Wound infections
Wound infections occur when injuries to the skin and underlying tissues become contaminated by bacteria, viruses, or fungi, often leading to complications. Commonly arising from both traumatic injuries and surgical procedures, these infections can manifest as pain, swelling, redness, and drainage, with fever indicating a more systemic spread. Certain bacteria, such as Staphylococcus aureus, are frequently responsible for these infections, particularly in hospital settings where antibiotic-resistant strains like MRSA and VRE pose significant risks. Risk factors heightening susceptibility to wound infections include obesity, diabetes, older age, and compromised immune systems. Preventive measures are crucial and include proper hygiene practices, use of prophylactic antibiotics, and careful surgical protocols. Treatment typically involves debridement of the wound and the use of intravenous antibiotics, with an emphasis on keeping infected wounds open to promote healing. Wound infections remain a global health concern, affecting millions and necessitating effective management strategies to prevent severe consequences.
Wound infections
- ANATOMY OR SYSTEM AFFECTED: Skin, tissue
- ALSO KNOWN AS: Surgical wound infection
Definition
Wound infections involve injury marked by the division of tissue or the rupture of membranes. These injuries develop infections caused by bacteria, viruses, or fungi. For surgical cases, wound infections are specific to the surgical site.
Introduction
Wounds caused by trauma or obtained during surgical procedures (invasive and noninvasive surgery) can become breeding grounds for infections. Most wound infections are caused by bacteria such as staphylococci and streptococci. Many surgical infections are caused by Staphylococcus aureus or S. epidermis. Symptoms of wound infection include pain, swelling, redness, and drainage from the wound area. An accompanying fever means the infection has spread through the body.
Specific types of wounds are more likely to be susceptible to tetanus (Clostridium tetani) infection, including puncture wounds, burns, and frostbite. Tetanus results from bacteria spores present in soil. These spores invade the wound, resulting in neurologic conditions, particularly spasms and fever. Gas gangrene is a tissue-destroying infection caused by Clostridium species and can result in septic shock.
Types of wound infection of special concern are methicillin-resistant S. aureus (MRSA) infection and vancomycin-resistant Enterococcus (VRE) infection, which are prevalent in hospitals and resistant to treatment with antibiotics. Hospitalized persons are especially susceptible because they may already have a compromised immune system and are sometimes exposed to germs from other sick patients. MRSA and VRE are common in community spaces, especially daycare centers, dormitories, and athletic facilities. Skin infections can occur in a rash or wound. Wounds exposed to fresh water or seawater are often susceptible to waterborne organisms such as Aeromonas, Pseudomonas, and Vibrio vulnificus.
Risk Factors
Some studies have demonstrated that certain characteristics render persons more susceptible to wound infections compared with persons who do not have these factors. Obesity and diabetes have high wound infection rates. Specific surgical infection risk factors include diabetes, obesity, the receipt of a blood transfusion during surgery, older age, hypertension, hyperlipidemia, length of surgery, and smoking. Additional risk factors include having a pre-existing infection, low serum albumin levels, being immunocompromised, malnutrition, and the use of drains or foreign materials in surgery.
Prevention
Tetanus infection is completely preventable with a vaccine, effective for ten years. MRSA, VRE, and other infections occurring commonly in clinics and hospitals can be reduced by practicing universal precautions, which are instrumental in preventing infection when treating the wounded. Universal precautions involve treating biologic fluids as though they were infected with the human immunodeficiency virus or another pathogen, treating each patient cautiously to avoid exposing oneself and others, thorough handwashing, sterilizing instruments, wearing protective gear, and properly disposing of medical waste.
Instrument sterilization, however, can be less effective than one might think. It is possible to reintroduce bacteria at any step of the sterilization process. Some hospitals are opting to use new, unused instruments for each surgery. Debate continues about whether wearing face masks during surgery protects patients; however, it does protect medical staff from blood spatter to the face. Prophylactic antibiotics before, during, and after surgery are often helpful in reducing infection rates, such as for knee or hip replacement.
Treatment
Depending on the type of infection, a lack of treatment may result in blood poisoning, gangrene (tissue death), or death. According to the World Health Organization, one should never close an infected wound. A protocol of washing, debridement (removing any dirt and dead tissue), and saline irrigation should be followed, and the wound should be left open but covered with dressing; the dressing should be changed a minimum of once daily. If the wound is not open but has pus under the surface, it is critical to drain the subcutaneous pus. Intravenous antibiotics should be used to treat a bacterial infection, preferably tailored to the type of infection (if testing is available at the site) to reduce unnecessary overexposure to antibiotics.
Impact
Infected wounds affect millions worldwide and can result in debilitation or death. Appropriate preventive measures and effective treatments are essential in reducing the widespread effects of wound infection.
Bibliography
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