What Does Infection Control and Prevention Mean in Wound Care?

An infected wound can severely impact a patient’s quality of life, leading to amputation and even sepsis. With effective infection control practices, clinicians can reduce and prevent these from occurring.

The goal for all wounds is that they heal as quickly as possible. And for wound care clinicians, there is so much satisfaction in that last wound assessment to see patients return to their prewounded lives.

However, most of the time, this is not an easy journey, and a lot of work goes into closing the wound. And one sure thing to halt wound healing is an infection.

Any break in the skin’s protective layers creates a risk for infection. Add in a couple of comorbidities, such as diabetes and peripheral arterial disease (PAD), and you now need an even bigger wall of protection around the wound.

Research shows that patients with diabetes aged 40 years and over are twice as likely to also have PAD than non-diabetic patients. In addition, other studies show that the mortality rate of patients after an amputation is 13% to 40% in one year. With statistics like these, it is easy to see the importance of maintaining effective infection control and prevention when treating wounds.

9 steps for infection control and prevention in wounds

Infection control practices are crucial to prevent complications in wounds. By following steps like these, you can reduce the risk of infection and promote successful wound healing.

1.     Practice hand hygiene

As clinicians, we hear that there is no better way to prevent infection than to ensure anyone touching, assessing, or dressing a wound has clean hands.

To avoid further spread of bacteria, it’s important to take the following actions (in addition to hand washing) before and after treating a wound:

• Changing gloves after assessing a wound and before applying a clean dressing
• Moving from clean to dirty
• Changing gloves when soiled
• Keeping nails natural and at a lower length

2.     Clean the wound

Steering clear of skin irritants, such as rubbing alcohol and hydrogen peroxide, can prevent damage to intact periwound skin and new tissue growth within the wound bed. Normal saline, surfactant wound cleansers, or mild soap and potable water are all sufficient to use when cleansing a wound. It is important to cleanse a wound to adequately remove biofilm and nonadherent necrotic tissue, which can harbor bacteria. Wounds should be cleansed from the middle moving outward, using a new gauze pad for each stroke.

Cleaning the periwound last can decrease bacteria close to the wound. The periwound should be cleaned in strokes moving away from the wound bed, not toward it. If needed, gently pat the wound dry with clean gauze. Patients and caregivers changing dressings in their homes should be instructed on proper hand hygiene before and after wound care.

3.     Choose the appropriate dressing

Choosing the dressing that best suits the wound is important, as well as considering dressings that donate moisture to a dry wound or control drainage to a highly exuding wound. This will keep the wound bed optimized and the periwound intact. Using single-use items once and discarding leftovers, as well as changing dressings at the correct frequency (for the dressing type) also help decrease the risk of infection.

4.     Look for signs of infection during the wound assessment

Signs of infection may include increased pain, increased drainage, purulent drainage, and wound odor that remains despite adequate cleansing and removal of soiled dressings from the work area. Redness, edema, periwound warmth, induration of wound edges, fever, and persistent hypergranulation may also be noted in an infected wound.

5.     Use instruments properly

Probes used for measuring and assessment should be used one time only. Each time you enter a wound, a new probe should be used. Probes should not be used on more than one wound. They should also be foam-tipped instead of cotton-tipped to prevent cotton particles from getting into the wound. It is possible to spread infection to other wounds by using the same probe to assess multiple wounds.

Debridement tools should be single use as well. Debridement instruments should be either single use and disposable or sent to sterile processing after each use. Bandage scissors should be disinfected with your facility’s chosen disinfectant before using them to apply a new, clean dressing. Patients and caregivers performing home dressing changes should be educated on how to properly cleanse scissors before each use.

6.     Don’t mix clean and dirty

Seeing patients with multiple wounds can quickly create a dirty, disheveled workspace. Tossing dirty dressings onto the chair or countertop or placing your clean dressing supplies next to used probes and dirty gauze creates the opportunity to spread bacteria. Work areas should be free of used, dirty supplies and materials before placing a clean, dry dressing.

7.     Debride necrotic tissue

Bacteria love necrotic tissue. It gives them an environment to thrive in. Removing necrotic tissue at each encounter helps decrease the risk of infection.

8.     Culture for signs of infection

A wound showing signs of infection should be cultured. Sensitivity should be obtained for adequate treatment. Necrotic tissue should be removed from the culture site first to allow for an appropriate swab. The Levine technique is recommended.

9.     Educate patients and caregivers on infection control and prevention

As wound care professionals, we only see patients for small amounts of time, so what they and their caregivers do at home matters. To support our patients and help them do their part in wound healing, we can provide them education in these areas:

• How to clean and dress wounds at home
• Instruction on the importance of compliance with medical appointments
• Taking antibiotics correctly and completely
• How to manage their comorbidities

The risks of osteomyelitis, sepsis, and amputation increase with an infected wound, and at the very least, will stall wound healing. The importance of infection control and prevention in wound care should not be underestimated or overlooked. It is an important part of wound care and wound healing regardless of setting. By implementing infection control practices, we can not only prevent further wound deterioration and loss of healing time but give patients a better quality of life.