II. Precautions

  1. Infected Chronic Wounds may not present with typical infectious findings
    1. Erythema, edema, pain and fever may be absent despite infection

III. Signs: Chronic Wound Colonization and Infection

  1. See Chronic Wound
  2. Chronic Wound Biofilm or Critical Colonization (Mnemonic: NERDS; Test Sensitivity 73%, Test Specificity 80%)
    1. Non-Healing Wound
    2. Exudate
    3. Red with easy bleeding (friable)
    4. Debris
    5. Smell
  3. Infected Chronic Wound (Mnemonic: STONEES; Test Sensitivity 90%, Test Specificity 69%)
    1. Size Increasing
    2. Temperature increased (fever)
    3. Os (probe to bone test positive)
    4. New areas of tissue breakdown
    5. Exudate
    6. Erythema or Edema
    7. Smell

IV. Labs

  1. Biopsy with Bacterial Counts (preferred biopsy method)
    1. Positive if >100,000 colony forming units in at least one sample
  2. Levine Technique (second best method)
    1. Debride superficial necrotic tissue
    2. Apply pressure with cotton swab rolled over a 1x1 cm area for 5 seconds
    3. Culture the swab
  3. Z-Technique
    1. Swab is rotated between fingers as it passed over the surface of wound in zig-zag pattern
    2. Avoid touching the wound edges with the cotton swab

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