What are the main elements of infection prevention in wound care?

Main Elements of Infection Prevention in Wound Care

Thorough wound cleansing and irrigation is the cornerstone of infection prevention in wound care, using running tap water or sterile saline solutions rather than antiseptic agents like povidone-iodine. 1

Wound Cleansing and Debridement

• Thoroughly irrigate superficial wounds until there is no obvious debris or foreign matter in the wound 1
• Use running tap water or sterile saline solutions for wound irrigation instead of antiseptic agents such as povidone-iodine, as they have similar infection rates but less tissue toxicity 1
• Proper debridement of any callus and necrotic tissue is crucial for healing and preventing infection 1
• Surgical debridement is helpful in converting a biologically chronic wound to that of an acute wound to promote healing 1
• Ultrasonic and enzymatic debridement are acceptable alternatives to surgical debridement when surgical options are not available 1

Dressings and Wound Coverage

• Cover clean superficial wounds and abrasions with an occlusive dressing to promote wound healing 1
• Occlusive dressings such as film, petrolatum, hydrogel, and cellulose/collagen dressings result in better wound healing than dry dressings 1
• There is no evidence that antibiotic or antibacterial dressings improve wound healing or decrease infection rates in clean wounds 1
• The surgical wound dressing should be kept undisturbed for a minimum of 48 hours after surgery unless leakage occurs 1
• Advanced dressings should not be used for primarily closed surgical wounds specifically for the purpose of preventing surgical site infections 1

Monitoring and Assessment

• If a person with a superficial wound develops redness, swelling, foul-smelling wound drainage, increased pain, or fever, remove the dressing, inspect the wound, and obtain medical care 1
• Patients with infected wounds require early and careful follow-up observation to ensure that the selected medical and surgical treatment regimens have been appropriate and effective 1
• Monitor for signs of infection, particularly in high-risk wounds such as those caused by animal or human bites 1

Antimicrobial Therapy

• Antimicrobial therapy should be used for patients with severe wound infections, including those with spreading cellulitis or patients with systemic signs of infection 1
• For infected wounds, antibiotics should be continued until there is evidence that the infection has resolved but not necessarily until a wound has healed 1
• For mild infections, 1–2 weeks of antibiotic therapy usually suffices, while moderate and severe infections typically require 2–4 weeks, depending on structures involved and wound vascularity 1
• Human and animal bite wounds or wounds contaminated with human or animal saliva should be evaluated in a medical facility as soon as possible due to high infection risk 1

Pressure Offloading and Specialized Care

• Off-loading of pressure is essential, particularly for diabetic foot ulcers and pressure injuries 1
• Negative Pressure Wound Therapy (NPWT) has demonstrated significant benefits in reducing infection rates in complex wounds 2
• For diabetic foot infections, a multidisciplinary foot-care team approach is recommended, preferably including or having ready access to an infectious diseases specialist or medical microbiologist 1

Risk Assessment and Prevention

• Identify patients at high risk for wound infections based on factors at patient, operative, and institutional levels 1
• Implement risk stratification in combination with risk modification strategies to reduce surgical site infections in high-risk populations 1
• Engage surgeons in infection prevention through active education techniques, consensus building sessions, and educational workshops 1
• Surgeons with knowledge in surgical infections should be involved in the infection control team and recognized as "champions" by hospital administration 1

By implementing these evidence-based practices for infection prevention in wound care, healthcare providers can significantly reduce infection rates, promote healing, and improve patient outcomes.