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Microbiology of Infected Wounds RN and LPN

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Microbiology of Infected Wounds RN and LPN

Welcome to the Microbiology of Infected Wounds training module #5, brought to you by Quality Surgical Management; the leading wound care specialty group under the leadership of the company's founder, Chief Executive Officer and Medical Director Dr. Steven Magilen who has more than 35 years of experience in wound care.

Lessons

Microbiology of Infected Wounds

Author: Blog by QSM

1 Welcome to the Microbiology of Infected Wounds training module #5, brought to you by Quality Surgical Management; the leading wound care specialty group under the leadership of the company's founder, Chief Executive Officer and Medical Director Dr. Steven Magilen who has more than 35 years of experience in wound care. There are 29 slides

Objectives

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2 By the completion of this course the participant will be able to: Differentiate between contamination, colonization and infection and when to treat with antibiotics. Demonstrate understanding of the Cardinal Signs of inflammation. Identify when a wound culture should be collected and proper collection technique. Distinguish the major differences between Gram (+) and Gram (-)

Microbiology of Wound Infection

Author: Blog by QSM

4 Contamination is the presence of organisms on the surface of a wound. The type and quantity of organisms vary from one wound to another and contamination can occur in a variety of ways. Often it arises through the transfer of normal body bacteria or through the improper washing of hands by health care workers.

Microbiology of Wound Infection

Author: Blog by QSM

5 Wound colonization is defined as the presence of multiplying micro-organisms on the surface of a wound, but there is no immune response from the host and no associated clinical signs and symptoms. This indicates that wound colonization, similar to wound contamination, is a normal state and is not associated with active disease, ill health

Microbiology of Wound Infection

Author: Blog by QSM

6 Wound infection is defined as “the presence of multiplying organisms which overwhelm the body’s immune system resulting in an inflammatory response from the patient”. This definition indicates that wound infection leads to active disease which is likely to delay the wound healing process. Diagnosis is determined by identifying which type of micro-organism(s) are present

Microbiology of Wound Infection

Author: Blog by QSM

7 To manage wounds more effectively, healthcare professionals need to be able to determine when a wound is infected. Early detection of an infected wound will make treatment faster and more effective leading to better outcomes. So how do we know when a wound is infected? Well, there are two common features found in all

How do you know when a wound is infected?

Author: Blog by QSM

8 Signs and symptoms at the wound site are caused by the inflammation process. Inflammation develops as a normal protective response of the immune system. The generalized signs and symptoms of infection are the body’s response to infection. Periwound Erythema (more commonly known as Cellulitis) is infection which spreads through the subcutaneous layer of skin.

Microbiology of wound Infection

Author: Blog by QSM

9 Before we discuss the signs that the granulation tissue is infected; lets define what granulation tissue is. Granulation tissue typically consists of an abundance of blood vessels mixed with fibrous connective tissue. It grows from the base of a wound and is able to fill the wound, facilitating eventual epithelialization and wound closure. The

Microbiology of wound Infection

Author: Blog by QSM

10 Host resistance is the single most important determinant in wound infection. There must be a balance between the patient's immune response versus the type of the organism, quantity of the organism in the wound bed and the disease-causing ability (known as virulence) of the micro-organisms. Wound infection will occur when this balance is lost.

System factors that increase changes of wound Infection

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11 The next point to consider are the systemic factors that increase chances of wound infection. These factors are magnified by the patient's individual vulnerability and immune response which significantly influence what effect bacteria have within a wound. Factors include: Stress; including the stress caused by ill health and surgery. Malnutrition: poor nutrition increases the

Local factors that increase changes of wound Infection:

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12 Local factors also play a major role in determining whether a wound becomes infected. Wound characteristics such as size, position, duration and presence of dead tissue or blood clots are all important factors that also impact on wound colonization and infection. In terms of wound size, the Larger the wound the greater the surface

Gram positive and Gram negative

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13 Let's get down and dirty with the bacteria that cause the infections. Bacteria from most infections fall into one or two categories. Gram Positive or Gram Negative. The main factor that distinguishes one from the other is their cell wall. A large part of their success in invading other organisms involves the makeup of

Gram positive and Gram negative

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14 Danish scientist Hans Christian Gram devised a method to differentiate the two main types of bacteria based on the structural differences in their cell walls. In his test, bacteria that retain the crystal violet dye do so because of a thick layer of peptidoglycan and are called Gram-positive bacteria. In contrast, Gram-negative bacteria do

Aerobic VS Anaerobic Bacteria

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16 Before I continue, I'll give you a moment to review to the two images. Now that you've had a laugh, let's continue. Bacteria are considered as a type of prokaryote found all over the world. They can survive almost all known environments on earth because of their tiny body size and fast growing ability.

Aerobic Bacteria

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17 An obligate aerobe is an organism that requires oxygen to grow. Through cellular respiration, these organisms use oxygen to metabolize substances, like sugars or fats, in order to obtain energy. Aerobic respiration has the advantage of yielding more energy (adenosine triphosphate or ATP) than anaerobic respiration, but obligate aerobes are subject to high levels

Anaerobic Bacteria

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18 Anaerobes can further be divided into two categories. Obligate anaerobes are organisms that survive in habitats without oxygen. The word 'obligate' means 'restricted to,' and anaerobe is a Greek word that translates into 'living without air.' These organisms are harmed or even killed when exposed to oxygen. Many obligate anaerobes avoid oxygen altogether by

When to culture a wound?

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19 Now that you know what the local and systemic factors that lead to infection are, when should you culture a wound? The answer is, only when you suspect a wound is truly infected. Let's discuss wound cultures over the next few slides.

Wound Culture Techniques

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20 So we suspect a wound is infected. Now how do we go about collecting a culture? Which technique shall we use? In wound care, a swab is the most common method used for sampling a wound; however, tissue biopsy is considered the "gold standard" technique and is performed by a wound care specialist.

Tissue Culture

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21 A deep-tissue or punch biopsy for a quantitative culture determines the colony counts per gram of tissue. It is the "gold standard" for identifying wound bioburden and diagnosing clinical infection because there is a lower likelihood of containing surface contaminants often found in a swab culture. A deep-tissue biopsy collected by a wound care

Why Swab a Wound?

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22 Although the value of acquiring superficial swab samples has been seriously questioned in our industry, the procedure is simple, inexpensive, noninvasive and convenient for the majority of wounds. Swab sampling has been challenged on the basis that the superficial microbiology does not reflect that of deeper tissue and that subsequent cultures do not correlate

How to properly swab a Wound

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23 With the information you received in the previous slide, you want to make sure that if you elect to use this method to culture a wound it is done correctly. Swabbing after all, can provide acceptable samples for bacterial culture provided that the correct technique is used. The wound should always be cleansed prior

Nosocomial Infection

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25 Did you know that you are one of the biggest distributors of infections? Despite their best intentions, many health care professionals inadvertently act as vectors of disease, disseminating new infections among their patients. Attention to simple preventive strategies can significantly reduce disease transmission rates. While frequent hand washing remains the single most important intervention

Aseptic technique in the SNF

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26 As health care professionals in a skilled nursing facility, we are exposed to many contaminants and infectious organisms. Observation of medical aseptic practices will help to avoid nosocomial infections. Aseptic technique is a set of specific practices and procedures performed under carefully controlled conditions with the goal of minimizing contamination by pathogens.

Aseptic technique in the SNF

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27 Always wash your hands prior to touching your patient. Don gloves. Always prepare your treatment/dressings prior to touching your patient. Never reach into your pockets wearing contaminated gloves. Remove wet or soiled dressings from your work space promptly. Do not leave bloody dressings on bed or floor.

Aseptic technique in the SNF

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28 Dispose of bloody or soiled dressings in a red biohazard bag. In North Carolina, a red biohazard bag is only required if more than 20cc's of blood is present. Dispose of scalpels, curettes, suture needles, injection needles carefully and promptly in designated sharps containers. Clean your scissors with a new alcohol pad or bleach

Aseptic technique in the SNF

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29 Tips: Follow state guidelines by washing your hands and DONNING new gloves for each individual wound treated. Above all, be professional in appearance and conduct; this means always be well groomed with clean, pressed scrubs and professional shoes. REMEMBER, the patient's perception of you is very critical to the success in gaining their compliance.

Thank You!

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31 Message from Dr. Magilen. If You'd Like to Become QSM Wound Care Certified Click here to sign up.

References

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32 If You'd Like to Become QSM Wound Care Certified Click here to sign up. Hauser, A. (2013). Antibiotics Basics for Clinicians: The ABCs of choosing the right antibacterial agent. Philadelphia, PA., Wolters Kluwer Hunt, T., Hopf, H., Hussain, Z. (2000). Physiology of wound healing. Adv Skin Wound Care. 2000 May-Jun;13 (2 Suppl):6-11. Leaper, jD.,

Difference between Gram Positive & Gram Negative Bacteria

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15 This table illustrates some of the more common differences between the two groups of bacteria. Both groups have very different features. The main reason as to why Gram Negative bacteria was given this name is its inability to retain the stain (which is considered a negative trait), unlike the Gram Positive Bacteria. Gram-Negative bacteria
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