Journal of Community Nursing - page 30

30 JCN
2013,Vol 27, No 4
controversial. However, the use
of these products can be justified
in individuals whose immune
capability is severely restricted,
or where there is a high risk of
infection.
SYSTEMIC INFECTIONS
Spreading infection has potentially
serious implications for patient
well-being. Wound and blood
cultures are used to identify the
offending organism and to assess for
differential diagnosis. Appropriate
systemic antibiotic therapy should be
implemented straightaway (EWMA,
2006; WUWHS, 2008).Topical
antimicrobial dressings should also
be used to help reduce the wound
bioburden (EWMA, 2006;
WUWHS, 2008).
Antibiotics are administered
orally or intravenously. Most
reduce bacterial numbers by
targeting bacterial functions or
growth processes (Calderon and
Sabundayo, 2007). Most have a
narrow band of effectiveness,
with particular antibiotics being
needed to treat particular bacteria
species or strains. However, there
are problems with the use of
antibiotics:
Systemic antibiotics treat the
whole patient, not just the
wound. Therefore, they can affect
normal wound flora leading
to unpleasant side-effects and
systemic complications such as
Clostridium difficile
infections
Systemic antibiotics require an
adequate blood supply to reach
the point of infection, and so
may be ineffective in treating
wounds with a high necrotic
burden or in patients with
underlying arterial insufficiency
The use of antibiotics can
select for resistant bacterial
strains as antibiotics eliminate
species that are sensitive to
their specific action, while
leaving unaffected those in
which genetic modification
has enabled the evolution
of defence mechanisms.
This means antibiotics can
enable the resistant species to
proliferate and dominate the
wound micro-flora (Huovinen
et al, 1994). Resistance to
antibiotics has become a serious
problem for those involved
in wound care (White et al,
2001). Easterbrook (1998)
suggested that widespread and
often indiscriminate use of
antibiotics is a major factor in
the emergence of drug-resistant
bacteria
The emergence of bacterial
resistance has reduced the
treatment options for many
systemic infections. It is,
therefore, important that new
antibiotic options are developed
if the medical world is to have
new weapons to treat disease.
Currently, there are no new
antibiotic preparations in
development and no new
products on the horizon. This is,
therefore, a potential time-bomb
in emerging nations and the
developed world
Systemic antibiotics have limited
effect on biofilm colonies (Moss
et al, 1990; Marr et al, 1997;
Costerton and Stewart, 2001).
Thus, due to the limited
efficacy of systemic antibiotics
and the need to reserve them for
serious infections they are not
recommended for wounds that
only show signs of local infection
(Bowler et al, 2001). In addition,
topical antibiotics are linked to
the development of bacterial
resistance and can provoke delayed
hypersensitivity reactions (Zaki
et al, 1994), and so are neither
recommended nor have a role in
the management of chronic wounds
(WUWHS, 2008).
CONCLUSION
Wound infection occurs when
Answer the following questions
about this article, either to test the
new knowledge you have gained
or to form part of your ongoing
practice development portfolio.
1 – What are some of the risk factors
for wound infection?
2 – Name some of the ways in which
wound infection can be diagnosed.
3 – What are the common symptoms
of wound infection?
4 – Name some of the main techniques
for helping to reduce bioburden.
5 – Can you identify the main
components of the most common
antimicrobial dressings?
Five-minute test
WOUND CARE
KEY POINTS
Wound infection results from the
inability of the patient’s body to
control the burden of bacteria
within a wound.
Identifying those factors which
increase the likelihood of
infection and maximising the
patient’s natural defences are
essential steps in preventing
infection.
If infection occurs, it is important
that clinicians are able to identify
the signs and symptoms and
initiate speedy and appropriate
treatment.
Judicious use of topical
antimicrobial wound dressings
has proven to be an effective
method of reducing bioburden,
and enables clinicians to reserve
the use of antibiotics to those
patients in greatest need.
Spreading infection has
potentially serious implications
for patient wellbeing and wound
and blood cultures are used to
identify the offending organism
and to assess for differential
diagnosis.
The emergence of bacterial
resistance has reduced the
treatment options for many
systemic infections.
Due to the limited efficacy
of systemic antibiotics and
the need to reserve them for
serious infections, they are
not recommended for wounds
that only show signs of local
infection.
1...,20,21,22,23,24,25,26,27,28,29 31,32,33,34,35,36,37,38,39,40,...116