Infection management - Venous 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: Venous Leg Ulcers 1


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

Delayed healing despite appropriate compression therapy
Increase in local skin temperature
Increase in ulcer pain/change in nature of pain
Newly formed ulcers within inflamed margins of pre-existing ulcers
Wound bed extension within inflamed margins

Discoloration eg dull, dark brick red
Friable granulation tissue that bleeds easily
Increase in exudate viscosity
Increase in exudate volume
Malodor
New onset dusky wound hue
Sudden appearance/increase in amount of slough
Sudden appearance of necrotic black spots
Ulcer enlargement


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