Wound Care Management



Local Signs & Symptoms

  • PAIN
  • periwound skin is reddened
  • periwound skin is warm to touch
  • periwound skin or limb is edematous
  • periwound skin is indurated (hard) or boggy
  • purulent drainage (green,yellow,..)
  • drainage has a foul odour

Systemic Signs & Symptoms

  • fever
  • malaise
  • increased WBC

* N.B. To suspect infection, most of the local and systemic S&S listed here need to be present. Reddened periwound skin and fever only may be a sign of the inflammatory phase of healing.

  • Only swab a wound if the wound appears infected OR if the topical treatment has proved ineffective.

  • Swabbing the wound is essential to ensure that the correct antibiotic is being administered.

    When obtaining a swab:

    • The wound bed should be well cleansed with saline to avoid contamination of the culture by surface organisms;
    • Do not swab eschar, exudate or pus;
    • Select cleanest area of wound;
    • Firmly press and rotate swab in this area;
    • Include tunneling if present.

How the swab should be rotated inside the wound

Treating the infected wound

Treatment of infected wounds need to be discussed with the physician or wound care expert.

Systemic antibiotics (use only when definitive diagnosis has been established)

Topical treatments that decrease bacterial burden on a wound are:

Silver (eg. Acticoat) - sterile water activates the silver particles which act upon the wound base to kill a broad spectrum of bacteria. Acticoat
Cadexomer Iodine (eg. Iodosorb) - this treatment is iodine in starch. Unlike betadine, it is selective for many pathogens. Iodosorb is contraindicated in patients who have thyroid conditions and no more than 150g / week should be applied. Idosorb
Sodium Chloride dressing (Mesalt) - draws out interstitial fluid thus increasing circulation and bringing the body's natural healing factors to the wound bed. This treatment also sets up a hostile environment for bacteria. Mesalt
Topical antibiotics (eg. Flamazine) - should only be used in mild infections, for a short time to avoid resistance, and not be redundant with systemic antibiotics.  
Acetic acid (vinegar) - effective for Pseudomonas, to be used short term only.  
1/2 strength Betadine (povoiodine) - to be used for a maximum of three days, any longer and it is cytotoxic to tissues and can delay healing of wound.  
Chlorhexidine - active against gram negative organisms, but high toxicity to tissue.  
Sodium Hypochlorite (eg. Dakin's Solution) - is cytotoxic to healthy tissue and "should never be used in a clean wound". It is only of use as a chemical debriding agent and should be stopped as soon as the necrotic tissue is removed.