In the January issue of the Journal of American Medical Directors Association, an article titled “When is a Chronic Wound Infected?” studies various methods of determining when a chronic wound is infected and judges which of these methods is most accurate. The article begins by explaining that the skin is a major barrier against infection, and therefore, the risk of a wound becoming infected is extremely high when skin starts to break down. The criteria for a wound to be considered infected requires that bacteria be present in the wound, and that this bacteria is producing tissue damage. There are many different types of wounds, but this particular article studies chronic wounds, such as pressures sores.
Physicians and wound care specialists use colony forming units (CFU) per gram of tissue to measure the presence of bacteria in a wound. They have established the “10^5 Rule,” which asserts that in the surgical closure of ulcers, spontaneous healing will occur at bacteria levels lower than 10^5 CFU. This rule implies that once spontaneous healing occurs, the possibility of infection is diminished and caretakers can conclude that the chronic wound is not infected. However, according to the American Medical Directors Association, the “10^5 Rule” may be inaccurate because there are factors other than the quantitative measure of bacteria that contribute to the development of infections. One such factor is the virulence of the bacteria. For example, certain infections, such as staphylococcus aureus, pseudomonas aeruginosa, and Bacteroides fragilis are so virulent that even at levels below105 CFU, infection is highly likely and requires treatment.
The article determined that a tissue biopsy is the most accurate method of determining whether or not a patient is suffering from an infected wound. However, most skilled nursing facilities do not perform biopsies. Instead, they obtain a surface swab of the wound and test the sample for the presence of infectious bacteria because this process is less costly and much simpler than a tissue biopsy. Despite its practical benefits, the use of surface swabs to determine if a wound is infected can be misleading. Often, the infection is incorrectly diagnosed and consequently, patients do not receive proper treatment and are unable to make a full recovery.
However, laboratory tests are not completely at fault when an infected wound is incorrectly assessed. In nursing homes that are understaffed, as well as in those that employ unqualified nurses, infected wounds are often overlooked, ignored, or inaccurately diagnosed. In fact, pressure sores are usually preventable and it is therefore the responsibility of the nursing staff to take these preventative measures, so that your loved one may avoid the pain and suffering that is caused by an infected wound. In the case that a pressure sore becomes infected, it is the duty of the nursing staff to ensure proper treatment. In addition to the usage of medications, some treatments include pressure relieving techniques, such the use of special mattresses and the repositioning of the patient, as well as the cleaning and dressing of the wound.