How To Differentiate Between Infected Wounds And Colonized Wounds

By Jason R. Hanft, DPM, and Brigette Smith, DPM

   Since every wound has the potential for infection, it is important to differentiate between infection and colonization.1 There is no textbook that depicts all the possible appearances of wounds that contain bacteria. Indeed, the potential of wounds to heal or become infected depends on many variables. Wound care specialists have a responsibility to become familiar with the these variables as well as develop a trained eye for the clinical appearance of a wound so they may render the appropriate treatment.    There is an enormous amount of information concerning the treatment, staging and physiology of wounds and healing. The influx of emerging research is constantly affecting the current thinking on classifying wounds and providing appropriate treatment. Accordingly, one must be able to differentiate between contaminated and infected wounds, and understand how bioburden, critical colonization and the effects of bacteria affect the wound environment.    The human body harbors over 200 species of bacteria on the skin.2 At any time, one of these bacteria can be inoculated into the wound. Once the skin is injured, the body is vulnerable to contamination from the environment, surrounding skin and mucous membranes.1 The longer the wound is exposed, especially if it is devitalized or compromised, the easier it is for bacteria to colonize.1    In fact, wounds are an ideal place for bacteria to colonize and proliferate since they have a warm, moist nutritive environment. The type of bacteria present and whether the bacteria has infected the wound depends on the type, depth, location, level of perfusion and the efficacy of the host response.1 Consider the following equation relating to infection.3,4 Infection = bacteria dose x virulence host resistance

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