Infected Wounds and Their Treatment: Beyond the Basics

Infected wounds are easy to identify, or so the common wisdom says. You conduct a visual examination. Is it red, puffy, oozing, smelly? If it has at least one of those characteristics, likely infection is the culprit. But there’s more to infected wounds than the basics. They are painful, costly, and impact every step of the care continuum. For those reasons and others, we need to find ways to identify wounds at risk earlier, seek ways to prevent them, and find better options for treatment.

Infected wounds present unique challenges, not just in terms of patient outcomes but also in their broader impact on workflows, stress, quality of care, and outcomes. Because refreshers can be beneficial at any point in your career, let’s take another look at what infected wounds are, the most common types of infections encountered, and effective treatment strategies.

What effect do infected wounds have on patient outcomes and your daily work? How do we stay ahead of infection, and what lessons can we learn from each case?  With insights like this, you could stay a step ahead of troublesome infected wounds.

What Are Infected Wounds?

Let’s go back to wounds 101. Wounds become infected when bacteria, fungi, or other microorganisms enter the body through a break in the skin, whether an acute wound (a surgical incision or a laceration) or a chronic one (like pressure ulcers or diabetic foot ulcers). Infected wounds exhibit classic signs like redness, swelling, warmth, pain, and sometimes even a discharge of pus or an unpleasant odor. But the signs can be subtle too—maybe it’s just an increase in pain or a delay in healing that can be easy to overlook in a busy hospital or wound care clinic.

The lack of consistency can be tricky, leading to an important question: are we sometimes missing early indicators?

Common Infections in Wounds

While a lot of pathogens can infect wounds, certain bacteria tend to show up more often than others.

• Staphylococcus aureus (including MRSA) is a frequent culprit, particularly in surgical or traumatic wounds.
• Pseudomonas aeruginosa is commonly associated with chronic wounds, particularly in moist environments like those commonly seen in diabetic ulcers.
• Escherichia coli and Enterococcus species are also frequent players in wounds with deep-tissue involvement or in immunocompromised patients.

Fungal infections, while less common, can complicate wound healing, particularly in patients with compromised immune systems. Some patients are more prone to infections than others just as some wounds are more likely to lead to infections. Wounds that are large, deep, or have jagged edges are, predictably, more susceptible to infection. And of course, dirt or foreign particles in the wound, bites from animals or humans, and injuries involving dirty, rusty, or germ-laden objects increase risk. A Tdap booster is also recommended for most of the above as well.

Certain health conditions and environmental factors also play a role in potential wound infections. Patients with diabetes, weakened immune systems (such as those living with HIV or on immunosuppressant medications), or limited mobility are at higher risk. Older adults are particularly vulnerable, and nutrient and vitamin deficiencies can significantly affect wound healing and increase the likelihood of infection.

Treating Infected Wounds

Wound infections can’t be treated with a one-size-fits-all approach. Effective management begins with a thorough assessment, carefully factoring in patient needs and health status, followed by cleaning and debridement. Sometimes, antibiotics are needed, but when should they be used? While the antibiotic question is complicated and multi-faceted, what we do know is basic steps help lead the way to healing, including:

1. Wound Cleansing and Debridement. Cleaning and removing dead tissue are fundamental to infection control. Effective debridement allows for the removal of necrotic tissue that harbors bacteria. Various methods can be employed, from sharp debridement to enzymatic agents. When was the last time you reconsidered the debridement methods you’re using? Are there more advanced or innovative options that could make a difference, maybe in the frequency, patient comfort, or completeness of debridement?
2. Antibiotics. Systemic antibiotics are crucial for deep or spreading infections, but the rise of antibiotic resistance demands that we prescribe them with caution. Topical antibiotics or antimicrobial dressings may be helpful for localized infections but shouldn’t replace systemic treatment when it’s warranted. Finding the right balance is key. How often do you see cases where topical treatment alone isn’t enough?
3. Advanced Dressings and Therapies. There has been considerable growth in the area of antimicrobial dressings, negative pressure wound therapy, and other therapies developed to promote healing. Still, choosing the right therapy isn’t always straightforward. Should you be leaning more into the use of these advanced treatments, or are you sometimes relying on them without sufficient evidence?

According to recent studies, early intervention with proper wound care management can reduce infection-related complications.  There have also been some promising innovations in the field.  For example, a recent study by Keck Medicine of the University of Southern California (USC) demonstrated the power of using autofluorescence (AF) imaging (a technique used to detect bacteria by utilizing their natural ability to emit light when exposed to certain wavelengths).  The process helps to detect bacteria during wound debridement and significantly improves the accuracy of bacterial removal, thereby reducing the risk of wound infections. One of the major benefits of this approach is that it gives providers the opportunity to make more rapid medical decisions during treatment, potentially preventing severe complications such as amputations. While not yet widely used, clinicians believe that due to its potential, it will become more commonly adopted by practitioners in the future.

The Impact of Infected Wounds on Patients and Providers

Infected wounds can be more than just a setback—they often mean the difference between a straightforward recovery and prolonged and unnecessary suffering for the patient. Pain, extended hospital stays, increased healthcare costs, and a higher risk of complications, such as sepsis or amputation, all become factors when infection takes root. The emotional toll on patients can’t be underestimated either, as infected wounds often cause anxiety and frustration about their recovery process, leading to yet further delays.

Wound care providers also have to deal with the frustrations of managing a wound infection that refuses to heal despite their best efforts, which may become doubly frustrating if the wound itself is chronic or non-healing as well. Then of course there are the challenges of trying to explain to a patient or their family why the infection isn’t improving as quickly as they’d hoped.

And what about the effect on facilities? They range from penalties to lower quality ratings to reduced reimbursement. Several years ago, a still-quoted study in Value Health found that wound infections are very costly in the U.S., especially for Medicare patients. About 15% of these patients have chronic wounds that don’t heal, costing around $28 billion each year when these wounds are the main issue. The study notes that when other related health problems are included, the cost rises to $31.7 billion. The most expensive types of wounds are surgical site infections and diabetic foot ulcers, with much of the costs coming from hospital outpatient services.

How Can We Better Manage the Burden of Infected Wounds?

The cost and impact of infected wounds highlight the importance of finding better ways to manage them. And that’s also why it’s time for a more proactive approach. Prevention, early detection, and better patient communication and engagement are vital. Here are a few steps we can take now.

• Prevention through better hygiene and patient education: Simple as it sounds, many infections start because of inadequate hygiene or failure to follow initial care instructions. Providers may assume patients know the importance of cleaning wounds or changing bandages, but they may not. Primary wound care education is vital.
• Collaboration across disciplines: A team-based approach involving wound care specialists, infectious disease experts, and nurses can often lead to better outcomes. Look at the methods you use. Could you do more? Would new programs to encourage better communication and collaboration among teams help?
• Early use of diagnostic tools: New technologies, like rapid diagnostic tests, allow for earlier identification of bacterial strains and antibiotic resistance patterns, ensuring quicker and more accurate treatment.  Is your wound care team staying up to date on the latest innovations? Do you have programs or a process to promote the sharing of new findings?

What Questions Should You Be Asking about Wound Infection?

It’s also a good time to reflect on the questions to ask to ensure our wound infection detection and prevention processes are up-to-speed.

1. Is the staff too busy to identify the early signs of infections in all patients? How can workflow be better streamlined to ensure they have the time needed?
2. Are we missing subtle signs of infection in our daily rounds?
3. How can we improve patient adherence to wound care regimens after discharge?
4. What steps are we taking to reduce antibiotic resistance in our treatment of wound infections?
5. What types of wounds do we see again and again? In what patient populations? How are we intervening when we get those insights?

The Future of Wound Infection Management

There’s much we can and should do. With advances in diagnostics, treatments, and a more holistic understanding of patient care, we can reduce the incidence and impact of infected wounds. But the work doesn’t stop with new technologies or even processes; it’s also about refining the basics of wound care, keeping communication open within care teams, and educating patients.

Infected wounds can be a major obstacle to healing, but they also present an opportunity for wound care professionals to rethink and refine their practices. What’s working in your facility? What could be better?

By asking these questions and staying up to date with the latest research and best practices, we can all contribute to better outcomes—for our patients, organizations, and the wound care profession.