The Rundown on Wound Infection

To better understand the intricacies of wound infection, let’s look at a hypothetical test case: Rosa, a 50-year-old single mom of a 6th-grade boy, working as a housekeeper in the Southeast. In 2021, she was diagnosed with breast cancer and chose to undergo a mastectomy, knowing she had to take radical steps to be there for her son.

It was a hard decision and a difficult surgery. A few weeks after Rosa’s procedure, she noticed unusual pain, redness, and seepage. Her physician said it was routine and not to worry, but Rosa knew something was wrong. In her native Colombia, she had been a pharmacy student and recognized the signs of an infection. After months of additional physician visits and another surgery to repair damage caused by the wound infection, Rosa was finally on the path to healing.

Her story highlights three important realities of healthcare today:

1. Clinicians should listen to patients when they think something isn’t right.
2. Dedicated wound care providers make a difference daily in patients’ lives.
3. Wounds can be tricky to treat, and infections do happen. Prevention and leading-edge solutions are crucial to ensure the best possible care.

So, let’s look at wound infections, their dangers, the current and upcoming treatments available, and what providers should look out for to help identify and prevent them.

What Is a Wound Infection?

Infections occur when microorganisms, generally viruses and bacteria, get into the body and cause a reaction in tissue. We’re exposed to materials that could cause an infection—especially if we have an open wound—daily. The bacteria that lead to infections are on our hands, items we touch daily (looking at you, smartphones and tablets), kids and grandkids (well-known germ factories), and much more. While routine infections are typically benign and can heal quickly, some are more serious.

Clinicians describe those infections as either acute or chronic. Acute wounds heal within a few weeks as they progress through the normal stages of healing, while chronic wounds fail to heal within this timeframe and often get stuck in one phase.

When this bacteria, or a virus or other microorganism on or around us, is introduced to a wound, this infection can lead to inflammation and tissue damage. The most prevalent bacteria are Staphylococcus aureus, which includes both methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible Staphylococcus aureus (MSSA).

This bacteria may lead to more routine skin and soft tissue infections, as noted above. However, it’s also common to encounter bacteria in healthcare environments like hospitals, skilled nursing facilities, and other medical institutions. They enter the wound through various means—things like contaminated wound dressings, surgical instruments, or even just our skin flora.

The body’s response to a wound infection is an amazing process involving immune responses that target invading pathogens. Medical News Today notes that patients may be more prone to wound infections due to factors like advanced age, poor overall health, and compromised immune systems. Diseases like diabetes magnify susceptibility to infections because they impair the body’s ability to heal and fight off pathogens, as do chronic conditions like autoimmune diseases.

Other risk factors that increase the risk of wound infection include:

• People living with HIV or those taking immunosuppressant medications.
• Patients who can’t move, which can provide the right environment for pressure injuries to develop due to extended time in bed.
• Adults of any age who lack proper nutrition and have vitamin deficiencies.
• Individuals who use illicit drugs, including methamphetamines, fentanyl, and heroin.

Understanding the mechanisms of wound infections is crucial for developing effective treatment strategies and preventing complications.

Types of Wound Infections

Wound infections can be classified into several types, each with its own set of challenges and treatment protocols. Understanding these types can help in identifying the appropriate treatment and prevention strategies.

1. Bacterial Wound Infections: These are the most common types of wound infections and as mentioned at the start of this article, are typically caused by bacteria such as Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. These wound infections can range from mild to severe and often require antibiotic treatment.
2. Fungal Wound Infections: Less common than bacterial infections, fungal wound infections can be caused by fungi like Candida albicans. These infections are often seen in immunocompromised patients and may require antifungal medications for treatment.
3. Viral Wound Infections: Although rare, viral wound infections can occur and are usually caused by viruses such as herpes simplex. These infections may present with symptoms like blisters and require antiviral medications.
4. Surgical Wound Infections: These infections occur after surgical procedures and can be caused by bacteria, fungi, or viruses. Surgical wound infections are a significant concern in healthcare settings and require stringent infection control measures to prevent.
5. Traumatic Wound Infections: These infections occur following traumatic injuries like cuts, punctures, or abrasions. They can be caused by a variety of pathogens, including bacteria, fungi, and viruses, and often require prompt medical attention to prevent complications.

Symptoms of Wound Infection

Recognizing the symptoms of a wound infection early can make a significant difference in treatment outcomes.

Here are some common signs to watch for.

1. Redness and Swelling: One of the first signs of an infected wound is redness and swelling around the affected area. The skin around potentially infected wounds may also feel warm to the touch.
2. Pain: Increased pain or tenderness around the wound site can indicate a wound infection. This pain may be persistent and not improve with time.
3. Pus or Discharge: The presence of pus or a thick, yellowish discharge is a clear sign of infection. This discharge may also have a foul odor.
4. Foul Odor: An infected wound may emit an unpleasant smell, which is often due to the presence of bacteria.
5. Fever: A fever can be a sign that the infection has spread beyond the wound site and is affecting the body systemically. This is a serious symptom that requires immediate medical attention.
6. Chills: Experiencing chills or feeling cold, even when the body temperature is normal, can be a sign of a more severe infection.
7. Swollen Lymph Nodes: Swollen and tender lymph nodes in areas like the neck, armpits, or groin can indicate that the body is fighting an infection.

What Are the Dangers of Wound Infection?

Wound infections can significantly delay healing, increase pain, lead to chronic wounds, and be serious complications for overall health. For patients with comorbidities like diabetes or a compromised immune system, the risks are even higher.

Diabetic wounds, which often occur on lower limbs that become infected, may increase the chance of amputation. These infections often hit underserved populations – people of color, the economically disadvantaged, and those in rural areas, making finding ways to prevent infections even more crucial to address social drivers of health (SDOH) initiatives.

If left un- or under-treated, a wound infection can lead to sepsis, a serious infection that can be life-threatening. It affects about 1.7 million US adults annually and is a likely contributor to more than 250,000 deaths.

The impact of wound infections extends beyond the physical symptoms. Science Direct notes that “chronic wounds impact patients’ quality of life by disrupting their self-esteem, sleep, social interaction, work capacity, and psychological well-being.” Additionally, chronic wounds in particular can be costly to patients. They may have prolonged hospital stays, additional doctor visits and copays, medication costs, and expenses for hiring outside help.

What Are the Current Treatment Options for Infected Wounds?

There are several accepted treatments for infected wounds. Antibiotics remain the cornerstone of wound infection treatment. Topical antibiotics like mupirocin and systemic antibiotics such as cephalexin are commonly used. However, we’ve all heard about the problems of antibiotic-resistant medications, and providers are becoming more cautious about prescribing them.

Debridement, the removal of necrotic tissue, is essential for infection control. Methods include surgical, enzymatic, and autolytic debridement. Effective debridement reduces bacterial load and promotes healing. By removing dead tissue, debridement helps to create a clean wound bed, thereby providing an optimal environment for the healing process. It also allows for better penetration of topical treatments and reduces the risk of further infection.

Dressings are materials used to cover and protect wounds. They can be made from various substances and serve multiple functions, including protecting the wound from infection, absorbing exudate, maintaining a moist environment to promote healing, and, in some cases, delivering medications.  

Upcoming Treatments and Innovations

Over the past decade, research has led to several promising wound care innovations, and more are coming. One that has had a significant impact on providers already is the use of wound imaging solutions that integrate smartphones and tablets into the wound management process. These solutions provide 3D images of wounds, enhancing infection identification by providing detailed views that capture depth and surface irregularities.

The technology adds a whole new layer of valuable insights to the assessment process, as these images enable accurate measurement of wound dimensions and volume. This is crucial for monitoring changes over time and detecting signs of infection, like increased size or depth. Advanced algorithms can analyze color and texture, visually documenting and identifying common infection indicators like redness or necrotic tissue.

Clinicians writing in Advances Wound Care have provided an excellent overview of additional current and new diagnostics and treatments for wound infection. They note that the wound infection continuum has three stages: contamination, colonization, and infection.

However, “current wound infection diagnostics like the visual observation of signs and symptoms of wound infection cannot identify these stages.”  

To help, clinicians also use modalities like MRI, CT, ultrasound, and PET scans. While a great help for some conditions, they can be time-consuming and costly. There are some innovations gaining attention that may aid in this area. Point-of-care testing and molecular diagnostics are among the solutions that can guide targeted therapy, ultimately improving patient outcomes.

Smart bandages  and bioengineered skin substitutes are also being explored for their potential to enhance wound healing and prevent infections. These substitutes use antimicrobial agents to deliver medications and prevent infections.

An Ounce of Detection

When it comes to stopping wound infections, we can adapt a well-known adage to make a point – “an ounce of detection is worth a pound of cure.” Think about an elderly patient with a Phase I pressure injury, which appears as red, irritated skin that doesn’t turn white if you press on it. At this stage, there isn’t a wound yet. Now think about what might happen if that wound is promptly treated compared to if it’s not addressed until a few days later. Neglected, that wound could become a Phase III or IV hospital-acquired pressure injury (HAPI), leading to pain and delays in healing for the patient as well as penalties, fines, and lower reimbursement for the hospital.

Examples like this highlight that early detection of wound infection is crucial for effective management. Stay on the lookout for typical signs of infection—increased redness, warmth, swelling, pain, pus, and discharge. Symptoms like fever and elevated white blood cell count may indicate a more severe infection, signaling the need for clinical intervention.

Understanding patient risk factors also helps identify those at higher risk. Regular monitoring and proactive management of these patients can help mitigate the risks. Advancements in diagnostic tools are improving our ability to quickly and accurately identify infections. Look for solutions that work seamlessly into workflow and provide the documentation and reporting required.

Talk to your colleagues!  Good care coordination is also beneficial. Read the patient notes in the EHR, and share data about patients with conditions or symptoms that worry you.

Prevention and Patient Education

Preventing wound infections is crucial for promoting healing and avoiding complications. Below are some effective strategies and educational tips for patients.

Preventing Wound Infections

1. Keep the Wound Clean: Regularly wash the wound with soap and water, and gently pat it dry with a clean towel. Keeping the wound clean is the first step in preventing infection.
2. Apply Antibiotic Ointment: A thin layer of antibiotic ointment can help prevent bacterial infections. This should be done as per the healthcare provider’s recommendations.
3. Cover the Wound: Use a sterile bandage or dressing to cover the wound. This protects potential infected wounds from dirt, bacteria, and other contaminants.
4. Change the Dressing: Change the dressing daily or whenever it becomes wet or dirty. This helps maintain a clean environment for the wound to heal.
5. Monitor for Signs of Infection: Regularly check the wound for any signs of infection, such as increased redness, swelling, or pus. Early detection is key to effective treatment and prevention of more severe infections.

Educating Patients on Wound Care

1. Explain the Importance of Wound Care: Educate patients on why proper wound care is essential for healing and preventing complications. Understanding the ‘why’ can motivate them to follow care instructions diligently.
2. Demonstrate Wound Care Techniques: Show patients how to clean and dress their wounds properly. Hands-on demonstrations can be more effective than verbal instructions alone.
3. Provide Written Instructions: Give patients written guidelines on wound care, including step-by-step instructions and signs of infection to watch for. This serves as a handy reference they can consult at home.
4. Encourage Patient Participation: Involve patients in their wound care routine. Encourage them to take an active role, such as changing their own dressings and monitoring for signs of infection.
5. Follow Up with the Patient: Regular follow-ups are crucial for monitoring the wound’s progress and providing additional education and support as needed. This helps ensure that the wound is healing properly and that any issues are addressed promptly.

By implementing these strategies and educating patients effectively, we can significantly reduce the risk of wound infections and promote better healing outcomes.

Meet Challenges of Wound Infection

There’s so much happening in wound care right now. Researchers, clinicians and innovators are working hard every day to find better ways to spot and prevent infections. We’ve still got a lot to do, but think about how far we’ve come and all the valuable knowledge we’ve gained, even in just the past few years.

Wound care providers are on the front lines daily, identifying, preventing, and treating infections. Combining this real-world knowledge with up-to-date treatments and innovations is vital to improving patient outcomes.

Those committed to continuous learning and adapting to promising technologies and solutions will remain crucial in the fight against wound infections. By embracing new knowledge and innovations, we can enhance practices, improve patient care, and ultimately contribute to better health outcomes for everyone.