This article was medically reviewed by Dr. Edward McManus.
According to the National Institutes of Health (NIH), chronic wounds affect 6.5 million patients in the United States. This poses a significant health concern that many people are not aware of. In general, individuals who see doctors regularly for underlying health issues, including many conditions related to poor circulation and blood flow, are more prone to wound infections. Nevertheless, it’s important for everyone to understand how wounds become infected, the symptoms, how to prevent them, and the best treatment options. ID Care’s infectious disease wound care expert Dr. Edward McManus explains everything you need to know.
As background, the skin is the body’s first line of defense. It’s protected by a thin, acid film called the acid mantle, a dynamic barrier containing microorganisms called the normal flora that help prevent pathogens from entering the body. According to WoundSource, when the skin is broken or penetrated, any contaminating microorganisms in and around the wound – typically bacteria or fungi – can cause an infection. This event triggers the body’s immune system, inflaming damaged tissue and inhibiting healing.
Just as the types of wounds vary by patient, so do wound infections. Says Dr. McManus, “Infections run a wide gamut of possibilities because it’s quite dependent on the host, the patients themselves, and what their underlying health is like. For example, whether they have diabetes, vascular disease, preexisting immune conditions, or other health-related issues. Also, whether they’re on chemotherapy or steroids, reducing their ability to fight an infection. And it’s important to consider the environment and circumstances where that injury or wound occurs. All these things need to be considered as they can influence the risk of getting a wound infection.”
What Causes a Wound Infection?
A wound infection can arise from major tissue trauma from surgery, but also from a minor cut, bite, or skin puncture from everyday activities. While the causes of wounds are infinite, the sources of infection are most commonly two-fold. “When we talk about the causes of wound infections, we’re primarily talking about bacteria and fungi,” states Dr. McManus. “Part of the colonization of your skin, your biome, the flora that’s on the surface of your skin. It’s the bacteria that exists there that’s contaminating the area where you got injured.”
“Somebody might get a wound infection after stepping on shells on the beach or even after cleaning a fish tank at home with an open cut,” says Dr. McManus. “These simple tasks can result in an infected wound.”
But other infections, though rarer, can result from surgical site wounds after surgery. These infections are caused by bacteria that’s present on a patient’s skin when the surgical site incision is made. Whether the procedure is a joint replacement or abdominal surgery, exposing and damaging tissue, even in a sterile environment, poses a small chance of infection.
Since there are many causes of wounds, there are also many causes of infections. There are various infecting agents that can colonize wounds, but they are primarily bacterial and fungal microorganisms. The most common pathogens that cause wound infections include:
- Bacteria – the most-common pathogen, including Staphylococcus (staph), Streptococcus (strep), MRSA, Clostridium, Cellulitis, to name a few
- Fungi – yeast and mold including Candida, Cladosporidium, and Aspergillus, among others
Further, some infection sources can actually mimic a wound without being one. Says Dr. McManus, “Certain viral infections, like shingles, can have skin manifestations, like an oozing rash, that may look like a wound. But it’s not really a wound itself.”
What are the Signs and Symptoms of an Infected Wound?
The primary indicator of a possible wound infection is delayed healing. “Almost every wound should heal within two weeks,” states Dr. McManus. “If a wound is taking beyond four weeks to heal, there’s some intervening factor. Infection is not the only reason that a wound would be delayed in healing. Some wounds are stagnant because of poor blood supply due to diabetes and other health conditions. They can also be stagnant because of poor diet. Your body heals wounds through an inflammatory response. When that response doesn’t work, you’re left with a wound that doesn’t heal.”
Signs and symptoms of a wound infection vary, but all are a way of your body saying that something isn’t right. There are four classic manifestations of a wound infection when you think of inflammation, and they are all born from their Latin origin as follows:
- Tumor – Swelling
- Dolor – Pain
- Rubor – Redness
- Calor – Warmth
Adds Dr. McManus, “Now there’s a fifth element that’s recently been added, and that’s loss of function. Whether you can’t move your finger or you can’t move your foot. It’s that part of your body that you’re less able to use due to the infected wound.”
These five symptoms of wound infections can occur in combination, alone, and sometimes not at all. “People can have any one of them. You don’t need to experience all of them,” says Dr. McManus. “Some people don’t have any manifestations because they’re on steroids, going through chemotherapy or have diabetic neuropathy.” For example, diabetic neuropathy causes nerve damage resulting in numbness, usually in the feet and lower legs, inhibiting normal pain response. Adds Dr. McManus, “Sometimes a wound goes undetected for a year or more. Patients can’t feel it, so they don’t even know they have a wound that’s infected.”
Who is Most at Risk for Wound Infections?
It’s important to know that those individuals most at risk for an infected wound are those also suffering from chronic health conditions and ongoing ill health. Dr. McManus succinctly states, “Rather than trying to create a laundry list of who is most at risk for a wound infection, it’s simpler to say, anybody who needs to see a doctor regularly. Whether it’s for diabetes, rheumatoid arthritis, kidney disease, hypertension, or heart disease, these people are already health compromised and should be more alert to monitor a wound for normal healing.” Infected wounds that are left undiagnosed and untreated can be dangerous, so understanding who is most at risk is essential.
The following outlines key factors for people most at risk for wound infections:
- Poor blood circulation
- Lack of mobility
- Weakened immune system
- Poor hygiene
How is an Infected Wound Diagnosed?
When any individual presents with a wound that isn’t healing, an infectious disease specialist at ID Care will conduct a thorough evaluation, including a review of the individual’s health history as well as an examination of the wound to determine the cause and optimal treatment plan.
It’s also important to note that chronic wounds lasting longer than four weeks are generally referred to our Wound Care Centers located at leading New Jersey hospitals that ID Care physicians are affiliated with and care for patients at. These specialized Wound Care Centers have the most advanced diagnostic tools, testing procedures, and treatment options – including non-invasive Hyperbaric Oxygen Therapy (HBOT) – as well as antibiotic and other medical interventions.
While identifying an infected wound early on is important, ID Care wound care specialists know that having a great pair of ears is vital in accurately diagnosing the infection. “Obviously, examining the injury is important, but a big part of our skill set is really listening.” Dr. McManus sits with each patient and relates, “tell me the story of how this happened, how did it all begin. Tell me a little more about yourself and your general health. The medications you take, the conditions you have, and those related circumstances.” Having really good ears is essential for diagnosing a wound infection, and most importantly, how to treat it to get the patient on the road to recovery.
How are Infected Wounds Treated?
Following diagnosis of an infected wound, an essential first step in wound treatment is called debridement, a procedure involving thorough cleaning of the wound area and removing all callused, infected and dead tissue, as well as foreign debris and residual material from any dressings that may have been covering the wound area. Once the wound is debrided, the cells in the area are then stimulated to send cytokines or healing factors, enabling the body to properly mend the wound. Says Dr. McManus, “We consider that a success. Long-standing wounds that often present have been there for a year or longer, and under the care of a specialist in a Wound Care Center, should heal in 12 weeks.”
An effective treatment plan looks at many factors, including addressing underlying conditions, such as poor blood flow and oxygen caused by diabetes and nutritional deficiencies, as well as the duration and type of infection at hand. Individualized treatments, which can range from IV antibiotics and topical agents, to localized hydrotherapy and hyperbaric oxygen therapy administered in a Wound Care Center, are often administered in coordination with other providers caring for patients with comorbid conditions.
How Can Wound Infections be Prevented?
Preventing wounds from becoming infected is the first line of defense, and there are some basic measures to take. Exposed tissue should be thoroughly cleaned and covered with a Band-Aid or bandage. Another simple over-the-counter measure is to use an antibiotic-free wound gel, available at most drug stores. MediHoney is also a medical-grade, honey-based, safe alternative to treat wounds, and is available at major chains such as CVS, Walmart, and Walgreens. These therapies keep out infection and also keep the wound clean and moist, important for proper wound healing.
A primary driver of wound healing is proper hydration. Says Dr. McManus, “You don’t want to macerate the skin. You want to keep that scabbed area moist because you have a lot of cell movement. The way a wound heals is through contraction. Macrophages have to stretch out and then contract to pull that wound back together and tighten it up. They can’t operate in a dried-out scab. That’s why you want to keep the wound moist.”
But a big component in keeping wounds infection-free is beyond anyone’s control. “You have to have good genetics,” Dr. McManus states bluntly. “It simply drops your risk dramatically if you don’t already have conditions that predispose you to these complicated wound healing situations.”
While those afflicted with chronic health issues are more susceptible to infection, everyone – regardless of their overall health – should always monitor wounds closely. Dr. McManus shares these tips:
- Keep the wound area clean and moist to aid healing
- Apply an antibiotic-free wound gel or MediHoney on open wounds and cover them.
- Monitor your wound and observe how it’s healing, including the five signs of infection
- Get medical attention from a wound care specialist if it’s not healed after 2 to 4 weeks
When Should You See a Wound Care Specialist Like ID Care?
If a wound fails to heal within two to four weeks, it’s best to first see an infectious disease expert trained in the latest wound care rather than as the second or third treating physician. States Dr. McManus, “Traditionally, infectious disease doctors see patients with an infected wound at the end of seeing many doctors. It would be helpful for us to see them much sooner because of our specialty, relationship, and knowledge about what other doctors do and what our expertise and capabilities are. Bottom line, seeing us earlier rather than later is much more beneficial to patients.”
Considering that many of those with non-healing wounds are already compromised due to chronic conditions, seeking prompt care from experts like those at ID Care can be lifesaving. “Christopher Reeves, the actor, died from an infected wound,” relates Dr. McManus. “He was a quadriplegic from a horse accident. But he had a wound that didn’t heal, it got infected, and he died from it. Sadly, that’s what ultimately took Superman’s life.” Timely medical intervention, especially for those already in poor health, is vital to ensuring non-healing wounds don’t result in irreversible or even catastrophic consequences.
How Does ID Care Extend Care to People with Wound Infections?
States Dr. McManus, “There are Wound Care Centers. Most of them are sponsored by the health systems and hospitals that we are affiliated with and go to. We’re on staff at all Atlantic Health System wound care programs. We’re on staff at Prime Healthcare hospital locations, St. Peter’s University Hospital, Hackensack Meridian JFK Medical Center and Raritan Bay Medical Center. And we’re at several of the RWJBarnabas Health hospitals as well. We also do wound care on an outpatient basis through our 10 office locations.”
ID Care’s specialists take an individualized approach to patient care. As experts in wound infections and infectious diseases, we have the experience and resources to solve underlying problems, not just treat symptoms. “We’re trained to successfully identify infections on all parts of the body,” says Dr. McManus. “We’re global thinkers. A cardiologist focuses on your heart, a pulmonologist focuses on your lungs, but we are the grout of care. We fill in the gaps between the tiles. We’re true problem solvers.”
See What New Jersey’s Leader in Infectious Diseases Can Do for You.
As trained specialists in wound infections, ID Care leads the way across all infectious diseases with over 50 experienced providers. We’re proud to be the region’s largest private network of infectious disease specialists, with 10 convenient outpatient locations, as well as consulting and caring for patients in over 130 healthcare organizations throughout New Jersey. We employ state-of-the-art technology and the most advanced protocols, as well as conduct ongoing research to find better treatments and prevention methods in the field of infectious disease.