Infection Control

In the majority of cases, infection can be prevented by adequate debridement and cleansing. Wounds should be cleansed daily and with dressing changes. Normal saline is the most appropriate solution for cleansing. Avoid skin cleansers or antiseptics that are cytotoxic, such as povidone-iodine, hydrogen peroxide, and acetic acid. Signs of a wound infection include delayed healing, increasing wound size, purulent exudate, pain, and foul odor. Initially, consider a trial of topical antibiotics, such as silver sulfadiazine cream (Silvadene), for 2 weeks. Superficial cultures of the wound are not helpful because they detect only the surface colonization. Ideally, bacterial tissue cultures should be performed to guide antibiotic coverage. Systemic antibiotics are reserved for patients with cellulitis, osteomyelitis, bacteremia, or sepsis (AHCPR, 1994).

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