Innovations in the assessment and diagnosis of wound infection


approach[7]


. His review of the evidence


suggests improved efficacy in reducing biofilms when Prontosan is used for cleansing.


IMPORTANT DOCUMENTS An international consensus document — Wound Infection in Clinical Practice — recently outlined assessment parameters for the diagnosis of wound infection[8,9]


, providing clinicians with a useful tool. The 10-page, easy-


to-read document has five main headings: n


Principles of best practice n Diagnosis


n Management n


n


Topical antimicrobial therapy Systemic antibiotic therapy.


The most significant impact of this


publication at a local level was the increased awareness of the need to standardise wound swabbing. The recommendations from this were implemented into many local wound infection policies and protocols in an effort to clarify when and how to swab a wound. In 2009, The Australian Wound Management


Association released a position paper entitled Bacterial Impact on Wound Healing: from contamination to infection[10]


. This 16-


page document provides comprehensive management recommendations for Australian healthcare and includes 14 recommendations,


including: n


Developing mechanisms to collect data on wound infections, including prevalence, organisms cultured and bacterial resistance in all healthcare settings


n


Adopting a consistent consensus framework for defining the level of bacterial impairment of wound healing based on assessment of the patient and his or her wound


n


Regarding wound swab results as a general guide to appropriate antibiotic therapy but not as a binding measure


n


Determining the length of treatment with topical and/or systemic agents by the response of the wound and the patient


n


Using topical antiseptic solutions for the general treatment of topical contamination or minor skin infections not on clean, healing wounds.


The impact of this document at the


author’s facility resulted in the centralised dissemination of silver dressings and the use of laminated posters to guide decisions for


AUTHOR DETAILS Terry Swanson is a nurse practitioner


KEY INNOVATION The most significant work that has influenced my practice in relation to assessment and diagnosis of infection would be Cutting and Harding’s 1994 paper on wound infection1


.


Although the subjective and objective criteria developed at that time did not detail specific wound types, it raised my awareness of covert signs of infection. Chronic wounds in a compromised host require the clinician to play ‘wound detective’ and use their knowledge and powers of observation to identify signs other than inflammation. Some patients’ do not have the ability to mount a defence against a high bioburden or virulent microbe, and the threat for loss of limb or life is very real if these are not observed and managed in the early stages. Cutting and Harding’s paper has been the


foundation for further research as well as the development of international and national guidelines, consensus documents and position papers and as such remains the most influential work on wound care for this author.


THE FUTURE It is the author’s personal challenge for 2011 to develop a competency-based curriculum for teaching wound debridement to nurses. In Australia, the Australian Wound Management Association (AWMA) has been working toward accreditation of courses but it may still be some time before this is finalised. Underpinning this plans is the author’s firm belief in the use of wound bed preparation to deliver proactive, efficient, and effective wound care and her aim is for this to be incorporated into everyday care.


selecting appropriate dressings based on the wound condition and exudate levels.


ONGOING EDUCATION When educating clinicians about identification and management of wound infections the author frequently uses the International Wound Infection Institute (IWII) curriculum for wound infection. It is a free presentation that can be adapted depending on the audience and downloaded from www.woundinfection- institute.com.


References


6. B Braun. Clinical Evidence. Available at: http://www.bbraun.com.au/index.cfm ?1E34A6C7D034A2C3D13E015D20C1 6C74 (accessed 4 January, 2011).


7. Cutting K. Addressing the challenge of wound cleansing in the modern era. Br J Nurs 2010; 19(11 Suppl): S24–9.


8.World Union of Wound Healing Societies (WUWHS). Principles of Best Practice: Wound infection in clinical practice. An international consensus. 2008; MEP, London.


9. Cutting K, White R, Mahoney P. Clinical identification of wound infection: A Delphi approach. In: Identifying Criteria for Wound Infection. EWMA Position Document. 2005; MEP London.


10. Australian Wound Management Association (AWMA). Bacterial Impact on Wound Healing: From contamination to infection. Position Document of the Australian Wound Management Association. Available at: http://www. awma.com.au/publications/2009/ bacterial_impact_position_ document_V_1_0.pdf (accessed 4 January, 2011).


www.woundsinternational.com


6


Practice Development


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