Wound Infection

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DEFINITION

• Traumatic wound (break in the skin) shows signs of infection
• Includes sutured wounds, puncture wounds, scrapes
• Most contaminated wounds become infected 24 to 72 hours after the initial break in the skin.

Signs of Wound Infection

• Pus or cloudy fluid draining from the wound
• Pimple or yellow crust formed on the wound (impetigo)
• Scab has increased in size
• Increasing redness around the wound (cellulitis)
• Red streak is spreading from the wound toward the heart (lymphangitis)
• Wound has become extremely tender
• Pain or swelling increasing after 48 hours since the wound occurred 
• Wound has developed blisters or black dead tissue (gangrene and myonecrosis)
• Lymph node draining that area of skin may become large and tender (lymphadenitis)
• Onset of widespread bright red sunburn-like rash
• Onset of fever
• Wound hasn't healed within 10 days after the injury

CA-MRSA: Community Acquired Methicillin-Resistant Staphylococcus aureus

• Staphylococcus aureusis a bacteria that can cause a variety of skin infections including pimples, boils, abscesses, cellulitis, wound infections, and impetigo.
• In the 1960's strains of Staphylococcus aureus that were resistant to penicillin-type antibiotics started appearing in hospitals and health care settings. These were referred to as Methicillin-ResistantStaphylococcus aureus (MRSA) Infections.
• More recently, strains of penicillin-resistant Staphylococcus aureus have increasingly become the cause of skin infections in healthy individuals in the community. These are now being referred to as Community Acquired Methicillin-ResistantStaphylococcus aureus (CA-MRSA) Infections. There have been outbreaks in athletes (e.g., wrestling teams) and in prison populations.
• CA-MRSA requires treatment with specific types of antibiotics.
• More information about CA-MRSA is available at http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html.

See More Appropriate Topic (instead of this one) If

• Have stitches and wound is not infected, see SUTURE QUESTIONS

WHEN TO CALL YOUR DOCTOR

Call Your Doctor Now (night or day) If

• You feel weak or very sick
• Bright red, sunburn-like rash on you body
• Fever occurs
• Red streak runs from the wound
• Increasing redness around the wound
• Severe pain in the wound
• Face wound with signs of infection
• Finger wound, where finger has sausage shaped swelling and pain

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If:

• You think you need to be seen
• Pus or cloudy drainage from the wound
• Pimple where a stitch comes through the skin
• Wound becomes more tender after the second day
• Taking an antibiotic for more than 3 days and wound infection not improved

Call Your Doctor During Weekday Office Hours If

• You have other questions or concerns

Self Care at Home If

• Wound doesn't look infected and you don't think you need to be seen

HOME CARE ADVICE FOR MILD REDNESS OF WOUND

1. Warm Soaks or Local Heat: If the wound is open, soak it in warm water or put a warm wet cloth on the wound for 20 minutes 3 times per day.  Use a warm saltwater solution containing 2 teaspoons of table salt per quart of water. If the wound is closed, apply a heating pad or warm, moist washcloth to the reddened area for 20 minutes 3 times per day.
2. Antibiotic Ointment: Apply an antibiotic ointment 3 times a day.  If the area could become dirty, cover with a Band-Aid or a clean gauze dressing.
3. Pain Medication:
   • For pain relief, take acetaminophen or ibuprofen
   • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
   • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
   • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
   • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid  this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
   • CAUTION: Do not take acetaminophen if you have liver disease.
   • Read the package instructions thoroughly on all medications that you take. 
4. Expected Course: Pain and swelling normally peak on day 2. Any redness should go away by day 3 or 4. Complete healing should occur by day 10.
5. Contagiousness: For true wound infections, you can return to work or school after any fever is gone and you have received antibiotics for 24 hours.
6. Call Your Doctor If:
   • Wound becomes more tender
   • Redness starts to spread
   • Pus, drainage or fever occurs
   • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.