Course intro

This course is ideal for understanding infection.

Society of Tissue Viability endorsed

This module has been through rigorous reviews to achieve endorsement from the Society of Tissue Viability, so it can be used with complete confidence. The endorsement confirms that this module provides clinicians with:

  • High-quality education that meets stated learning objectives and outcomes
  • Material that is free from product bias or promotion
  • Education that is evidence-based
  • Education that is fully accessible to members of the general wound care community

Time Required

Estimated time to complete infection course: 120 minutes

Learning Outcomes

On completion of this infection course, you should be able to:

  • Understand the stages of wound infection, risk of infection and clinical signs of infection
  • Discuss how biofilms form and how they can delay healing
  • Discuss the treatment options for infected wounds, including the use of antimicrobials
  • Understand cellulitis, including classification and treatment

Wound infection remains a challenging burden in healthcare and is often associated with delayed wound healing and an increase in morbidity. Wound infections are difficult to treat and can also add to complications and cause distress to the patient. Early detection and recognition, along with appropriate and effective intervention, is necessary to reduce both health and financial consequences.

Wound infection can be financially costly to healthcare organisations. It can also negatively affect the quality of life for patients, families, and carers due to pain, malodour, frequent dressing changes, loss of appetite, malaise, or deterioration of glycaemic control on people with diabetes (Wounds UK, 2013; IWII, 2022).

“Prevention, early diagnosis and management of infection are central tenets of good wound care, especially in compromised patient groups with chronic wounds” (Jones, 2012, pg. 90).

As individuals we are covered in a range of bacteria known as normal body flora, which live quite harmlessly on the body without causing any problems. However, should the skin become broken in any way, then normal body bacteria may gain entry, contaminating the wound.

All wounds are contaminated or colonised with microorganisms, and their influence on a wound is complex. However, not all contaminated wounds become infected. It is widely accepted that most chronic wounds are colonised with microbes, although most wounds, even chronic, can and do heal. In these cases, the patient’s immune system and the microbes in the wound are in balance.

Wound infection is the invasion of a wound by proliferating microorganisms to a level that invokes a local, spreading and/or systemic response in the host. Microorganisms multiply within the wound, developing a range of virulence factors to overcome the host defences, leading to local tissue damage and impeding wound healing. (IWII, 2022)

Chronic wounds such as pressure ulcers and leg and diabetic foot ulcers are likely to be colonised with bacteria due to the nature of the open wound and the tissue types within the wound (Reilly et al., 2006). Several factors will determine whether this will lead to the wound becoming infected:

  • The quantity of bacteria and microorganisms
  • The patient’s resistance to the level of bacteria in the wound (immune response)

Microbial bioburden within wounds can range from contamination, colonisation, local infection, spreading infection and systemic infection.

The Wound Infection Continuum (International Consensus, 2022) recognises the various levels of bioburden in the wound.