Wound Infection

Wound Infection


Techniques to Reduce Infection in a Traumatic Wound



Basic Information image



Procedure




• Principles are the same as for elective surgery.


• Patient sedation and wound analgesia:


image Avoid using phenothiazine tranquilizers in hypovolemic patients.

image Perineural anesthesia is useful for wounds of distal extremities, while regional infiltration of local anesthetic is used elsewhere.

image Direct infiltration of the wound is acceptable only after wound has been cleaned.

• Wound cleansing:


image One of the most important components of effective wound management

image In acute wounds <3 hours duration, water or saline may be all that is needed for adequate wound cleansing. For field use, saline solution is made by adding 10-mL salt to 1-L boiling water (8 teaspoons to a gallon).

image Commercial wound cleansers are recommended when enhanced wound cleansing is needed. Constant-Clens (Tyco Healthcare Kendall, Mansfield, MA) appears to be the least toxic of wound cleansers. Antiseptics should not be added to wound cleanser as they increase the cytotoxic effects.

image Vetericyn (Oculus Innovative Sciences, Inc., Petaluma, CA) has many of the attributes of an ideal wound cleanser. It is a super-oxidized solution with a neutral pH, has broad antimicrobial spectrum against bacteria, fungi, viruses, and spores, and reportedly has 15 seconds of bactericidal effect. It also has a shelf life >12 months.

image Use smooth sponges to scrub the wound.

image Scrubbing the wound with antiseptic soaps is not recommended because of cytotoxicity. Additionally, Povidone-iodine surgical scrub was shown to be ineffective in reducing bacterial levels in wounds.

• Wound lavage/irrigation


image In acute wounds <3 hours duration lavage effectively reduces the number of bacteria residing on the wound surface.

image Lavage solutions are most effective when delivered by a jet of at least 7 psi at an oblique angle to the wound. Pressures of 10 to 15 psi have been shown to be 80% effective in removing infection potentiating factors and adherent bacteria from a wound. This pulsatile pressure can be achieved by forcefully expressing lavage solutions from a 35- or 60-mL syringe through an 18-gauge needle, using a spray bottle, a “Water Pik,” or a Stryker inter-pulse irrigation system (Stryker InterPulse irrigation system, Med-Vet Innovations, Inc., Penrose, CO). Wounds should not be irrigated with fluids delivered at pressures >15 psi, which would force contaminants into tissue.

image Sterile isotonic saline or lactated Ringer’s solutions are commonly used. Tap water delivered from a hose can be used for large wounds, initially. Solutions are often combined with antiseptics/antimicrobials.

image Volume of fluid for lavage/irrigation depends on size of wound and degree of contamination. Minimally, gross contaminants should be removed. Discontinue before tissue becomes water-logged.

• Antiseptics used for wound lavage/irrigation


image Povidone-iodine solution [PI] (10%)

image Commonly used because of its broad antimicrobial spectrum against gram-positive and gram-negative bacteria, fungi, and Candida organisms. Bactericidal effect is 15 seconds. Bacterial resistance has not been identified.

image Diluting the solution uncouples the bond, making more free iodine available for antimicrobial activity. 0.1 and 0.2% (10–20 mL/L) concentrations are recommended.

image Disadvantages include:
image Inactivated by organic material and blood

image <0.1 % concentrations are inactivated by large number of neutrophils

image Concentrations >1% are required to kill Staphylococcus aureus

image Chlorhexidine diacetate solution [CHD] (2%)

image Broad antimicrobial spectrum. NOTE: Ineffective against fungi and Candida organisms, while Proteus and Pseudomonas organisms have developed or have an inherent resistance to CHD.

image When applied to intact skin, antimicrobial effect is immediate and has a lasting residual effect caused by binding to protein in the stratum corneum.

image Currently, 0.05% CHD (1 : 40 dilution [25–975 mL] of the 2% concentrate) solution is recommended for wound lavage. Greater concentrations can be harmful to wound healing.

image Dilution in a sterile electrolyte solution results in precipitation within 4 hours. This does not affect the antibacterial effects of CHD.

image 0.05% CHD has more bactericidal activity than PI.

image Continued activity in the presence of blood and pus.
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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on Wound Infection

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