Ask the treatment expert: Is an infection indicated after two weeks without healing?

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Q: If a wound has no signs of healing after two weeks could it be infected?

A: Yes, according to the most recent Clinical Practice Guidelines from NPUAP (the National Pressure Ulcer Advisory Panel). There is a high index of suspicion for local infection in pressure sores with no sign of healing after two weeks.

All wounds may be contaminated, although not all are infected. There are numerous variables that may determine the potential for infection, such as existing medical conditions, the individual's state of nutrition and hydration and extrinsic factors.

In addition to the classic signs of infection (i.e., pain, erythema, edema, heat and purulent exudate), be alert to systemic signs (i.e., elevated temperature, elevated WBC, confusion and/or malaise).  Along with these signs, observe for secondary wound infection symptoms, such as foul odor, delayed healing, wound breakdown, discolored granulation tissue, pocketing at the wound base and serous drainage with concurrent inflammation.

It is important to recognize infection and manage the bioburden (number of bacteria on the pre-sterilized surface). The wound may need to be cultured if clinical signs of infection are present.

Early intervention using antimicrobial dressings including topical silver preparations and iodine are among the antimicrobial dressings that may be used. If the wound has the ability to heal, then the use of betadine may not be appropriate.

The wound bed may need to be debrided by numerous measures if necrotic tissue is present. Be aggressive with your debridement modalities. Topical antibiotics (i.e., bactroban used with MRSA) may be appropriate. In some cases, the use of systemic antibiotics may be necessary.

Always be aggressive with your plan of care. Early intervention with non-healing wounds after two weeks is crucial.

Please send your wound treatment-related questions to Sandra Wickard at



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