Wound Care

Wound Management, Products, and Support Surface Selection 259
— Staphylococcus
— Psuedomonas
— Corynbacteria
— Bacteroides
• Wound contamination refers to the presence of bacteria on
the wound surface with no bacterial multiplication.
• Contamination and colonization are commonly found in
wounds healing by secondary intention and are prerequisites
for granulation formation.
• Wound infection prolongs inflammatory response, delays collagen
synthesis, retards epithelialization, and increases tissue injury
due to the bacterial competition for limited amounts of oxygen.
• Acute wounds are susceptible to skin flora invasion and the
larger the loss of the surface area, the more increased the susceptibility.
• Suspect a high bioburden of bacteria in a clean appearing
wound that does not demonstrate healing or improvement
within 14 days if the wound is receiving the appropriate topical
treatment.
• Chronic inflammation results in proliferation of fibroblasts
and scar tissue.
• Infection may also affect the proliferative phase of wound
healing by causing granulation tissue to become edematous,
hemorrhagic and fragile.
• Fragile granulation tissue bleeds readily when gently manipulated
with a sterile cotton-tipped applicator also known as a
6-inch applicator. This is often a symptom of wound infection.
• Discoloration of granulation tissue may also be a symptom of
wound or ulcer infection and is represented by granulation
tissue that is pale, dusky, or dull in color when compared to
surrounding healthy tissue.
• Delayed healing equals no change, or an increase in the volume
or surface area of the wound or ulcer over the preceding
4 weeks leads to delayed healing. Evaluate documentation for