Wound Care - Wounds And Infection

Front 1

Contamination vs. Colonization vs. Infection

Back 1

Contamination: Normal, non-replicating microbes found on skin and in intestines (10,000 microbes/gram). No adverse effects and protect body from dx causing pathogens
Colonization: Normal, replicating microbes without a host response
Infection: reaches Critical Colonizatoin (1,000,000/g) and these microbes invade VIABLE tissue. This will mount an inflammatory response

Front 2

4 adverse effects of high concentrations of microbes

Back 2

1. Maintains inflammatory phase (delay/prevent wound healing)
2. Inc metabolic demand (microbes and host fight for oxygen and nutrients)
3. Tissue necrosis (bacterial end/exotoxins may be cytotoxic causing host cell dysfxt or death)
4. Risk of abscess (body can't get rid of it)

Front 3

Signs of infection extending the inflammatory phase

Back 3

Signs of inflammation
Prominent necrotic tissue
Usually some drainage (appearance can be viable)

Front 4

Factors in prognosis of chronic wounds

Back 4

# of microbes (bioburden)
Virulence (toxicity - amt of toxin that is lethal)
Host Resistance (immune function)

Front 5

What local factors increase the risk of infection?

Back 5

Ischemia
Presence of necrotic tissue
Chronic wounds

Front 6

What are Universal Precautions?

Back 6

Blood and body fluid precautions - managed as if contaminated

Front 7

What are Standar Precautions?

Back 7

Incorporates Universal Precautions with hand washing and personal protective equipment to reduce risk of transmission of microbes
Due to reasonable expectation of contact with blood or wound fluid

Front 8

6 things to do for "infection control"

Back 8

Universal Precautions
Standard Precautions
Hand Washing
Follow Directions
Sterile Technique
Clean Technique

Front 9

Sterile vs. Clean technique

Back 9

Sterile: Set up an maintain a sterile field. Destroys ALL microbes from area.
Clean: No sterile field, disinfected field. Used with whirelpool, US, stim electrodes. Procedure used to reduce overall number of microorganisms

Front 10

When to use Sterile Technique?

Back 10

Packing (deep/tunneling wounds)
Large wounds
Burns (no APCs)
Immunosupression (resistance is low.. don't want ANY microbes)

Front 11

Infected wound presentation

Back 11

S/s of inflammation out of proportion to expectations
ie. periwound eryhtema (possible streaking); extensive eleveation of temp
Not sufficient for daignosis of infection, but sufficient for suspicion
Be on the look out for a would that has a decline in status despite appropriate care

Front 12

Attributes of infection: Amount, consistency, color, and odor of drainage

Back 12

Amount: Disproportional to size and extent of wound
Consistency: thick, viscous, purulent, creamy drainage
Color: white, yellow, green or blue
Odor: maloderous even when free of necrotic tissue

Front 13

In infected wounds, what causes inc viscosity and purulence of drainage?

Back 13

Viscosity due to bacteria, dead cells and protein
Purulence - milky white due to dead WBCs

Front 14

What should you do if you suspect wound infection?

Back 14

Ask for a wound culture

Front 15

4 choices for wound cultures

Back 15

1. Swabbing
2. Fluid Aspiration
3. Tissue biopsy (gold standard)
4. Microbiology lab (gram stain)

Front 16

How to do a swabbing wound culture and pros/cons

Back 16

Swab with alginate tip.
PROs: simple, lack of trauma, avoid surgery
CONs: Surface bacteria only, so may not reflect the infecting microbes deeper in wound

Front 17

What exactly is a wound culture?

Back 17

Placing a microorganism in an ENV conductive to cell growth

Front 18

How to do fluid aspiration and pros/cons

Back 18

Stick needle in wound, and steal some fluid
PROs: Assess bacteria within wound
CONs: must be sufficient fluid, risky bc may spread infection or cause fistula
Usually only used for abcesses

Front 19

What is osteomyelitis?

Back 19

Bone or bone marrow infection often caused by Staph Aureus (MRSA)
Dx: tricky, infection can be occult. Poor healing, bone biopsy/aspiration, imaging

Front 20

If you can see or touch bone, what should you assume?

Back 20

Osteomyelitis until you prove otherwise

Front 21

Tests for fungal infection?

Back 21

Stains: Gomori-Wheatley or Acridine Orange

Front 22

Why do we need to be cognisant of fungal infections?

Back 22

May worse with antiboiotic therapy or antiinflammatories b/c they knock down the immune system

Front 23

4 types of interventions for infection

Back 23

1. Antibiotics (topical or systemic)
2. Antiseptics
3. Debridement
4. Modalities

Front 24

How do antibiotic agents work?

Back 24

Inhibit bacterial synthesis of proteins, PGs, or nucleic acids or interfering with cellular metabolism

Front 25

Bactericidal vs. bacteriostatic agents?

Back 25

Bactericidal: cause irreparable damage to bacteria resulting in death
Bacteriostatic: Inhibit bacterial cell growth

Front 26

What are "broad-spectrum" drugs? Should we use them? Why or why not?

Back 26

"Super drugs" able to destroy many types of bacteria (gram+ or -)
Ovoid this because you want to be as specific to the microbial agent as possible. Also, use of these drugs can encourage exposed microbes to build resistance - this is how resistant strains of bacteria arise

Front 27

Sensitive vs. resistance strains

Back 27

Sensitive - resonds to med
resistanct - does not respond. Bacteria produce enzymes that inactivate antimicrobials

Front 28

2 most common resistant strains of bacteria?

Back 28

MRSA (methicillin-resistance Staphyloccoccus aureus)
VRE (vancomycin-resistant Enterococci)
These bacterias develop resistance over time - they were once sensitive to antimicrobial therapy

Front 29

What do we have to be thankful about resistant strains of bacteria?

Back 29

They have not become more resistance, even though they are more common

Front 30

Aerobes vs. anaerboes

Back 30

Bacteria that either require oxygen rich environment to flourish or do not
Want to know this when deciding what antimicrobial therapy to use
Staph can survive in either

Front 31

What category of drugs are antiseptics? What do they do?

Back 31

Broad-spectrum antimicrobials
They kill microorganisms - includes bacteria, healthy tissue, and immune cells
Inc duration of INF, retard wound contraction, and delay epitheliazation

Front 32

When may you want to use antiseptics?

Back 32

Short term - anti-microbial such as an animal bite

Front 33

Examples of antiseptics

Back 33

Bleach
Acetic acid
H2O2
Povidone-iodine (Betadine)

Front 34

Why debride?

Back 34

Remove necrotic tissue which...
is a bredding ground for microbes
Lowers wound oxygenation
Occupies host cells that try to clean it up
Block granulation/epithelialization

Front 35

Types of debridement

Back 35

Sharp, water pick, forceps, probe

Front 36

Modalities for infected wounds?

Back 36

UV light (not used much)
ESTIM with cathodal pulsed, Hi-volt, or DC

Front 37

What is the Planktonic Model?

Back 37

Refers to a hydrophilic environment where single-celled bacteria are in a "floating" environment. This is how bacteria grows in a test tube
Minimal Glycocalyx (extracellular polymeric material produced by bacteria)
Susceptible to antibacterial agents
Most of knowledge of antibiotics is based on this model

Front 38

What is a biofilm?

Back 38

Community of microorganisms that attatch to the wound or solid surface encasing themselves in the extracellular polysaccharide matrix (glycolyx)

Front 39

What is a Glycolyx?

Back 39

Extracellular polysachharide matrix that allows microbes to survive in wound environments otherwise unfavoarble
Protect bacteria from antimicrobials, trap WBCs so they become ineffective
Increases resistance
May even turn body's own defenses against it (Fibrin)

Front 40

How do biofilms increase virulence and resistance?

Back 40

Intercellular communication in a biofilm activates certain genes that inc vir and resis
50-100x more resistant that free living bacteria

Front 41

How many biofilms work synergistically?

Back 41

May have different types of microbes in a biofilm (multimicrobial)
ie. Aerobes may promote growth of anaerobes where oxygen is limited

Front 42

Explain dental plaque as an example of a biofilm

Back 42

Streptococci results in colonies in and between teeth
Dietary sucrose utilized to form glycocalyx and assist adhesion to tooth
By-products are trapped in biofilm, such as acids that destroy the tooth enamel and dentin

Front 43

What are biofilms resistant to endogenously?

Back 43

Neutrophils, macrophages, and antibacterials

Front 44

How can biofilms "outlive" tx?

Back 44

Some bacteria slough off and restart infection once antibiotics are ended

Front 45

Mechanisms of Biofilm Tolerance? 4 stages

Back 45

Slow Penetration
Stress response (start replicating)
Altered Env (will survive)
Persisters (stick around)

Front 46

4 options for Biofilm Based Wound Care

Back 46

Debridement (frequent and aggressive)
Selective biocides
Antibiofilm Agents
Antibiotics (Adjunct, strong and long like me)

Front 47

What are Selective Biocides?

Back 47

I haven't the slightest idea
Silver, Iodosorb, Hydrofera Blue

Front 48

What are Antibiofilm agents?

Back 48

Lactoferrin, Xylitol, Farnasol
Plant producs, fatty acid gel