Q: Should we always use topical antibiotics in wounds?

A: Nursing staff often use bacitracin as a standard of practice at facilities. This should be revisited because of worsening antimicrobial resistance. Antimicrobial stewardship programs should incorporate skin and wound management. 

Skin flora, or the residing organisms on the skin, changes based on residence. Hospitals, post-acute and long-term care  patients (as well as staff) may have organisms that are multidrug-resistant. This can lead to quick and serious infections if not assessed or treated early. Twice-weekly skin assessments with a shower or bed bathing is one of the best practices to incorporate this practice. Once a skin injury is identified, a prompt assessment and ongoing management are required.

Acute and chronic wounds also have bioburden (bacteria living on the surface). With skin injury, microbial activity continues in the inflammatory and proliferative phases. If biofilm is formed on the wound surface, penetration of a medication or antibiotic from the surface becomes challenging and may lead to delayed healing or infection.

The provider and nursing staff must understand how to manage factors that can prevent wound infection. The Wound Care Association utilizes the pneumonic TIME (Tissue factors, Inflammation, Moisture and Edge) to remind about major contributors.

In addition to reviewing antibiotic dependence, consider culling other outdated approaches, such as the use of wet-to-dry dressings that can remove healed skin from wounds when taken off. 

Documentation of the nutritional status and risk factors with healing potential also is crucial for every acute, chronic, or non-healing wound. Hand hygiene, universal precautions, and proactive management remain the gold standards for prevention or spread of infection. 

Fatima Naqvi, MD, CMD, is medical director at AMDA – The Society for Post-Acute and Long-Term Care Medicine. Send her your wound-related questions at [email protected].