From the Guidelines
To decrease wound infection in patients with uncontrolled diabetes mellitus, controlling blood sugar preoperatively is crucial, as it reduces the risk of infection and promotes wound healing. This is supported by the most recent and highest quality study, which emphasizes the importance of glycemic control in preventing wound infections 1.
Key Interventions
- Controlling blood sugar preoperatively is essential to reduce the risk of wound infection and promote healing.
- Proper wound care, including cleaning wounds with normal saline and applying appropriate dressings, is also crucial.
- Offloading pressure from wounds, particularly on the feet, using specialized footwear, casts, or wheelchairs, prevents further trauma.
- Patients should receive prophylactic antibiotics only when clinically indicated, not routinely.
- Nutritional support with adequate protein intake and sufficient calories promotes healing.
Rationale
Hyperglycemia impairs immune function, decreases neutrophil activity, and promotes bacterial growth, while also causing microvascular damage that reduces tissue perfusion and oxygenation, making glycemic control fundamental to infection prevention. The most recent guidelines recommend a target HbA1c below 7% and blood glucose levels between 80-180 mg/dL to achieve optimal glycemic control 1.
Additional Considerations
- Regular wound assessment using standardized tools helps track progress and detect complications early.
- Advanced wound therapy, such as topical growth factors, acellular matrix tissues, and bioengineered cellular therapies, may be considered for chronic wounds that fail to heal with standard treatment.
- A multidisciplinary approach to wound care, including infectious disease specialists, is recommended to improve outcomes.
From the Research
Decreasing Wound Infection in Uncontrolled DM
To decrease wound infection in patients with uncontrolled Diabetes Mellitus (DM), several strategies can be employed:
- Control Blood Sugar: Controlling blood sugar levels is crucial in reducing the risk of wound infection in diabetic patients. Studies have shown that maintaining blood glucose levels less than 200 mg/dL in the postoperative period can decrease the incidence of deep wound infections 2, 3.
- Preoperative Blood Sugar Control: Controlling blood sugar levels before surgery is also important, as hyperglycemia can impair wound healing 4, 5.
- Antibiotic Prophylaxis: Administering antibiotics within 30 to 60 minutes before skin incision can help reduce the risk of wound infection 6.
- Maintaining Normothermia: Maintaining normothermia during surgery can also help reduce the risk of wound infection, as hypothermia can impair wound healing 6.
Incorrect Options
- Shaving: Shaving is not a recommended method for reducing wound infection, as it can cause micro-trauma to the skin and increase the risk of infection.
- Increase Hypothermia: Increasing hypothermia is not a recommended method for reducing wound infection, as hypothermia can impair wound healing and increase the risk of infection.
The most effective strategies for decreasing wound infection in uncontrolled DM are controlling blood sugar levels, preoperative blood sugar control, antibiotic prophylaxis, and maintaining normothermia 2, 4, 3, 6, 5.