II. Precautions
- Infected Chronic Wounds may not present with typical infectious findings
- Erythema, edema, pain and fever may be absent despite infection
III. Signs: Chronic Wound Colonization and Infection
- See Chronic Wound
-
Chronic Wound Biofilm or Critical Colonization (Mnemonic: NERDS; Test Sensitivity 73%, Test Specificity 80%)
- Non-Healing Wound
- Exudate
- Red with easy bleeding (friable)
- Debris
- Smell
- Infected Chronic Wound (Mnemonic: STONEES; Test Sensitivity 90%, Test Specificity 69%)
- Size Increasing
- Temperature increased (fever)
- Os (Probe To Bone Test positive)
- New areas of tissue breakdown
- Exudate
- Erythema or Edema
- Smell
IV. Labs
- Biopsy with Bacterial Counts (preferred biopsy method)
- Positive if >100,000 colony forming units in at least one sample
- Levine Technique (second best method)
- Debride superficial necrotic tissue
- Apply pressure with cotton swab rolled over a 1x1 cm area for 5 seconds
- Culture the swab
- Z-Technique
- Swab is rotated between fingers as it passed over the surface of wound in zig-zag pattern
- Avoid touching the wound edges with the cotton swab