Standard measures of

management of infected wound

Most patients with wound infections are managed in the community.

Management usually takes the form of dressing changes to optimize healing,

which usually is by secondary intention. Occasionally, further intervention in the

form of wound debridement and subsequent packing and frequent dressing is

necessary to allow healing by secondary intention

Guidelines for wound management: 
1. Promote a multidisciplinary approach to care.
2. Initial patient and wound assessment is important and whenever there is a change in
condition.
3. Consider the psychological implications of a wound- especially relevant in the
paediatric setting in relation to developmental understanding and pain associated with
the wound and dressing changes.
4. Determine the goal of care and expected outcomes.
5. Respect the fragile wound environment.
6. Maintain bacterial balance- use aseptic technique when performing wound
procedures.
7. Maintain a moist wound environment
8. Maintain a stable wound temperature. Avoid cold solutions or wound exposure.
9. Maintain an acidic or neutral pH.
10. Allow a heavily draining wound to drain freely.
11. Eliminate dead space but don’t pack a wound tightly.
12. Select appropriate dressings and techniques based on assessment and scientific
evidence.
13. Instigate appropriate adjunctive wound therapies- e.g. compression, splinting and
pressure redistribution equipment, off-loading orthotics.
14. Follow the principles for managing acute and chronic wounds. 
Wound: Secondary healing
To promote healing by secondary intention, perform wound
toilet and surgical debridement.
1. Surgical wound toilet involves:
- Cleaning the skin with antiseptics
- Irrigation of wounds with saline
- Surgical debridement of all dead tissue and foreign
matter. Dead tissue does not bleed when cut.
2. Wound debridement involves:
- Gentle handling of tissues minimizes bleeding
Control residual bleeding with compression, ligation
or cautery.
- Dead or devitalized muscle is dark in color, soft,
easily damaged and
does not contract when pinched.
- During debridement, excise only a very thin
margin of skin from the
wound edge
Systematically perform wound
surgical debridement,
initially to the superficial layers
of tissues and subsequently to
the deeper layers
2. After scrubbing the skin with
soap and irrigating the wound
with saline, prep the skin with antiseptic.
3. Do not use antiseptics within the wound.
4. Debride the wound meticulously to remove any loose foreign material
such as dirt, grass, wood, glass or clothing.
5. With a scalpel or dissecting scissors, remove all adherent foreign
material along with a thin margin of underlying tissue and then irrigate
the wound again.
6. Continue the cycle of surgical debridement and saline irrigation until the
wound is completely clean.
7. Leave the wound open after debridement to allow healing by secondary
intention.
8. Pack it lightly with damp saline gauze and cover the packed wound with
a dry dressing.
9. Change the packing and dressing daily or more often if the outer dressing
becomes damp with blood or other body fluids.
10. Large defects will require closure with flaps or skin grafts but may be
initially managed with saline packing
 Unless the infection is very minor, antibiotics are usually needed to
treat the infection and stop it spreading.
 If the wound is larger, or the infection seems to be getting worse, then
an antibiotic to be taken by mouth (oral antibiotic) is needed.
 Wounds which have been in contact with soil or manure, or which
are particularly 'dirty', may put you at risk of developing tetanus.
Most people are protected from tetanus by the routine vaccination
 programme.
If you have a 'dirty' wound and have not had the full tetanus
vaccination course, or if you are not sure, Arrange for a 
tetanus vaccination if needed.
Laboratory Studies

The simplest, and usually the quickest, staining method involves

obtaining a Gram stain for infective organisms. Staining for fungal

elements can be obtained at the same time.

Most laboratories routinely will culture for both aerobic and anaerobic

organisms. Fungal cultures can be requested. Isolation of single

colonies allows further growth and identification of the specific

organism. Sensitivity testing then follows mainly for aerobic

organisms.
Ultrasonography

Ultrasonography (US) can be applied to the infected

wound area to assess whether there is a collection for

which drainage is required.

References
.WHO/EHT/CPR 2005, formatted 2009 Best practice

guidelines in disaster situations.

. https://emedicine.medscape.com/article/188988-

treatment.Author: Hemant Singhal, MD, MBBS, MBA,

FRCS, FRCS(Edin), FRCSC; Chief Editor: John Geibel,

MD, MSc, DSc, AGAF .