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Module 4.4: Infection
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Risk of infection

The risk of developing an infection is influenced by the characteristics of the individual, their wound, and the environment. Factors are systemic, multifaceted and comprise of many variables. These can include:

  • Age
  • Diabetes (poorly controlled)
  • Peripheral neuropathy (sensory, motor, and autonomic)
  • Neuroarthropathy
  • Hypoxia and poor tissue perfusion e.g. anaemia, cardiac and respiratory diseases, arterial and vascular diseases, renal impairment, rheumatoid arthritis, and shock.
  • Immune deficiency and immunosuppressant drugs
  • Obesity
  • Malnutrition
  • Smoking, alcohol and/or drug use
  • Recent surgery
  • Long operation times
  • Low body temperature
  • Inappropriate use of prophylactic antibiotics
  • Corticosteroid use
  • Radiation therapy or chemotherapy
  • Connective tissue disorders (e.g. Ehlers-Danlos syndrome)

(IWII, 2022)

It’s important to note that the type of wound also contributes to the risk of infection. Acute wounds have a different range of factors compared to those of chronic wounds.

Wound Risk Factors

Acute Chronic Acute and Chronic
  • Contaminated or dirty wounds
  • Traumatic injuries
  • Operation is classified as contaminated or dirty
  • Inappropriate hair removal
  • Operative factors (e.g. prolonged surgery, blood transfusion or hypothermia)
  • Duration of wound
  • Large wounds
  • Anatomically located near a site of potential contamination (e.g. perineum or sacrum)
  • Foreign body presence (e.g. drains, sutures or wound dressing fragments)
  • Haematoma
  • Necrotic or sloughy wound tissue
  • Impaired tissue perfusion
  • Increased exudate and oedema that is not adequately managed
  • Wounds over bony prominences or probing to bone
  • Involvement of tissue deeper than skin and subcutaneous tissues (e.g. tendon, muscle, joint or bone)

Adapted from IWWII, 2022

Environmental factors can often be overlooked but are an essential part of a good assessment. They also can have a role in the prevention of infection.

  • Unhygienic environment (e.g. dust, unclean surfaces, or presence of mould/mildew)
  • Hospitalisation (due to increased risk of exposure to antibiotic resistant microorganisms)
  • Inadequate hand hygiene and aseptic technique
  • Inadequate management of moisture (e.g. due to exudate, incontinence, or perspiration)
  • Interface pressure that is inadequately off-loaded