Wound infection: Treatment, symptoms, advice and help

Definition

This is self evidently infection in or around the wound after surgical intervention.

Incidence

With better surgical technique, prophylactic antibiotics and newer suture materials, the incidence wound infection has fallen from around 10% twenty years ago to less than 5% of all operations.

Causes

1. Pre-operative factors

There may be pre-existing infection, for example, from perforated appendix or a broken bone which perforates the skin. The patient may be a latent carrier of bacteria in the nose.

2. Operative factors

There may be lapses in the theatre technique with failure of adequate sterilisation of instruments, the surgeon’s hands or dressings but it is much more likely that wound infection will occur because of the type of surgery with bacterial contamination occurring when the bowel or bladder are opened.

3. Post-operative factors

These are introduced after the patient is returned to the ward and with thorough attention to hand washing this has almost been eradicated.

Signs and Symptoms

The infection is usually evident 48 hours or 72 hours after the operation but can be delayed for up to 2 weeks. There is pain in the wound with swelling and redness around it. The patient has a temperature and may feel generally unwell.

Treatment

Modern surgical, anaesthetic, theatre and ward nursing practices are all geared towards preventing infection and in several incidences prophylactic antibiotics are given thus where any foreign bodies are to be implants, for eg. a heart valve, new joint or mesh for hernia repair, antibiotics are given at the time of operation and often for 1-2 days afterwards.

Patients also have prophylactic antibiotics when the risk of contamination is high, for example during bowel surgery and where the wound itself is contaminated at the time of the surgery, for example during trauma.

When infection has become established and an abscess is related to the wound, this has to be formally drained and antibiotics are only given in this instance if there is a spreading infection around the wound.

Outcome

With modern powerful antibiotics there is usually complete resolution of the infection. An overwhelming infection with fatal consequences usually only happens when there is a large untreated collection of infection in either the chest or abdominal cavity.