What are some steps we can take to prevent sepsis from an infected wound?
Any resident with an infected wound is at risk for sepsis. If you suspect a wound is infected, you need to optimize the resident’s health by rapidly debriding any nonviable tissue, using antibiotics in a targeted manner, evaluating nutritional status, stabilizing glycemic control, improving blood flow to the area, reducing immunosuppressant therapy if possible, and appropriately managing topical treatments.
You also can consider using zinc and vitamin C on a short-term basis to boost the immune system, and removing a Foley catheter to reduce the risk of secondary infection. Ensure the resident gets adequate rest and sleep; it is during stage 3 of sleep that our greatest amount of skin and deep tissue healing and regeneration occurs.
Monitor the resident’s vital signs and mentation for signs of sepsis. A drop in blood pressure, increase in heart rate, increase in respiratory rate, and fever can signal sepsis, which typically has a rapid onset. Licensed nurses taking vital signs will help ensure that any change from baseline is quickly identified.
If the infection is not controlled with traditional treatment, a biofilm or underlying osteomyelitis might be the cause. Microscopy and tissue biopsy are the only ways to truly identify a biofilm. The only way to truly confirm osteomyelitis is a bone biopsy. But if that is not an option, an MRI is recommended.
If either biofilm or osteomyelitis is confirmed, debridement/removal of the infected tissue or bone is necessary to attempt to eradicate the infection. If that is not possible, care planning should be reviewed with the resident/family. Aggressive systemic antibiotics will be necessary, but even with them, the infection may never be eradicated without removing the bone or infected tissue.
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