Wound management – infection

Wound classes:

There are 4 classes:

• Incised – of recent origin without significant contamination
• Lacerated – of recent origin, with tissue damage and/or contamination
• Late – 6-18 hours after injury
• Infected – wounds seen beyond 18-24 hours. Must be regarded as infected

Bacteria can be assumed to be present in all accidental wounds and in those sustained at a surgical operation when an area that is colonised by organisms is involved (e.g. the colon).

Good wound care is the first essential for the prevention of infection:

• In accidental injury:
• Debridement
• Delayed primary closure
• In surgical incisions:
• Debridement is unnecessary
• Delayed closure is sometimes useful if there is contamination at operation

Many wounds can be assumed to be contaminated the moment they are sustained (e.g. when the abdomen is opened to deal with an intraperitoneal infection):

• In the early part of the preparative phase (when bacterial proliferation is just beginning) it may be possible to eliminate these organisms by establishing a high concentration of antibiotic in the tissues by parenteral administration
• This prophylactic use of antibiotics over a short period of time is now common in many circumstances