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How to Heal an Infected Wound

Any wound can become infected, so it is necessary to apply proper care by practicing good hygiene. A good rule of thumb when suffering a wound injury (besides cleansing the wound site) is to apply an antibiotic ointment for at least the first few days after injury to help protect it from infection. If a wound does get infected, it will also be able to affect surrounding skin, causing complications.

“Wound infection is a common problem. Infection of the wound happened due to entry of the bacteria through breached skin. These bacteria stop healing and produce sign and symptoms.  From the beginning of the civilization scientist are fighting against infection. It is evident that wound infection is a challenging situation for the physicians. 

Multiple organisms can cause wound infection. For the treatment of infection, a large number of antibiotics are used.  Both broad spectrum and narrow spectrum antibiotics are available nowadays. It is ideal to give proper antibiotic after culture and sensitivity of the wound swab, pus or infected tissue.  Unfortunately, this practice is uncommon among the physicians especially of the developing countries. Improper and irrational use of antibiotics and genetic and non-genetic drug resistant mechanisms of bacteria lead to drug resistance.  Drug resistant bacteria are the most important therapeutic challenge in the field of infectious diseases.  Many of them are multi drug resistant. Among them MRSA and ESBL producing gram negative bacteria are of major concern. Most wound infections can be classified into two major categories: skin and soft tissue infections, although they often overlap as a consequence of disease progression.  Infections of hospital-acquired wounds are among the leading nosocomial causes of morbidity and increasing medical expense.”1

Even worse, an infection can spread into the bloodstream and cause a fatal condition known as sepsis.

Phases of normal healing

“Although wound healing is a dynamic cascade of events initiated by injury and extending well beyond the restoration of tissue continuity, it may be divided into distinct phases as characterized by both the predominant cellular population and cellular function.

Tissue disruption causes bleeding and initiates the coagulation cascade. Platelet activation, in the form of degranulation and adhesion, leads to hemostasis and chemotaxis of inflammatory cells. These are the hallmarks of the initial phase of healing. The inflammatory phase of healing (injury to 5 days) is defined by neutrophil infiltration with subsequent replacement by macrophages and lymphocytes. Each population of cells acts in response to specific cytokines that are temporally released as the normal healing process progresses. Neutrophils function primarily to clean the wound environment by production of superoxides that kill bacteria and by phagocytosis of necrotic material. Although optimal healing requires that all different populations of cells be present, only macrophages are an absolute necessity. The fibroplastic phase is the second phase of wound healing (days 4 through 12). Macrophages produce growth factors and other cytokines which then promote fibroblast migration, proliferation and collagen synthesis. It is during this phase that tissue continuity is restored; angiogenesis and epithelialization are also achieved. The maturation and remodeling of the scar begins during the fibroplastic phase and is characterized by reorganization of the previously synthesized collagen. Collagen is broken down by matrix metalloproteinases (MMPs) and net collagen in the wound is the result of a balance between collagenolysis and collagen synthesis.”2

How to take care of a wound

Below are some tips on how to take care of a wound caused by a cut, tear, bruise or burn:

– Observe the wound carefully, this way you will know the injury severity level.

– Wash the wound with soap and warm water. If the water does not remove all the dirt inside, use small tweezers to pick up debris.

– Avoid infection by using a topical antibiotic cream for at least two days.

– Cover the wound with a bandage, this way you can keep it clean and without risk of infection.

– Continue observing the wound site for any changes that might catch your attention.

To determine that your wound is healthy and has not been infected, you should notice the following:

– The wound’s color will be pink and will become clear with time.

– Normal body temperature

– Your wound will be painless to the touch.

Symptoms of infection

If you are not yet sure of having an infected wound, look out for the below red flags:

– General fever

– A continuous reddish coloration of the area, inflammation and sensitivity

– Persistent pain, even with gentle contact

– Secretion of pus

– Absence of scarring or healing

– Bad smell and appearance

“Symptoms of infection may include redness, swelling, warmth, fever, pain, lymphangitis, lymphadenopathy, and purulent discharge. The treatment of wound infections depends on the severity of the infection, type of wound, and type of pathogen involved. Treatment may include debridement and wound dressings that promote granulation, tissue preservation, and moisture. Empiric antibiotic treatment should be based on the potentially causative organism. Superficial mild infections can be treated with topical agents, whereas mild and moderate infections involving deeper tissues should be treated with oral antibiotics. Most severe infections, and moderate infections in high-risk patients, require initial parenteral antibiotics. Cultures should be obtained for wounds that do not respond to empiric therapy, and in immunocompromised patients.”3

If you notice the above symptoms (especially the presence of pus and a bad smell) it is most likely an infection you are dealing with. Treating it quickly and carefully before it gets worse is the way to go. Follow these steps:

Disinfect the Wound

This is the first thing you must do. Wash the wound with saline and soap, these two products will disinfect the wound and regulate the pH of the area. Dry with a sterile gauze to avoid any bacteria that might exist on towels or napkins. When doing this, you must make sure to remove all the secretion or dirt that is in the wound and leave it completely clean.

“Although bacterial colonization can be found in any wounds, especially chronic wounds, usually normal healing can occur. An infected wound has different history; it does not progress through the stages of wound healing because the energy to heal the wound is exhaustedly used to fight bacterial burden. Wound will suffer from metabolic load imposed by bacteria (bacterial bioburden). It remains in the inflammatory phase and interfere with the epithelialization, contraction, and collagen deposition. The endotoxins that are released when the bacteria is killed, will stimulate phagocytosis and the release of collagenase, which contribute to collagen degradation and destruction of surrounding, previously normal tissue.”4

The Antibiotic

After drying the infected wound, look for an antibiotic ointment and apply it on the affected area. It’s recommended to do it between 2 or 3 times a day. This process should be done for at least a week to make sure you completely eliminate the infection and accelerate the healing process.

Keep the wound under supervision

It is vital to keep the wound under supervision to monitor its evolution. In case you don’t observe any improvement, it is necessary to go to your physician or a specialist where they will determine the degree of infection and prescribe the appropriate medications and care for their proper healing.

“The wound healing, in any tissue, is a normal biological process and it involves four complex steps: homeostasis/coagulation; inflammation, migration and proliferation; re-epithelialization and restoration.

The four stages of wound repair
Fig 1. The four stages of wound repair. Reprinted from “Treatment strategies for infected wounds.” Molecules, 23(9), 2392. By Negut, I., Grumezescu, V., & Grumezescu, A. (2018).

 

Each phase of the wound healing process is influenced by a series of essential mediators, like platelets and cytokines, inflammatory cells, cellular and extracellular matrix, proteinases, growth factors and inhibitors. Usually, the hemostatic and inflammatory stages take place immediately after damage, but the inflammatory stage may last for up to 6 days. The proliferation stage is considered as the beginning of angiogenesis and the development of the extracellular matrix. A prolonged time of the inflammatory and/or proliferative phase will result in a hindered healing, encouraging excessive scar tissue establishment. The remodeling stage typically initiates.

Each phase of the wound healing process is influenced by a series of essential mediators, like platelets and cytokines, inflammatory cells, cellular and extracellular matrix, proteinases, growth factors and inhibitors. Usually, the hemostatic and inflammatory stages take place immediately after damage, but the inflammatory stage may last for up to 6 days. The proliferation stage is considered as the beginning of angiogenesis and the development of the extracellular matrix. A prolonged time of the inflammatory and/or proliferative phase will result in a hindered healing, encouraging excessive scar tissue establishment. The remodeling stage typically initiates 3 weeks after damage and can take up to 2 years to fully settle.”5

Illustration of the continuum from contamination to wound infection
Fig 2. Illustration of the continuum from contamination to wound infection. Contamination is represented by the existence of non-replicating bacteria and is a common circumstance in chronic wounds; wound contamination does not promote impaired healing. Colonization is the occurrence of replicating microorganisms without triggering host responses. Acute colonization is characterized by the manifestation of replicating bacteria resulting in moderate local reaction; this increase of bioburden can delay wound healing. Infection occurs when microorganisms are multiplying and have entered the tissue, producing a systemic host response. Reprinted from “Treatment strategies for infected wounds.” Molecules, 23(9), 2392. By Negut, I., Grumezescu, V., & Grumezescu, A. (2018).

 

 References:

(1) Aftab, S., Tarik, M. M., Siddique, M. A., & Yusuf, M. A. (2014). Clinical and Microbiological Aspect of Wound Infection: A Review Update. Bangladesh Journal of Infectious Diseases, 1(2), 32-37. Available online at https://www.researchgate.net/publication/281578472_Clinical_and_Microbiological_Aspect_of_Wound_Infection_A_Review_Update

(2) Efron, D. T., & Barbul, A. (2001). Wounds in infection and sepsis-role of growth factors and mediators. In Surgical Treatment: Evidence-Based and Problem-Oriented. Zuckschwerdt. Available online at https://www.ncbi.nlm.nih.gov/books/NBK6957/

(3) Worster, B., MD.; Zawora, M., MD.; Hsieh C., MD. (2015). Common Questions about Wound Care. Thomas Jefferson University, Philadelphia, Pennsylvania. Am Fam Physician. 2015 Jan 15;91(2):86-92. Available online at https://www.aafp.org/afp/2015/0115/p86.html Available online at

(4) Prasetyono, T. O. (2009). General concept of wound healing, revisited. Available online at https://www.researchgate.net/publication/270529073_General_concept_of_wound_healing_revisited

(5) Negut, I., Grumezescu, V., & Grumezescu, A. (2018). Treatment strategies for infected wounds. Molecules, 23(9), 2392. Available online at https://www.mdpi.com/1420-3049/23/9/2392/pdf

 

Robert Velasquez
13 October, 2018

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Hello everyone, my name is Robert Velazquez. I am a content marketer currently focused on the medical supply industry. I studied Medicine for 5 years. I have interacted with many patients and learned a lot...read more:

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