Wound management w infection control Flashcards
What is the difference between compliance vs adherence?
Compliance: 1 way interaction in which the clinician directs the patient to follow instructions
Adherence: patient freely chooses to follow suggested guidelines
What are some reasons for non-adherence?
Unintentional:
- misunderstanding
- forgetfulness
Intentional
What are some ways to promote adherence?
- set mutually agreed-upon, low-risk solutions
- educate the patient on the “why”
- provide clear instructions and practice “teach back”
- inform patient of likely consequences if non-adherent
- encourage caregiver/support system involvement
- identify and remove barriers
What are some patient characteristics that would warrant a nutritional screening?
- cachexia
- emaciation
- transparent skin
- pallor
- dull/thinning hair
- mouth sores
- missing or poor dentition
What are some recent dietary history notes that would warrant a nutritional screening?
- significant weight loss
- grossly inadequate intake of vital nutrients
- poor understanding of proper nutritional guidelines
What are some wound characteristics that would warrant a nutritional screening?
- chronic wounds
- slow-healing wounds
- repeat ulcerations
- pressure ulcers
- neuropathic ulcers
- extensive burns
What are some patient comorbidities that would warrant a nutritional screening?
- Diabetes
- cancer
- obesity
- HIV/AIDS
- GI dysfunction
- dysphagia
What is the difference between parenteral and enteral nutrition?
Parenteral:
- nutrition delivered intravenously
Enteral:
- nutrition delivered via feeding tube (OG, NG, Nasojejunal, gastrostomy)
What are some common conditions for patients to have nutrition delivery devices?
- comatose patients
- swallowing problems
- mechanically ventilated patients
- GI dysfunction
- cancer, stroke, ALS
What are the adequate nutrients required for homeostasis, repair, and regeneration?
- water
- protein
- carbohydrates
- fats
- vitamins
- minerals
How much water is required for an open wound to heal?
2.7-3.7 liters per day to help with healing
apart from patients with medical conditions limiting fluid intake
What are some things tested in the laboratory
- Creatinine
- serum albumin
- prealbumin
- BUN (blood urea nitrogen)
- total lymphocyte count
- blood glucose
- A1c
- Cholesterol
- CPK
What does testing for creatinine look at and what are normal values?
-kidney function
- protein metabolism
- 30-170 U/L
- Male: 52-336 U/L
- Female: 38-176 U/L
What does testing for serum albumin look at?
- measure of protein deficiency and malnutrition
- Hepatic cirrhosis, heart failure, malnutrition, Crohn’s disease will have lower levels
- 3.5-5.2 g/dL
What does testing for prealbumin look at?
- measures results of an intervention sooner b/c of shorter half life
- 19-39 mg/dL
What does testing for BUN look at?
- indicator of kidney function b/c looking at product of protein metabolism
- 6-25mL
increased BUN = decreased healing
What does testing for total lymphocyte count look at and what are normal values?
- indirect measurement of nutritional status and immune function
- 5-10 x 10^9/L
What does testing for blood glucose look at and what are normal levels?
- elevated levels increase risk of ulceration, infection, and impaired wound healing
- 70-100 mg/dL
What does testing for A1c look at?
- average blood glucose over 3 months
- <5.7%
What does testing for cholsterol look at?
- HDL, LDL, and VLDL levels
What does testing for CPK look at?
- enzyme found in heart, brain, and muscle that is checked when suspected of having a heart attack
What are normal hematocrit and hemoglobin levels?
Hematocrit:
- Men: 42-52%
- Women: 37-47%
Hemoglobin:
- Men: 14-17.4 g/dL
- Women: 12-16 g/dL
What are normal platelet levels?
140-400 k/uL
What are some infection control guidelines to protect both the clinician and patient?
- hand hygiene
- use of PPE
- Respiratory hygiene/cough etiquette
- sharps safety
- safe injection practices
- sterile instruments/devices
- clean and disinfected environmental surfaces
What are some contact precautions and examples of this?
PPE: gloves and gown
EX: VRE, MRSA, scabies, lice, large non-contained draining wounds
What are some droplet precautions and examples of this?
PPE: gloves, gown, mask
EX: necrotizing fasciitis, certain PNA’s, influenza
What are some airborne precautions and examples of this?
PPE: gloves, gown, special mask, negative pressure room
EX: Tuberculosis, measles
What is the difference between clean and sterile technique?
Clean:
- standard technique using boxed gloves
- intended to reduce/prevent transmission from one location to another
Sterile:
- not warranted for most wound care
- used for immunocompromised pts, severe burns, large surface area wounds, packing deep wounds
How are different baceria named?
Named via:
- shape: cocci (round), spirilla (spillic), or bacilli (rod)
- reproduction: divide in chains (strept) or divide in clusters (staphly)
- staining appearance: gram-positive (crystal violet - BAD) or gram negative (not as damaging exotoxins)
- growth environment: aerobic or anaerobic
What is methicillin-resistant staphylococcus aureus?
MRSA
- can live hours to days on surfaces
- can cause cellulitis, osteomyelitis, abscess
- common in blood, stool, and wounds
- treated with Mupirocin
What is vancomycin-resistant enterococci?
VRE
- common in surgical wounds
- treated with ampicillin-amoxicillin
What is pseudomonas aeruginosa?
- gram-negative anaerobe
- sickly sweet odor
- appears as a greenish blueish color around the rim
What are different types of fungus?
Tinea: ringworm
Candida: yeast (warm and wet areas)
What are biofilms?
- complex communities of bacteria or fungi held together by a self-produced polymer matrix
- persist on medical devices, surfaces, and tissues causing chronic infection
Where are biofilms found and why are they dangerous?
- generally found on devitalized tissues, implanted devices, and within gastric mucosa
- biofilms can survive in environments where they normally could not
- hard to kill and redevelop rapidly
present in 6% acute wounds but up to 60% in chronic wounds
What is the pH of skin and about how many microflora are on the skin?
pH: 5.5
About 10^3 microbes per gram of skin tissue are on our skin
What is the difference between contamination and colonization and are these normal?
Contamination: microbes non-replicating
Colonization: replicating microbes
YES, these are both normal
What is critical colonization?
- bioburden that reaches a critical point and begins to adversely affect host
- reaches point of damaging tissue
What is infection?
- healthy tissue that becomes damaged
- replicating microbes invade viable body tissue
can cause infection w/ low concentrations but said to happen when >10^5 microbes per gram of tissue accumulate
Why do microbes cause problems?
- compete w/ host cells for available O2 and nutrients
- bacterial exotoxins may be cytotoxic
- bacterial endotoxins may activate host inflammatory processes
- wound infections delay and may prevent wound healing
What are characteristics of rubor (redness) if a wound is infected?
- poorly defined erythemal boarder
- disproportionate
- may possess red streaks leading out from wound
What are characteristics of calor (temperature) if a wound is infected?
- patient may be febrile
- warmer localized tissue temp spreading over a wider surface area
What are characteristics of tumor (swelling) if a wound is infected?
- disproportionate to size and extent of wound
- may be indurated
What are characteristics of dolor (pain) if a wound is infected?
- new onset or increased pain
What are characteristics of functio laesa if a wound is infected?
- feeling of malaise or illness
What are characteristics of drainage if a wound is infected?
- disproportionate amount - may be copious
- creamy, thick or purulent consistency
- white, green, yellow, or blue in color
- may have distinctive odor
What are the characteristics of a declining wound that classify it as infected?
- plateau in healing
- change in granulation tissue (less, friable, change in color)
What is an abscess?
- localized collection of pus, that body can contain but not fight completely
What are local risk factors for infection?
- ischemia
- necrotic tissue
- wound debris
- chronic wounds
What are host risk factors for infection?
- break in skin integrity
- diabetes
- malnutrition
- obesity
- steroid use
- immunocompromise
- increased age
What do wound cultures do?
- confirm the presence or absence of infection
- swap cultures are used to quantify number and type of bacteria
tissue biopsy is gold standard
What are antimicrobial agents used for?
- destroy unicellular organisms
What are two methods to treat or prevent infection?
- Topically
- Systemically
What are topical ways to treat or prevent infection?
- creams (8-12 hours) and ointments (8-24 hours)
- antimicrobial dressings
- iodine or silver containing dressings
- topical honey
What are systemic ways to treat or prevent infection?
- bactericidal (destroy)
- bacteriostatic (inhibit cell growth)
- antifungal (yeasts and mold)
What are ways to manage wound infections?
- antimicrobials
- treatment/prevention of infections
- debridement of dead tissue
What are three antifungals?
- nystatin
- oxiconazole
- miconazole
What is an antiseptic?
Antiseptic: antimicrobial that is cytotoxic
- should be used to disinfect inanimate objects or for washes for intact skin
What are some common antibiotic misuses?
- prescribed without infection present (50% deemed unnecessary)
- wrong antimicrobial prescribed
- taken incorrectly
What are some common adverse drug reactions?
- mild skin reactions, hives
- difficulty breathing, anaphylactic shock
- photosensitivity
- hearing loss
- fever
- hepatitis, kidney damage
What patients tend to have more reactions to topical antimicrobials?
- patients with venous insufficiency
What are some keys for infection prevention?
- handwashing
- standard precautions
- manage medical conditions known to increase risk of wound formation
- proper patient positioning
- proper skin care
- proper foot care
