Ask the treatment expert ... about signs and symptoms of wound infection

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Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC
Rosalyn Jordan, RN, BSN, MSc, CWOCN, WCC

Can you supply a good primer for aides and others to determine whether a wound is infected?

The skin is a protective barrier that prevents harmful microorganisms from entering the body and attacking tissue. An individual's skin is the first line of defense against infection. If there is a break in skin integrity, bacteria may enter the exposed tissue, leading to a local infection. Bacteria may even spread to deep tissue layers, major organs and bone, resulting in serious, life-threatening, systemic infections.  

All wounds are exposed to bacteria. Therefore, all wounds are contaminated. Initially, the body responds to wounding with an inflammatory reaction intended to destroy, digest and remove the harmful bacteria. 

Erythema, edema and warmth of the wound and surrounding skin during the first two to 10 days after the wound occurs are the classical signs and symptoms of the inflammatory period. The actual state of “infection” occurs when the bacteria invade healthy, viable tissue in the wound bed, and the offending organisms and the bacteria begin to multiply and form colonies.

If the bacteria multiply and colonize in the surface tissue, necrotic tissue, slough or wound drainage, the wound is not considered infected but rather contaminated. 

The classical signs and symptoms of infection in an acute wound are: 1. Erythema in the periwound area, 2. Fever, 3. Elevated white blood count, 4. Pain, 5. Edema, 6. Warmth, 7. Purulent drainage

If prolonged healing is evident, proper assessment of the wound is to consider a possible wound infection. Non-healing may be the only sign and symptom of infection, especially in chronic wounds. 

Early identification is critical. If no healing is noted within two to four weeks when treating a chronic wound, a treatment plan for an infected wound should be initiated.