Wound infection in clinical practice: Principles of best practice

This fourth edition of Wound Infection in Clinical Practice was developed by members of the IWII Board and Committee, supported by the medical writer and methodologist, Dr Emily Haesler, Chair of the IWII Education and Evidence Subcommittee. Its development included a systematic review of the literature, a Delphi consensus process, external peer review and the integration of relevant IWII publications. This rigorous process was undertaken to ensure that the document reflects contemporary evidence, international expert consensus and practical clinical experience.

The international and multidisciplinary author group includes academics, scientists, nurses, medical practitioners and pharmacists. The document was also reviewed by experts from a range of disciplines, including podiatry, infectious diseases, surgery and experts in paediatrics. This breadth of expertise reflects the importance of collaborative and multidisciplinary approaches to the prevention and management of wound infection.

This document is intended to support specialist clinicians in education, advanced clinical practice, and the development of policies and procedures. It is also designed to provide generalist clinicians with current information presented in clear, understandable language, together with practical and informative recommendations.

New and expanded content includes neonatal and paediatric considerations, the assessment of clinical signs across diverse skin tones, evolving concepts and paradigms, and medicated and non-medicated approaches to wound infection management. Evidence published since the third edition in 2022 has further informed our understanding of wound infection, biofilm, prevention, assessment and management.

IWII Expert Working Group
Emily Haesler, Terry Swanson, Geoff Sussman, Donna Larsen, Susie Seaman, Paulo Alves, Leanne Atkin, Thomas Bjarnsholt, Keryln Carville, Daniel J. Gibson, Lisa Gould, Patricia Idensohn, Lindsay Kalan, David H. Keast, Kimberly LeBlanc, Prashini Moodley, Harikrishna K.R. Nair, Karen Ousey, Steven Percival, Nicola Waters, Dot Weir

Peer reviewers
Guido Ciprandi, Nicoletta Frescos, Kyle Kilby, David Leaper, Edward Raby, Paulo Ramos, George Rodeheaver

1. Implement and support an organisational-level antimicrobial stewardship program to provide guidance, monitoring and education on antimicrobial use in wound care.

2. Establish a therapeutic relationship with the individual and their carers to support holistic wound infection assessment, shared decision making and a person-centred approach to preventing and treating wound infection.

3. Assess the individual’s risk for wound infection and develop a management plan to address modifiable risk factors.

4. Identify wound infection based on clinical signs and symptoms. When indicated, use microbiological investigations to identify causative microbes and/or perform haematological and radiological investigations to assess severity of infection.

5. Select tissue biopsy as the preferred method to collect a wound specimen for diagnostic investigations. When tissue biopsy is not available, perform a wound swab using Levine technique.

6. Select either sterile/surgical aseptic technique or clean/standard aseptic technique when performing a wound dressing procedure. Conduct a risk assessment that considers the individual, the wound and environmental considerations to guide technique selection.

7. Implement standard precautions when conducting a wound dressing procedure.

8. Therapeutically cleanse the wound bed and wound edge, the periwound skin and the surrounding skin when the wound dressing procedure is performed.

9. Perform debridement when clinically indicated. The method and frequency of debridement should be selected based on the individual’s clinical history and risk factors, assessment of the wound, goals of care, clinician’s scope of practice, individual preferences and available resources.

10. Use an antiseptic as part of a comprehensive wound infection management plan when wound infection is confirmed or suspected. Consider using an antiseptic in individuals at high risk for invasive wound infection based on a risk assessment.

11. Select an antiseptic based on:

• Antimicrobial spectrum and resistance,
• Properties of the active ingredient,
• Cytotoxicity, pH and allergenicity,
• Goals of care and other individual factors, and
• Resources, availability and organisation/wound care service policies.

12. Commence systemic antibiotic therapy urgently when there are signs and symptoms of systemic or spreading wound infection. Perform a risk assessment and use clinical judgement to determine whether commencement of systemic antibiotic therapy is appropriate for treating signs and symptoms of overt local wound infection.

13. Use an age-related approach to identify and mitigate risk for wound infection, to identify and assess wound infection and to select appropriate wound infection treatments in neonates, infants and children.