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Pressure Ulcers

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Treatment of wound infections
Wound healing is impaired by the presence of infection with more than 100,000 bacteria per gram of tissue. Infection is usually recognized by the presence of purulent exudate, surrounding erythema, foul odor, tenderness, and systemic signs; the presence of these signs is an indication for antimicrobial therapy.

Wound swab cultures often reveal polymicrobial growth, making it difficult to distinguish colonization from true infection. Curettage of the ulcer base after debridement, needle aspiration, or tissue biopsy are more reliable for identifying the pathogenic organisms, but are not usually necessary unless the ulcer does not respond to topical anti-microbials.

Topical antimicrobials, including gentamicin, silver sulfadiazine, and mupirocin, are effective in reducing bacterial levels and improving the appearance of infected ulcers. A two-week trial of topical antimicrobials may be considered in wounds that
do not appear infected but are not clinically improving. On the other hand, topical antiseptics such as povidone-iodine, sodium hypochlorite, or hydrogen peroxide should be avoided since they may be toxic to fibroblasts. Systemic antibiotics are reserved for serious infections resulting from pressure ulcers (eg, bacteremia or osteomyelitis).
Maintaining a moist wound environment
Wound fluids may contain tissue growth factors that facilitate reepithelialization. Thus, pressure ulcer healing is promoted by dressings that maintain a moist wound environment while keeping the surrounding intact skin dry. A moist wound environment is promoted by loosely packing the wound with saline moistened gauze that is not allowed to dry, although occlusive dressings are equally effective and reduce the nursing time required for wound care.

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