Journal of Community Nursing

Clinical skills Wound infection is one of the most common complications a patient with a wound may experience (Dowsett, 2015). The development of wound infection can result in delayed healing ( Dowsett, 2015 ), loss of a limb or even death (International Wound Infection Institute [IWII], 2016). Wound infection can have a significant impact on the cost burden that acute and chronic wounds contribute to the NHS, due to extended treatment time, antimicrobial therapy and possible hospital admissions (Guest et al, 2017). The cost to the patient should also be considered, as symptoms such as pain, odour and exudate have a detrimental effect on patient quality of life (Wounds UK, 2016). Timely identification of wound infection through accurate clinical assessment and instigating correct treatment help to reduce the economic burden, leading to improved patient outcomes (Hughes, 2016). Treatment for wound infection includes:  Topical antimicrobial agents  Systemic antibiotics  Wound debridement  A combination of all three (Wounds UK, 2017). Part 3: Wound infection Guidance produced by Health Improvement Scotland (HIS, 2018) indicated that successful management of a patient with a wound infection should consist of a standardised approach to assessment, reduction in variation in practice, and reduction in the use of inappropriate antimicrobials and antibiotics. To achieve this, it is essential that healthcare professionals have the knowledge and skills to identify wound infection in a timely manner and instigate appropriate treatment. WHAT HAPPENS WHEN BACTERIA ARE PRESENT? The skin acts as a physical barrier to microorganisms (Gottrup et al, 2013). Any break in the skin’s integrity, such as a wound, provides access for microorganisms to enter the body. The environment within a wound bed is moist and nutrient rich, which is ideal for microorganisms to colonise and proliferate (Gottrup et al, 2013). In normal wound healing, there is an equilibrium between the host (patient) and microorganisms that are present (European Wound Management Association [EWMA], 2005). During the inflammatory phase of wound healing, white blood cells, such as neutrophils and macrophages, assist in removing and engulfing bacteria by a process known as phagocytosis (Vuolo, › Reflective practice… When diagnosing wound infection, consider:  What may indicate that my patient/the wound is at risk of developing infection?  What signs and symptoms are the patient/wound displaying that may indicate that infection is present?  Could the signs and symptoms that the patient/wound is displaying be due to factors other than wound infection (differential diagnosis)?  What investigations should I consider and when should they be undertaken?  When should I use topical antimicrobial products versus systemic antibiotics?  How can I prevent my patient from developing a wound infection? 36 JCN 2020,Vol 34, No 4 In the first part of our clinical skills series, the process of robust assessment was discussed as a cornerstone to wound management to identify and manage possible barriers to wound healing. A contributory factor to delayed wound healing is wound infection, which should be identified by conducting comprehensive wound assessment, and then treated in a timely manner. This article explores the signs and symptoms of wound infection, risk factors, as well as treatment strategies available. 2009). Most chronic wounds are polymicrobial (Gottrup et al, 2013), i.e. within the wound there may be several species of bacteria, and not all bacteria present will result in a wound infection. Wound infection is a complex process, influenced by the host (patient) response, number of The new JCN clinical skills series looks at different aspects of wound management in the community, with useful tips on patient care and improving practice. The third part gives a practical overview of identifying and managing wound infection. Kirsty Mahoney, senior tissue viability nurse, Welsh Wounds Innovation Centre