Infection management - Artierial Leg Ulcers

ASSESSING WOUND INFECTION

Criteria for identifying wound infection have been identified and validated by an international multidisciplinary group of 54 experts using the Delphi approach. The following key criteria for ulcers have been highlighted in the 2005 European Wound Management Association position document on infection1.

Criteria for wound infection: Arterial Leg Ulcers1


MANAGEMENT

According to the 2006 European Wound Management Association position document on "Management of wound infection" the principles of infection management are to:2

  • "Provide an environment to promote rapid healing
  • Minimise the use of antimicrobial agents that may adversely affect human cells
  • Use antimicrobial agents appropriately to reduce the selection of resistant strains
  • Restrict the use of systemic agents to when they are specifically indicated
  • Avoid topical sensitisation or allergic reactions"

The choice of dressing to minimise the risk of infection is important. "Decisions need to be based on the ability of the dressing to:

  • Manage increased exudation
  • Remove necrotic tissue
  • Reduce malodour
  • Conform to the site and shape of the wound
  • Perform wound bed preparation functions
  • Satisfy patients' expectations
  • And meet treatment goals".2

Cellulitis
Pus/abscess

Change in colour/viscosity of exudate
Change in wound bed colour*
Crepitus
Deterioration of wound
Dry necrosis turning wet
Increase in local skin temperature
Lymphangitis
Malodour
Necrosis - new or spreading

*Black for aerobes, bright red for Strepotcoccus, green for Pseudomonas

Erythema
Erythema in peri-ulcer tissue - persists with leg elevation
Fluctuation
Increase in exudate volume
Increase in size in a previously healing ulcer
Increased pain
Ulcer breakdown


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