Infection

sources of infection

bacteria, fungi, virus

bacterial infection effect on microbes on the wound bed would be dependant on

type of bacteria, number of colony forming units/gram, host immune system

host resistance

ability of the host to mount an immune response in order to resist bacterial invasion or damage (most important factor in determining how severe an infection is)

virulence

quality of being extremely poisonous, infectious or damaging or the extent to which a disease or toxin possesses this quality

contamination

non-replicating bacteria with no effect on wound healing

colonization

replicating bacteria that have attached to the wound surface with no harm to the host and no effect on the wound healing process

critical colonization

presence of replicating bacteria with sufficient number to induce a host response and cause subtle clinical changes in the wound healing process

infection

movement of replicating bacteria that have invaded the surrounding tissue with visible effects in wound healing process in periwound tissues

sepsis

presence of replicating bacteria that produces a whole body inflammatory state termed systemic inflammatory response syndrome

local factors of host resistance

size, location and age of wound, necrotic tissue or foreign bodies, presence of scar, previous radiation, inadequate or improper topical treatments

systemic factors of host resistance

poorly controlled diabetes, inadequate vascular perfusion, edema, immunosuppressive drugs, malnutrition, alcohol, neutrophil

endogenous infections

invasion of indigenous, bacteria gets in from you're own skin

exogenous infections

contamination from microbial populations in the environment

clinical signs/symptoms of infection

pain, erythema, edema, heat, purulent exudate, discoloration, friability of granulation tissue, pocketing of wind

characteristics of inflammation

pain, erythema, edema, heat

treat an infection if

3 or more signs/symptoms noted

increasing pain

plasma derived mediators are activated near tiny, unmyelinated fibers (exception is neuropathy)

erythema

vasoactive mediators are produced in response to any damage to mast cells in connective tissue

purulent exudate

rich in WBCs, common in infections produced by strongly chemotactic bacteria

delayed healing

lack of progress toward wound closure and no decrease in wound size (should see healing in 2 weeks)

discoloration of granulation tissue

pale or dusky, excessive angiogenic responses and granulation tissue from invading micro-organisms

friable granulation tissue

excessive angiogenic response caused by heavy bioburden, bleeds spontaneously or with light pressure

pocketing at base of wound

wound base irregular maybe due to lack of granulation tissue around islands of infection

foul odor

usually due to gram-negative bacilli, always associated with presence of anaerobes

clinical presentation of systemic infection

fever, chills, hypotension, multiple organ failure, fatigue

treat superficial infections

topically with antimicrobial dressings

treat deep/systemic infections

systemically

if swabbing an infection

dont swab over hard eschar, use sterile swab, swab area of most dramatic infection after cleansing and debridement

cellulitis

inflammation of connective tissue of the skin from bacterial infection (any bacteria)

cellulitis spreads through either

lymphatics or blood (will start streaking)

clinical signs of cellulitis

pain, warmth, erythema, edema

cellulitis treatment

antibiotics, elevation, analgesics, compression (ASAP)

osteomyelitis

infection and inflammation of bone

order of imaging for suspected osteomyelitis

xray, MRI, and bone biopsy (gold standard)

if there is bone exposure at a wound

refer to imaging and wait for results before treating