Wound infection Wound infection & its impact on wounds healing & its impact on wounds healing

by primary & secondary intentionby primary & secondary intention

Shila PatelShila PatelLead Nurse Infection Prevention & ControlLead Nurse Infection Prevention & Control

Epsom and St Helier University Hospitals NHS TrustEpsom and St Helier University Hospitals NHS Trust

Today’s TopicsToday’s Topics Defining wound infectionDefining wound infectionImpact on the patientImpact on the patient– Factors influencing individual vulnerabilityFactors influencing individual vulnerability– Microbial pathogenicity and virulenceMicrobial pathogenicity and virulence– Implications for the patientImplications for the patient– Pain Pain Cost to the NHS and societyCost to the NHS and societyImpact on the practitioner-patient relationshipImpact on the practitioner-patient relationshipCase presentationCase presentationPreventing cross-infectionPreventing cross-infectionSummary Summary

Defining wound infectionDefining wound infection

The first step to understanding the impact of wound The first step to understanding the impact of wound infection is defining wound infection accuratelyinfection is defining wound infection accurately

4 basic conditions exist in open wounds:4 basic conditions exist in open wounds:

ContaminationContaminationColonisationColonisationCritical colonisationCritical colonisationInfectionInfection

Contamination Contamination - a normal state- a normal state

Defined as the presence of non-multiplying Defined as the presence of non-multiplying organisms on the surface of a woundorganisms on the surface of a wound

Not associated with delayed wound healing / Not associated with delayed wound healing / active diseaseactive disease

All wounds are contaminated with micro-All wounds are contaminated with micro-organismsorganisms

The type and quantity of organisms will vary The type and quantity of organisms will vary from one wound to anotherfrom one wound to another

Contamination Contamination Contamination can occur in a variety of ways:Contamination can occur in a variety of ways:

– Transfer of normal body bacteria, e.g. Staphylococcus aureus Transfer of normal body bacteria, e.g. Staphylococcus aureus (including MRSA) & Staphylococcus epidermidis from other body (including MRSA) & Staphylococcus epidermidis from other body sites into a woundsites into a wound

– During surgery, e.g. bowel surgery when gut flora can readily During surgery, e.g. bowel surgery when gut flora can readily contaminate the wound site, e.g. E.Colicontaminate the wound site, e.g. E.Coli

– Cross-contamination from other patients, often via the hands of Cross-contamination from other patients, often via the hands of healthcare staff healthcare staff (preventing cross-contamination is therefore vital)(preventing cross-contamination is therefore vital)

– Environmental contamination, e.g. following a road traffic accident Environmental contamination, e.g. following a road traffic accident

ColonisationColonisation- a normal state- a normal state

Defined as the presence of multiplying micro-Defined as the presence of multiplying micro-organisms on the surface of a wound, but with organisms on the surface of a wound, but with no host immune response, or clinical signs and no host immune response, or clinical signs and symptomssymptoms

Similarly to contamination it is a normal state Similarly to contamination it is a normal state and not associated with active disease, ill health and not associated with active disease, ill health or delayed wound healingor delayed wound healing

May be the pre-cursor to critical colonisationMay be the pre-cursor to critical colonisation

Colonised woundColonised wound

Critical colonisationCritical colonisation- abnormal state- abnormal state

A transition state between surface colonisation A transition state between surface colonisation and invasion of micro-organisms into viable and invasion of micro-organisms into viable tissuetissue

The point at which the organisms can no longer The point at which the organisms can no longer be controlled and may lead to infection. There be controlled and may lead to infection. There are no obvious signs of healing at this stageare no obvious signs of healing at this stage

It is worth noting that this is largely a conceptual It is worth noting that this is largely a conceptual stage, with limited supporting evidencestage, with limited supporting evidence

InfectionInfection

Defined as the presence of multiplying Defined as the presence of multiplying micro-organisms that overwhelm the micro-organisms that overwhelm the body’s immune system resulting in body’s immune system resulting in spreading cellulitis (inflammation of the spreading cellulitis (inflammation of the tissues)tissues)

Causes active disease, likely to delay Causes active disease, likely to delay wound healingwound healing

InfectionInfection Clinical diagnosis involves:Clinical diagnosis involves:

Assessing the patient / wound for the presence of clinical signs / symptoms, e.g.:Assessing the patient / wound for the presence of clinical signs / symptoms, e.g.:– Pus Pus – Cellulitis – redness, heat, swellingCellulitis – redness, heat, swelling– Increasing pain Increasing pain – Wound breakdownWound breakdown– Fever Fever – Increased leucocytesIncreased leucocytes

andand

Identifying the causative micro-organism(s) (many wounds are polymicrobial)Identifying the causative micro-organism(s) (many wounds are polymicrobial)

Note: defining wound infection is a clinical diagnosis. Positive microbiology Note: defining wound infection is a clinical diagnosis. Positive microbiology results in the absence of clinical signs/symptoms is not wound infection but results in the absence of clinical signs/symptoms is not wound infection but rather wound colonisation (even if positive for MRSA)rather wound colonisation (even if positive for MRSA)

Infection Infection

Infection Infection

Infection Infection

What determines colonisation or infection?What determines colonisation or infection?What determines the impact of infection?What determines the impact of infection?

Individual vulnerability, including wound characteristics

Type, quantity & diseasecausing ability (virulence) of the micro-organisms present

versus

Emmerson, 1998

Infection occurs when the balance between these factors is lost

Wound characteristicsWound characteristics

Anatomical position of the woundAnatomical position of the wounde.g. sacral sores more likely be become e.g. sacral sores more likely be become colonised/infected due to contamination colonised/infected due to contamination with urine/faeceswith urine/faeces

Duration Duration the longer a wound exists the greater the the longer a wound exists the greater the opportunity for colonisation/infection and opportunity for colonisation/infection and further complicationsfurther complications

Factors influencing individualFactors influencing individual vulnerabilityvulnerability

Circulatory disordersCirculatory disorders– e.g. cardiovascular disease e.g. cardiovascular disease

– Causes reduced blood and OCauses reduced blood and O22 supply to wounds, slows the healing supply to wounds, slows the healing process and increases the risk of infectionprocess and increases the risk of infection

– For rapid wound healing to occur the wound tissue OFor rapid wound healing to occur the wound tissue O22 tension needs tension needs to be to be > 40mm Hg> 40mm Hg

– Levels < 20 mm Hg is unlikely to support healingLevels < 20 mm Hg is unlikely to support healing

– In healthy individuals with acute wounds the tissue In healthy individuals with acute wounds the tissue OO2 2 tension ranges tension ranges between 60-90mm Hgbetween 60-90mm Hg

– In chronic non-healing wounds the wound tissue tension can drop In chronic non-healing wounds the wound tissue tension can drop between 5-20mm Hg causing cell destruction and tissue necrosis, between 5-20mm Hg causing cell destruction and tissue necrosis, both of which facilitate microbial growthboth of which facilitate microbial growth

Factors influencing individualFactors influencing individual vulnerabilityvulnerability

Metabolic disordersMetabolic disorders– e.g. diabetes mellituse.g. diabetes mellitus

– Reduces neutrophil activity and interferes with Reduces neutrophil activity and interferes with phagocytosisphagocytosis

– This can delay the normal inflammatory This can delay the normal inflammatory response and ingestion of microorganisms, response and ingestion of microorganisms, preventing formation of granulation tissue and preventing formation of granulation tissue and increasing the risk of infection increasing the risk of infection

Factors influencing individualFactors influencing individual vulnerabilityvulnerability

Nutritional statusNutritional status– Malnutrition is associated with a poor immune Malnutrition is associated with a poor immune

response and increased risk of wound response and increased risk of wound infectioninfection

– Malnutrition is defined as a deficiency, excess Malnutrition is defined as a deficiency, excess or imbalance of essential nutrients and or imbalance of essential nutrients and causing a measureable adverse effectcausing a measureable adverse effect

– Some studies have found up to 40% of pts Some studies have found up to 40% of pts are malnourised on admission to hospitalare malnourised on admission to hospital

Factors influencing individualFactors influencing individual vulnerabilityvulnerability

ImmunosuppressionImmunosuppression– Can arise for a variety of reasons: concurrent infections Can arise for a variety of reasons: concurrent infections

and drugs, e.g. chemotherapy and long term steroid and drugs, e.g. chemotherapy and long term steroid therapytherapy

– Can predispose to potentially serious infectionCan predispose to potentially serious infection

Advancing ageAdvancing age – Also associated with increased susceptibilityAlso associated with increased susceptibility

– Age linked to increased chronic disease and slower Age linked to increased chronic disease and slower immune responseimmune response

Factors influencing individualFactors influencing individual vulnerabilityvulnerability

Additional specific risk factors associated with Additional specific risk factors associated with surgical site wound infectionsurgical site wound infection– Obesity: deep layers of adipose tissue reduce Obesity: deep layers of adipose tissue reduce

blood and Oblood and O2 2 perfusion to the woundperfusion to the wound

– Pre-operative colonisation with Staphylococcus Pre-operative colonisation with Staphylococcus aureus, sensitive and resistant strains (MRSA), aureus, sensitive and resistant strains (MRSA), increased risk particularly linked to complex increased risk particularly linked to complex procedures / implant surgery, e.g. hip prosthesisprocedures / implant surgery, e.g. hip prosthesis

Factors influencing individualFactors influencing individual vulnerabilityvulnerability

The range of vulnerability factors The range of vulnerability factors discussed indicates that the impact of discussed indicates that the impact of wound infection will vary from one pt to wound infection will vary from one pt to another depending on the number, type another depending on the number, type and severity of risk factors experiencedand severity of risk factors experienced

The more susceptible an individual the The more susceptible an individual the greater the impact is likely to begreater the impact is likely to be

Microbial pathogenicity & virulenceMicrobial pathogenicity & virulencePathogenicityPathogenicity is the ability of a microorganism is the ability of a microorganism to cause disease and is dependant on their to cause disease and is dependant on their virulence factorsvirulence factors

VirulenceVirulence are the factors by which are the factors by which microorganisms invade, multiply and cause microorganisms invade, multiply and cause damage to tissuesdamage to tissues

Virulence factors can be genetic, biochemical Virulence factors can be genetic, biochemical or structural or structural

They involve a number of complex processesThey involve a number of complex processes

Microbial pathogenicity & virulenceMicrobial pathogenicity & virulenceVirulence factors fall into 2 main categories:Virulence factors fall into 2 main categories:

Invasiveness factorsInvasiveness factors

– Invasin production: extracellular substances / Invasin production: extracellular substances / enzymes facilitate invasion of host cells, e.g. enzymes facilitate invasion of host cells, e.g. hyaluronidase, produced by streptococci & hyaluronidase, produced by streptococci & staphylococci and attacks connective tissuestaphylococci and attacks connective tissue

– Ability to overcome / bypass host defence Ability to overcome / bypass host defence mechanisms, e.g. slime production mechanisms, e.g. slime production (Pseudomonas aeruginosa) enabling avoidment (Pseudomonas aeruginosa) enabling avoidment of phagocytosisof phagocytosis

Microbial pathogenicity & virulenceMicrobial pathogenicity & virulenceToxigenesis factorsToxigenesis factors

Ability to produce toxinAbility to produce toxin

Exotoxins and endotoxins which can cause Exotoxins and endotoxins which can cause either a local or systemic effect, dependant either a local or systemic effect, dependant on the amount of toxin releasedon the amount of toxin released

(Todar, 2009)(Todar, 2009)

Microbial pathogenicity & virulenceMicrobial pathogenicity & virulence

Structural featuresStructural features

A variety of structure features also facilitate virulence, e.g.: A variety of structure features also facilitate virulence, e.g.:

– Capsules which offer protection from phagocytosis and Capsules which offer protection from phagocytosis and complement actioncomplement action

– Pili which facilitate attachment to host cellsPili which facilitate attachment to host cells

Sticky Sticky biofilmbiofilm on the wound surface which facilitate on the wound surface which facilitate polymicrobial communities by evading host defence polymicrobial communities by evading host defence mechanismsmechanisms

– Ability to emit single bacteria which lead to further local Ability to emit single bacteria which lead to further local infections / weaken the collagen matrix in healing wounds, infections / weaken the collagen matrix in healing wounds, resulting in further wound breakdown / re-ulcerationresulting in further wound breakdown / re-ulceration

Biofilm on woundBiofilm on wound

Synergistic relationshipsSynergistic relationshipsPolymicrobial woundsPolymicrobial wounds

Individually some microorganisms can Individually some microorganisms can have low virulence have low virulence

However, wounds containing a variety of However, wounds containing a variety of microorganisms can develop synergistic microorganisms can develop synergistic relationships and gain virulencerelationships and gain virulence

Bio burden Bio burden A high bio burden can increase virulence A high bio burden can increase virulence

Quantitative measure of infection:Quantitative measure of infection:- 10- 105 5 cfu / cmcfu / cm2 2 (White, 2003)(White, 2003)

However, for some organisms, e.g. Group A Beta However, for some organisms, e.g. Group A Beta Haemolytic streptococci, very few organisms Haemolytic streptococci, very few organisms required for pathogenesis – high virulence factorsrequired for pathogenesis – high virulence factors

Large numbers of organisms may be identified Large numbers of organisms may be identified without overt infectionwithout overt infection

In polymicrobial wounds individual species of In polymicrobial wounds individual species of microorganisms may be present in low numbers but microorganisms may be present in low numbers but are pathogenic due to synergistic relationshipsare pathogenic due to synergistic relationships

All of these factors indicate the All of these factors indicate the impact of wound infection will vary impact of wound infection will vary from one pt to another according to from one pt to another according to the pathogenicity / virulence of the the pathogenicity / virulence of the microorganisms coupled with microorganisms coupled with individual susceptibilityindividual susceptibility

Implications for the patientImplications for the patientA number of studies have been undertaken considering the impact of surgical site A number of studies have been undertaken considering the impact of surgical site infection (SSI)infection (SSI)

Coello et al (2005)Coello et al (2005)They studied 140 English hospitals participating in the national Surgical Site They studied 140 English hospitals participating in the national Surgical Site Infection Surveillance Scheme between Oct 1997-June 2001Infection Surveillance Scheme between Oct 1997-June 2001

67,410 pts included in the surveillance following 9 types of surgical procedures, e.g. 67,410 pts included in the surveillance following 9 types of surgical procedures, e.g. limb amputation, abdominal hysterectomy, knee/hip prosthesislimb amputation, abdominal hysterectomy, knee/hip prosthesis

Results:Results: 2832 pts had an SSI, with superficial infection the most common. They 2832 pts had an SSI, with superficial infection the most common. They had an increased length of hospital stay and crude mortality was higher for all had an increased length of hospital stay and crude mortality was higher for all categories. After adjusting for confounding factors pts who underwent vascular categories. After adjusting for confounding factors pts who underwent vascular surgery, hip prosthesis & large bowel surgery had a higher adjusted mortality ratesurgery, hip prosthesis & large bowel surgery had a higher adjusted mortality rate

Conclusion:Conclusion: post-operative wound infection following certain types of surgery is post-operative wound infection following certain types of surgery is associated with significant mortalityassociated with significant mortality

Implications for the patientImplications for the patientPartanen et al (2006)Partanen et al (2006)

Evaluated the impact of deep wound infection following hip fracture Evaluated the impact of deep wound infection following hip fracture surgery on functional mobility and mortalitysurgery on functional mobility and mortality

2276 pts followed up, all over 50yrs & with non-pathological fractures. 2276 pts followed up, all over 50yrs & with non-pathological fractures. Control pts matched for age, sex, fracture type, treatment method and Control pts matched for age, sex, fracture type, treatment method and mobility, but without wound infection were used for comparisonmobility, but without wound infection were used for comparison

Results:Results: 29 pts developed deep wound infection. 4 months following 29 pts developed deep wound infection. 4 months following surgery the pts with deep wound infection had poorer mobility & greater surgery the pts with deep wound infection had poorer mobility & greater dependency on walking aids. These pts had an increased length of dependency on walking aids. These pts had an increased length of hospital stay. 1yr following surgery the overall mortality for pts with hospital stay. 1yr following surgery the overall mortality for pts with infection was also higher – 34.5% versus 24.1%. infection was also higher – 34.5% versus 24.1%. Diabetes was a common risk factor for the infection cohortDiabetes was a common risk factor for the infection cohort

Conclusion:Conclusion: deep wound infection following hip fracture surgery has a deep wound infection following hip fracture surgery has a significant impact on mobility and can increase the risk of mortalitysignificant impact on mobility and can increase the risk of mortality

Implications for the patientImplications for the patientIt is unclear whether the findings of these studies are It is unclear whether the findings of these studies are applicable to all types of woundsapplicable to all types of wounds

However, the studies demonstrate that wound infection However, the studies demonstrate that wound infection following certain surgical procedures, affects quality of life following certain surgical procedures, affects quality of life (mobility) and can increase mortality(mobility) and can increase mortality

Wound infection may also impact the pt in other ways. Wound infection may also impact the pt in other ways. Delayed discharge may delay a return to paid employment, Delayed discharge may delay a return to paid employment, cause financial difficulties, affect self-esteem and overall cause financial difficulties, affect self-esteem and overall psychological well-being psychological well-being

Therefore, potentially extensive impact for the patient in a Therefore, potentially extensive impact for the patient in a variety of waysvariety of ways

Pain Pain Wound infection can produce a significant increase in painWound infection can produce a significant increase in pain

Wound infectionWound infection

Chronic inflammation around wound siteChronic inflammation around wound site

Excitation of sensory receptors Excitation of sensory receptors Sensitisation of indirect pain Sensitisation of indirect pain e.g. nociceptorse.g. nociceptors mediatorsmediators

Pain is one of the most reliable indicators of wound infectionPain is one of the most reliable indicators of wound infection

Pain Pain Antimicrobial dressings, e.g. iodine / honey, can further Antimicrobial dressings, e.g. iodine / honey, can further increase pt’s pain on application increase pt’s pain on application (Hofman, 2006)(Hofman, 2006)

This can make the pt fear wound dressing changesThis can make the pt fear wound dressing changes

Increased psychological impact of painIncreased psychological impact of pain

Conversely it has also been reported that antimicrobial Conversely it has also been reported that antimicrobial dressings reduce pain in certain wound types, e.g. leg dressings reduce pain in certain wound types, e.g. leg ulcers ulcers (Vanscheidt et al, 2003)(Vanscheidt et al, 2003) & burn wounds & burn wounds (Vloemans et al, (Vloemans et al, 2003)2003)

Therefore, Therefore, the impact of pain can be really significant the impact of pain can be really significant

Appropriate pain assessment and management will be Appropriate pain assessment and management will be criticalcritical

Infected dermatitis – extremely painfulInfected dermatitis – extremely painful

Cost to the NHS & SocietyCost to the NHS & SocietyCoello et al (2005)Coello et al (2005)Considered the increased length of hospital stay and cost Considered the increased length of hospital stay and cost of SSI in wounds following a variety of surgical proceduresof SSI in wounds following a variety of surgical procedures

Results:Results: associated with increased length of hospital stay associated with increased length of hospital stay ranging from 3.3 days for abdominal hysterectomy to 21.0 ranging from 3.3 days for abdominal hysterectomy to 21.0 days for limb amputationdays for limb amputationAssociated additional cost to the NHS ranged from £959 Associated additional cost to the NHS ranged from £959 for abdominal hysterectomy to £6103 for limb amputationfor abdominal hysterectomy to £6103 for limb amputation

These results suggest that the cost of wound infection may These results suggest that the cost of wound infection may impact NHS service provision for other patients – it has to impact NHS service provision for other patients – it has to be paid for somehow and the NHS does not have unlimited be paid for somehow and the NHS does not have unlimited resourcesresources

Conclusion:Conclusion: the cost to the NHS can be significant the cost to the NHS can be significant

Impact on the practitioner-patient Impact on the practitioner-patient relationshiprelationship

Gardner & Cook (2004)Gardner & Cook (2004)

Considered how pts are informed about having a SSI in their Considered how pts are informed about having a SSI in their woundwound

Difficulties often experienced by pts in gaining relevant Difficulties often experienced by pts in gaining relevant informationinformation

Healthcare professionals avoid communicating this Healthcare professionals avoid communicating this informationinformation

Staff reluctance to discuss the matter may be related to Staff reluctance to discuss the matter may be related to feelings of guilt & responsibilityfeelings of guilt & responsibility

This may have a negative impact on the practitioner-patient This may have a negative impact on the practitioner-patient relationshiprelationship

Impact on the practitioner-patient Impact on the practitioner-patient relationshiprelationship

Whilst it is unclear whether these findings apply to all types of Whilst it is unclear whether these findings apply to all types of wound infection, it is possible that pts and staff do experience wound infection, it is possible that pts and staff do experience similar difficulties and feelings, e.g. with chronic wound similar difficulties and feelings, e.g. with chronic wound infectioninfection

This may be exacerbated if the wound is infected by MRSAThis may be exacerbated if the wound is infected by MRSA

Many pts already have a poor perception of MRSA via the Many pts already have a poor perception of MRSA via the media (Hamour et al, 2003)media (Hamour et al, 2003)

Therefore staff may feel reluctant to fully discuss the wound Therefore staff may feel reluctant to fully discuss the wound infection / status with the pt, further impacting the practitioner – infection / status with the pt, further impacting the practitioner – patient relationshippatient relationship

Adequate communication is vitalAdequate communication is vital

Case PresentationCase Presentation

70yr male patient70yr male patientOn admission to hospital found to be drowsy and On admission to hospital found to be drowsy and confusedconfusedIncontinent of urineIncontinent of urinePMH - COPDPMH - COPD

IHDIHD ParaproteinaemiaParaproteinaemia SchizophreniaSchizophrenia Renal impairmentRenal impairment

Residential homeResidential home

O/E O/E Alert but disorientated Alert but disorientated ObeseObese

Pyrexial - 38Pyrexial - 38° C ° C Urinalysis positive: nitrites, leucocytes, Urinalysis positive: nitrites, leucocytes,

bloodbloodBlood cultures – sterileBlood cultures – sterileMRSA screening swabs - positiveMRSA screening swabs - positive

(skin suppression therapy commenced)(skin suppression therapy commenced)Urinary retention – catheterisedUrinary retention – catheterised

ΔΔ Acute confusional state 2 Acute confusional state 2° to UTI° to UTITreated with14 days Co-amoxiclavTreated with14 days Co-amoxiclav

ProgressProgress

12 days after admission12 days after admission

Sacral sore grade 2-3 notedSacral sore grade 2-3 notedStill MRSA positive, including sacral sore, Still MRSA positive, including sacral sore,

after one course of skin suppression after one course of skin suppression therapytherapy

(NB CSU was MRSA neg) (NB CSU was MRSA neg)

3 days later3 days laterPyrexial - 39Pyrexial - 39° C° C

CSU > 50 WBC >10CSU > 50 WBC >108 /8 / L (coliforms) L (coliforms) Blood cultures sterileBlood cultures sterileStarted on TazocinStarted on TazocinFemoral line inserted for IV accessFemoral line inserted for IV accessContinued to spike fevers Continued to spike fevers Repeat blood cultures yielded MRSA Repeat blood cultures yielded MRSA Started teicoplanin Started teicoplanin

4 days later4 days later

Sacral soreSacral sore ““Deep sloughy cavity plus discharge - pus”Deep sloughy cavity plus discharge - pus”““Size of a fist”Size of a fist”

Referred to tissue viabilityReferred to tissue viability““Sacral pressure ulcer, grade 3Sacral pressure ulcer, grade 38-10 cm diameter as conservative estimate”8-10 cm diameter as conservative estimate”

Teicoplanin continued - sacral ulcer dressedTeicoplanin continued - sacral ulcer dressed

Over next 2 weeksOver next 2 weeks

Attention to dietAttention to dietSacral ulcer dressingsSacral ulcer dressings

Gradual deteriorationGradual deterioration Renal impairment – teicoplanin stopped - Renal impairment – teicoplanin stopped -

nearly 3 weeks completednearly 3 weeks completedHb droppedHb droppedParaproteinaemia worsenedParaproteinaemia worsenedPyrexial againPyrexial again

FinallyFinally

Referred for palliative careReferred for palliative care

Died just over 6 weeks after admissionDied just over 6 weeks after admission

RIPRIP

SummarySummaryMRSA septicaemia 2MRSA septicaemia 2° to infected sacral ° to infected sacral

ulcer, which developed in hospitalulcer, which developed in hospital

MRSA isolated from both blood and sacral MRSA isolated from both blood and sacral ulcerulcer

Root Cause Analysis: Septicaemia might Root Cause Analysis: Septicaemia might have been prevented by better carehave been prevented by better care

Therefore the impact / cost of wound Therefore the impact / cost of wound infection for the patient can be fatalinfection for the patient can be fatal

Preventing cross-infectionPreventing cross-infectionPreventing cross-infection from an infected wound, healing by Preventing cross-infection from an infected wound, healing by either primary or secondary intention, is vitaleither primary or secondary intention, is vital

Healthcare professionals have a duty to safeguard pts from Healthcare professionals have a duty to safeguard pts from Health Care Associated Infections, such as wound infection, as Health Care Associated Infections, such as wound infection, as much as possible much as possible

Implement standard infection control precautions at all times Implement standard infection control precautions at all times and with all patientsand with all patients

In additional at the time of wound dressing:In additional at the time of wound dressing:– Turn off bedside fans – they can distribute bacteria over a wide areTurn off bedside fans – they can distribute bacteria over a wide are

– Avoid bed-making as shaking sheets disperses skin scales / bacteriaAvoid bed-making as shaking sheets disperses skin scales / bacteria

– Avoid sweeping floors as this can distribute dust / bacteria found in dustAvoid sweeping floors as this can distribute dust / bacteria found in dust

SummarySummaryA variety of factors can influence the impact of wound infection in A variety of factors can influence the impact of wound infection in both wounds healing by primary and secondary intentionboth wounds healing by primary and secondary intention

There is a fine balance between individual patient vulnerability and There is a fine balance between individual patient vulnerability and the pathogenicity and virulence of the causative microorganismsthe pathogenicity and virulence of the causative microorganisms

When the causative microorganisms overwhelm the individual’s When the causative microorganisms overwhelm the individual’s immune system, wound infection will arise and the greater the immune system, wound infection will arise and the greater the vulnerability of the pt the greater the impactvulnerability of the pt the greater the impact

The impact or cost to the patient, the NHS and the practitioner-The impact or cost to the patient, the NHS and the practitioner-patient relationship can be significant. Good communication is vitalpatient relationship can be significant. Good communication is vital

Healthcare staff need to have a good understanding of these factors Healthcare staff need to have a good understanding of these factors to prevent wound infection whenever possible and where it cannot to prevent wound infection whenever possible and where it cannot be prevented accurate assessment and management is essentialbe prevented accurate assessment and management is essential

Thank you for listeningThank you for listening

Any questions?Any questions?