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55 Cards in this Set
- Front
- Back
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What type of tissue in a wound increases the chance of it becoming infected?
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necrotic tissue
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Does bacteria in a wound mean that it is infected?
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no, my own bacteria can be in a wound without it being infected
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Define abscess.
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localized infection that my system has walled off but can't kill
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What is one way to let a wound heal that seems counterintuitive?
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sometimes we need to let a wound get bigger and open up for them to heal
- sealed off under skin it becomes a breeding ground for bacteria |
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What are some problems seen with infections pertaining to the inflammatory phase?
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a prolonged inflammatory phase attempting to clean it up
- signs of inflammation (5 cardinal) - prominent necrotic tissue - some drainage (can appear viable) |
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What are problems with infection that are associated with metabolic demand?
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metabolic demand is increased because the microbes need to eat
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What are problems with infection that are associated with tissue necrosis?
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the continued inflammatory response begins to turn viable tissues into necrotic tissues
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What are some prognostic factors that we look at to determine the severity of the infection? (3)
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1. bioburden -- number of microbes
2. virulence -- toxicity, number of microbes or amount of toxin that is lethal 3. host resistance -- what are we dealing with? |
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What are 4 problems that we see associated with infection?
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1. maintained inflammatory response
2. increased metabolic demand 3. tissue necrosis 4. risk of abscess |
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Define universal precautions.
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treat all bodily fluids as though they are infected
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What are ways to control infection?
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1. following universal precautions
2. standard precautions 3. handwashing 4. following directions for equipment |
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What is the sterile technique for infection control?
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set up and maintain a sterile field, once it gets wet, the sterile field is compromised
- use of sterile gloves |
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What is the clean technique used during infection control?
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no sterile field or gloves used
includes WP, US, stim electrodes |
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When dealing with tunneling/deep wounds should the PT use sterile or clean equipment?
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sterile is recommended
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What is pulsatile lavage?
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vaccum pulls saline back up after it is pumped into the wound for cleansing
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When is the sterile technique suggested? (4)
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1. packing (deep/tunneling wounds)
2. large wounds 3. burns 4. immunosuppression |
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Why is using a sterile technique advised for burns? What type of cells are lost?
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infection prone, top layers of skin are lost (our defense layer)
- APC (dendritic, Langerhans cells are gone) |
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Why is using a sterile technique advised for immunosuppression?
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low resistance to infection, don't want to introduce anything into the breeding ground
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1. What is the ipresentation of an infected wound?
2. Is this sufficient for diagnosis of infection? |
1. the signs and symptoms are out of proportion to expectations
- extensive - poorly defined periwound erythema (streaking) - extensive temperature elevation (may request a culture at this point) 2. sufficient for suspicion, but not diagnosis |
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How does streaking appear in an infected wound?
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redness that looks like it follows vessels
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Describe the drainage associated with an infected wound.
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increased amount, viscosity, purulence (milky, pus) of drainage
viscosity increase -- d/t dead cells and bacteria itself foul odor even after cleansing |
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What bacteria is associated with an infected wound? What does it smell like? Color?
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pseudomonas aeruginosa is a common chronic wound infection
bluish drainage smells like tortillas |
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If swabbing for a wound culture what type of tip is used?
Do PTs swab for wound cultures? |
alginate tip
PTs can swab for wound culture, but really they need an MD order so it is not always considered appropriate |
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When swabbing for a wound culture, what type of bacteria is being swabbed for?
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surface bacteria only
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Describe fluid aspiration with wound cultures?
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- risky
- for abscesses - could cause tunneling from the needle poke |
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What is the gold standard for wound cultures?
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tissue biopsy
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Once in the microbiology lab, what type of stain is typical (even though there are many others)?
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Gram stain
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What is osteomyelitis? What bacteria is the most common cause?
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a bone or bone marrow infection
Staph Aureus (MRSA) is most common mechanism |
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How is osteomyelitis diagnosed? It's tricky, but what do we look for/do? (4)
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- poor healing
- bone biopsy/aspiration - imaging - if we can see or touch bone, assume osteomyelitis |
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What are 2 tests used for fungi?
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1. Gomori-Wheatley
2. Acridine Orange |
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What happens if we treat fungus with an anti-biotic or anti-inflammatory?
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the fungi may worsen because it needs an anti-fungal
- anti-inflammatories decrease competition on the skin, we need the immune system to function and fight off fungi |
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What are examples of fungal infections?
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ringworm
athlete's foot |
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What are interventions for infected wounds? (5)
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1. antibiotics (topical vs. systemic)
2. antiseptics (too much collateral damage) 3. debridement (remove necrotic tissue using forceps or probe) 4. modalities (bacteriocidal/bacteriostatic effects with Estim) 5. mist ultrasound |
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What are 2 types of strains resistant to antibiotics?
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- MRSA
- VRE |
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What do we look for in terms of antibiotics when treating an infected wound?
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the more specific the better, avoid broad spectrum drugs
**sometimes topical drugs work better because they are working right at the wound site |
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What are some examples of antiseptics?
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bleach
acetic acid H2O2 (hydrogen peroxide) povidone-iodine (Betadine) |
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Should we use antiseptics when treating infected wounds?
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usually cytotoxic, does more harm than good because it kills healthy and healing tissue, kills immune cells
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When might antiseptics be helpful in treating infected wounds?
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short term useage as it will kill multiple types of bacteria, then we can switch to a more specific antibiotic
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What is debridement? Why is it done? (4)
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removal of necrotic tissue
- breeding ground for microbes - lowers wound oxygenation - occupies host cells that try to clean it up - blocks granulation and epthelialization |
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What does aerobic bacteria do to wounds?
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aerobic bacteria competes for oxygen which makes the wound more anaerobic
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What type of modalities can be done to help heal a chronic wound?
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bacteriocidal / bacteriostatic modalities
- UV light (H1N1 virus) - E Stim (cathodal pulsed, hi-volt, DC) E stim: does not help with osteomyelitis but may with biofilms? |
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What is the process of a wound becoming infected by bacteria?
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1. contamination (non-replicating microbes)
2. colonization (replicating microbes but no host response) 3. replicating microbes invade viable tissues |
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What are biofilms? When do they occur?
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interacting communities of microorganisms bound to a solid surface
they occur at a given population or quorum |
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A coating know as _________ can make biofilms less vulnerable. How does it do this?
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glycocalyx
- enhances drug resistance - turn body's defenses against it |
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How do anaerobic and aerobic microbes work synergistically to optimize replication?
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they live in the same biofilm and they can work in different resistances
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What model has the majority of research for biofilms been performed on?
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planktonic model
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Describe the planktonic biofilm model.
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- relatively hydrophilic (free-floating)
- minimal glycocalyx (coating to make them less vulnerable) - susceptible to antibacterial agents (antibiotics) - most of our knowledge of antibiotic activity is based on planktonic bacteria -- HOWEVER most bacteria doesn't live this way |
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What is a common biofilm example?
*Brushing is an example of debridement* |
dental plaque -- streptococci
- colonizes in fissure and cracks between teeth - sucrose utilized to form glycocalyx, assists in adhesion to tooth - by-products are trapped in this microbial biofilm (acids that destroy tooth enamel and dentin) |
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Does a biofilm look terrible?
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no, they are just difficult to get to close
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What type of cells are biofilms resistant to?
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neutrophils
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Support how biofilms are difficult to get to close.
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- resisatnce is "tenacious survival vs. aggressive virulence"
- resistant to neutrophils - they "outlive the treatment" - bacteria can slough off and restart the infection once antibiotics are ended |
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What is the mechanism of biofilm tolerance? (4)
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1. slow penetration
2. stress response 3. altered microenvironment 4. persisters antibiotics can't get through d/t physical barrier, bacteria can live after an hour of bleach exposure |
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How does lactoferrin relate to treating a chronic infected wound?
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lactoferrin binds up iron making less available -- significant because bacteria needs iron to survive
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What are some multiple concurrent strategies for treating biofilms?
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1. debridement
2. selective biocides (antibiotics) 3. antibiofilm agents (ex: lactoferrin) 4. antibiotics |
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Currently there has been a lot of attention the ________ when treathing chronic wounds, but we need to be addressing ___________>
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microorganism(s), host factors
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