Infection Prevention in Patients with Complex Wounds
Abigail Dudderar, Eboni Willis, Damiana Zaborowski
Conway School of Nursing, NURS481 Practicum
April 27, 2026
MRSA infected wound demonstrating erythema and tissue breakdown. (Johns Hopkins Medicine, n.d.)
Nursing Assessment/ Interventions
- Breakdown of skin integrity (burns, surgical wounds, pressure injuries) allow microbial entry into underlying tissue (Zabaglo et al., 2024).
- Infection is caused with microbial contamination → bacterial growth and localized infection (Zabaglo et al., 2024)
- When bacterial load overwhelms host defenses, this leads to tissue damage, delayed wound healing, and possible systemic infection (Johns Hopkins Medicine, n.d.)
Nursing Considerations
Proper Hand Hygeine
- This is the single most effective measure that can be taken
Consider Patient Risk Factors for Infection
- If the wound is going to result from a planned surgury, this should be done beforehand
- Examples of risk factors are: DM1&2, immunospression,
Timely Administration of Antibiotics
Advanced Wound Dresssings and Interventions Often Require Unique Care
Low-pressure Saline Irrigation can be used for open skin fractures
- This is considered to be just as effective as high-pressure irrigation (Millan-Reyes, M.J.)
Honey based treatments can help to prevent infection
- Honey is a natural substance that helps to protect the wound bed
- It is often very painful to the patient when applied, so premedication (if ordered) is crucial
*See Attached
Case 1: Abby’s Patient:
Case 3: Damiana’s Patient
Case 3
- Most Prominent Health Information
- 3rd degree electrical burns to the palm, dorsal hand, and the base of the fingers, and the middle finger has been amputated. His hand is now covered in BTM and has has K-wires through the remaining fingers.
- To prevent infection in liue of the BTM, the patient was given 600 mg Q 12h of Linzolid PO. This medication is an antibiotic that is specifically helpful in preventing skin infections. (Mayo Foundation)
- Relevan Health History
- PMH of social marijuana and alcohol use
- increases risk for infection (Maggirwar)
- Patient Response to Interventions
- Damage was so extensive that more fingers may have to be amputated
- Patient remained a-febrile with no other signs of infection
- Patient’s dressing remained clean. dry , intact with no foul smelling drainage
- Patient encouraged to participate in the wound healing process by eating protein
- Pain stabilized which allowed the patient to sleep
Case 2
Most Prominent Health Information
- Post operative day 4 following exploratory laparotomy with bowel resection
- Partially open abdominal wound with packing
- Signs of early infection: Low grade fever (100.8 ℉), elevated WBC (13,500), purulent drainage and erythema at incision site
Relevant health history
- Type 2 DM (A1C 9.2%), obesity (BMI 32), emergent abdominal surgery due to bowel perforation
Patient response to interventions
- Wound monitored with daily sterile dressing changes
- Blood glucose managed with insulin therapy
- Response:
- Slight reduction in drainage amount
- No progression to systemic infection
- Pain stabilized
Case 1
- Most prominent health information
- 10 days postop following CABG and TAVR surgery.
- In and out of hospital for the past few months d/t complications/SE from CAD
- Developed stage 3 pressure injury due to length of stay. Recently changed status to DNR (d/t depression, being bedbound after recent surgeries)
- Relevant health history
- Smoking, HTN, HLD, PAD of the RLE, CKD, and breast cancer
- Hx of TAVR, PCI, pacemaker, CABG x1
- Patient response to interventions
- Daily wound cleansing and dressing changes
- Application of antimicrobial ointments
- Little to no improvement since tx started
- Pain is stable with opioids
Nursing Intervention #1:
- Proper sterile technique during wound care significantly reduces surgical site infections by preventing wound contamination (Zabaglo et al., 2024)
- Effective blood glucose control in post operative patients improves wound healing and lowers infection risk (Zabaglo et al., 2024)
Nursing Assessment:
- Assessment of wound characteristics, including size, depth, tissue type, drainage, odor, and condition of surrounding skin
- The disorder
- Infection prevention in patients with complex wounds remains a significant challenge in the clinical setting
- Medicare’s annual spending on wound care ranges from $28-96 billion
- Wound care tailored to patient needs and clinical context would greatly lower this number
- Impacts of the disorder on other body systems
- Local: delayed wound healing -> chronic wounds -> local tissue damage; abcesses, osteomyelitis
- Systemic: bacteremia, sepsis