Signs and Symptoms of Wound Infections

The immune system is essential in the body’s ability to heal. A healthy immune system can aid in the body’s ability to heal by reducing the risk of infection. When a wound becomes infected it affects the progression of wound healing. 

This  article goes over what factors affect wound infections and wound healing as well as nursing interventions to ensure optimal healing.

In order to be able to understand the steps involved with wound healing we need to look at the different classifications of wounds, stages of wound progression, wound dressing and interventions. 

Wound Classification

General wounds

These wounds are superficial and loss of epidermis. 

Partial thickness

These wounds involve both the epidermis and dermis.

Full Thickness

This involves the epidermis, the dermis, subcutaneous and sometimes the bone. 

Open Wounds

Incisions, incised wounds caused by sharp edged objects such as knives, razors, glass or splinters. 

Lacerations

Irregular tear like wounds caused by blunt force trauma. 

The wound healing process involves the replacement of destroyed tissue by new tissues. This occurs in 4 stages/phases. 

1. Hemostasis 

This is the blood clotting phase which stops bleeding and is considered the first stage of wound healing. It changes the blood from a liquid to a gel. This is done by constricting blood flow where the platelets stick together. It coagulates and creates what is called a platelet plug by utilizing fibrin as a binding agent. This process occurs very quickly to form a clot. Blood clotting issues can affect this stage of wound healing. 

2. Inflammation Phase

This stage is where localized swelling occurs and controls bleeding and prevents infection. It allows healing and repairs cells (white cells) at the site of the wound. Inflammation is a natural part of wound healing and is only problematic if the inflammation is prolonged and excessive.

3. Proliferative Phase

This is the rebuilding of the wound by new tissue development,  which involves collagen production and extracellular matrix through wound contraction and the building of new tissue. This is when granulation occurs. It’s usually pink/red and uneven and does not bleed easily (if it appears dark it can indicate an infection, ischemia and or poor perfusion). This is where the wound must remain moist and hydrated to aid in wound healing. 

4. Maturation Phase

This is considered the remodeling stage, where the wound fully closes because the cells that were involved in healing are no longer injured and are removed by a process called apoptosis (removal of inflammatory cells, and turning granulation tissue into scar tissue).

Risk of Infection

Wound healing stages are complex and any interference in the process can lead to infection and chronic wounds. Many factors can affect wounds including:

Venous Disease

This can affect the flow of blood, oxygen and nutrition to the wound site.

Infection

This triggers the immune system to increase inflammation and tissue damage which impedes the wound healing process. 

Diabetes

Diabetes makes it harder for the body to heal because of blood sugar glucose levels, neuropathy, and reduced immune system function. 

Being Elderly 

The healing process becomes slower during the aging process including all phases of the wound healing. Skin gets thinner and the body shows a decreased inflammatory response, as well as the proliferative response and remodeling phase occurs but to a lesser degree and there is a decrease in collagen production. 

Underlying Disease

Since diseases like diabetes or autoimmune diseases impair collagen production and perfusion (lack of oxygenation) it can greatly affect the healing process.

Smoking 

Smoking causes carbon monoxide to enter your blood cells, and lowers the amount of oxygen in the blood. Oxygen production is imperative for wound healing. This slows healing because less oxygen is delivered to the wound site. 

Malnutrition

An inadequate supply of proteins, carbohydrates, fats, and trace elements, vitamins, can hinder all stages of wound healing. 

Obesity

Increased weight can affect vascularity because of the increased demand on the circulatory system. Venous insufficiency can also have a negative effect on wound healing and potentially increase the risk of chronic wounds. Those who are obese often have a deficiency due to high calorie, high fat, and high carbohydrate diet that is lacking in vitamins and minerals. 

Medication Considerations

NSAIDS, chemotherapy, immunosuppressive drugs and corticosteroids can affect wound healing. Close consideration must be done to determine whether these medications should be withdrawn to facilitate wound healing. 

Radiation therapy

This therapy can cause permanent tissue damage in an area treated with radiation and potentially can affect wound healing in that area long term. Wound healing would be impacted by dose, fraction and what type of radiation treatment received. 

Stress, Anxiety and Depression

This can impact the healing process because of the increase of the stress hormone cortisol which slows the healing of wounds, it can also increase pain and pain is a stressor which can impede healing. 

Other factors affecting wound healing is the management of wound care and the wound itself. 

• Moisture balance: The dressing must be moist but not soaked as that can impair healing. 
• Wound temperature and PH levels 
• Pressure, friction, shearing, and limited mobility 
• Presence of foreign bodies 

Signs and Symptoms of Wound Infections 

It’s important to recognize the signs and symptoms of wound infection. It is also important to note that risks increase when the wound is in a high bacteria area of the body. Recognizing and managing a wound infection should be a primary management for all health care professionals. Keep an eye out for: 

Fever

A fever indicates that the body's way of fighting an infection. 

Malaise

An overall feeling of malaise can indicate there is an infection.

Green, Cloudy, Purulent Drainage

Usually wounds would drain as clear, or slightly yellow. If it has a foul odor and is green or cloudy it can indicate an infection. 

Increasing or Continual Pain

Pain should be subsiding as it heals, usually an indication if pain is increasing at the wound site it is indicative of an infection. 

Redness around the wound

Initially the wound would appear red due to the normal inflammatory response. Usually after 5-7 days the wound should decrease in redness. When the redness around a wound increases, expands, and worsens, it can be due to an infection. 

Swelling around the wound

Like redness, it’s normal in the beginning to have swelling, however, it should be continually decreasing as the wound heals. 

Hot skin near the wound

A slight warming of the skin around the wound is normal but increased warmth around the wound can indicate that there is a potential infection. The skin begins to warm because there is a release of vasoactive chemicals which increases the blood flow to the area and an increase in heat because the leukocytes produce antibodies to fight the bacteria. 

Loss of Function and Movement

Normally if movement was impacted by surgery, the patient may have limited movement, but as the wound heals, the patient should be able to slowly increase movement and function. If there’s an infection it may impact the patient's ability to do so. Infection effect may increase pain which would then affect function and movement. 

Factors to Consider when assessing a Wound

Part of wound management and prevention of wound infection, is continually assessing and applying the necessary intervention. These factors should be included when assessing a wound. 

Type of Wound

Whether the wound is acute or chronic 

Aetiology

Whether the wound is surgical, laceration, ulcer, burn, abrasion, traumatic, pressure injury, neoplastic. 

Clinical Appearance

What stage of healing the wound is in.  

Exudate

Fluid that filters into lesions or wounds or areas of inflammation (can be pus like or clear). 

Other things to take into consideration: 

• Location and surrounding skin 
• Tissue loss 
• Measurement of the wound 
• Wound edge 
• Pain 

Conclusion

It’s important to recognize the signs and symptoms of wound infection. Early detection can help resolve and prevent serious complications. It’s imperative to not only assess the wound but also optimize nursing interventions such as patient education, and monitoring.

Author Bio 

Mance Granberg, RPN 

Mance Granberg is a First Nations Abenaki from Quebec and a RPN who has been nursing for over 18 years. He's had the opportunity to nurse in a variety of disciplines from correctional nursing to Geriatric nursing.