Closed Wound Infections
Microbial states (Cook & Ousey, 2011) jd
Secondary Comorbidities (Anderson & Hamm, 2012) jd
Dressing Changes
Healing Process
Inflammatory Process
Classification
Diabetes - Poorly-controlled blood sugars results in cellular dysfunction that impedes all phases of wound healing.
Acute
Colonization - Presence of multiplying bacteria in a wound is balanced or kept in check by patients immune system. A normally healing wound is colonized with bacteria.
Sterile
Tissue Integrity
Healing Intention
Primary Intention
Protein Energy Malnutrition - Protein intake can result in decreased collagen production, angiogenesis and fibroblast proliferation, all of which negatively impact wound healing.
Obesity - Hyperventilation and decreased chest expansion then result in decreased vital capacity and decreased oxygenation of blood, thereby negatively impacting tissue oxygenation.
Contamination - Bacteria present on the surface of the wound but do not multiply and do not cause an immune response
Chronic
Non-Sterile
Proliferative
Remodleing
Secondary Intention
Tertiary Intention
Intact
Non-intact
Antibiotic Prophylaxis (WHO) jd
Contaminated wounds
Abdominal trauma
Lacerations > 5cm
High risk anatomical sites
Penicillin G
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Metronidazole
Adult IV 8-12 million IU once
Adult IV 1,500 mg once (infused over 30 mins)
Critical colonization - The point at which the patients immune response can no longer control the colonizing bacteria in the would = delayed healing
Infection - Presence of multiplying bacteria which overwhelm the patients immune system, disrupting healing and damaging would tissue
Preoperative skin preparation