classical toxic shock syndrome then still unknown to us. Staphylococcus aureus had been cultured from a pharyngeal swab. But even in 1987, it took us 48 hours to correctly diagnose the toxic shock syndrome in a 17 year old girl. The diagnosis became evident when she was found to have a staphylococcus aureus wound infection after a surgical procedure. For pediatricians, it is crucial to know this syndrome well. Not only menstruating girls using tampons, but also quite young children can acquire this disease. Quick diagnosis and prompt institution of the correct therapy can be life saving.
Abscess↗
Pattern of bacterial pathogens in surgical wound infections.
Wound swabs from surgical patients were studied from 1989 to 1991 to review the pattern of nosocomial infection in the University College Hospital, Ibadan, Nigeria. The prevalence rate of nosocomial infection was 4.9%. The ratio of gram-negative to gram-positive organisms in wound infection was 3:1 with klebsiella species and Pseudomonas species emerging as the most important gram-negative organisms. Staphylococcus aureus was the single most prevalent organisms in surgical would infections. Recommendations on control measures are given.
Bacterial Infections↗
Wound infection and wound swabbing.
There is a significant lack of knowledge in relation to the identification and management of infected wounds. More attention should be given in nurse education to knowing when and how to obtain would swabs. Wound swabbing practices should be standardised.
Decision Trees↗
Dressings and wound infection.
Wounds will readily acquire bacteria, unless protective measures are taken. The bacterial protection afforded by conventional absorbent cellulose dressings has been shown to be limited, particularly in the presence of serous exudate that may compromise dressing integrity. In addition, dressings may shed particles that remain in the wound. By contrast, many modern dressings are impermeable to bacteria, are removed completely, have been found to optimize reepithelialization rates and reduce the incidence of wound sepsis. Recently, it has been found that they could also play a role in preventing cross-contamination. Removing conventional cellulosic dressings from bacterially colonized wounds liberates wound bacteria into the air, and the numbers are slow to decline. However, using an in vitro wound model, use of the hydrocolloid dressing Granuflex (ConvaTec, Skillman, NJ) on experimentally colonized wounds resulted in significantly fewer numbers of airborne bacteria. Dispersal from wet conventional dressings was lower than from dry dressings; nevertheless, the numbers of bacteria per liter of air following removal of the hydrocolloid dressing were approximately 20% of those observed for gauze. These findings have also been confirmed in the clinic. To reduce the incidence of complications, wound care in general, and infection control procedures in particular, requires carefully disciplined team work.
Bandages↗
[Postoperative wound infections. IV. Flora and clinical course of postoperative wound infection].
Each wound infection may be coursed in few clinical manifestations and may concern either skin with subcutaneous tissue (superficial infection) or deeper layers-fascias, muscles (deep infection). The aim of this study was to evaluate the form of infection and its clinical course, and moreover, to find the specific flora of infected wounds. The material was 1527 surgically treated patients in the 3rd Surgical Department of the Collegium Medicum of the Jagiellonian University during one year. 66 patients with wounds of the head and 7 patients who died within first three days after surgery without wound infection signs were excluded from the study population. The healing of each wound was observed during the patient's hospitalisation and 30 days after discharge from hospital, and in orthopedic patients 6 months after discharge. The total number of 132 infected wounds was identified. The population of 1352 wounds healed without any complications was a control group. All the data were recorded in a Wound Infection Register Card and were collected in the computer database. The data were statistically analysed. Relationships between single factors and postoperative wound infection were evaluated using chi-square statistics and in the small number Fisher's exact probability test. Analysis of variance was used for continuous variables. Odds ratios and corresponding 95% confidence intervals were computed for all variables. Postoperative wound infection was found in 132 (8.9%) cases, including 76 (57.6%) in males and 56 (42.4%) in females. The average age was 50.9 years. The period of hospitalisation ranged from 3 to 119 days, with the mean of 31.9 days in comparison to 16.3 days in the control group.
Analysis of Variance↗