Wound Infection Guideline Pearls for Multi/Interdisciplinary Teams

Wound infections increase patient morbidity, mortality and length of hospital stay adding to the economic and clinical burdens of patient care. Multi/interdisciplinary teams improve wound outcomes, though specialty guidelines do not always agree on wound infection practice recommendations. This limits consistency of care across specialties and settings.  Purpose: A multi-national, interdisciplinary guideline development task force aimed to develop an international consolidated wound infection guideline (ICWIG) to supplement, not replace, specialty guidelines.  Its objective was to harmonize chronic or acute wound infection management for all specialties on wound care teams across settings, including timely evidence-based specialist referrals to optimize wound and patient outcomes.  Methods: Nineteen volunteer physicians, nurses, infection specialists PhDs and DPM candidates used structured literature searches of PUBMED , Cochrane and CINAHL literature databases from inception through November  1, 2013 to develop evidence based wound infection recommendations. Included were English publications or derivative studies on the following subjects (or synonyms): “wound infection” combined with  “risk factor”, “diagnosis”, “prevention”, “treatment”.  In vitro studies or those on parasitic infections were excluded.  Forty-two independent wound expert respondents to an online survey used judgment quantification to rate each recommendation as relevant (3-4 on a 1-4 rating scale) or conferring more benefit than harm  (1 on a 0-1 rating scale). Statistics: A recommendation was content validated as relevant if ≥ 75% of respondents rated it as relevant and beneficial.   Results:  Most (88.8%) of the 179 ICWIG recommendations rated relevant and beneficial to patients were summarized in checklist format. Surprisingly, 20 recommendations were rated irrelevant and harmful by most respondents. Conclusion/Discussion: Many relevant, safe recommendations can serve team wound infection management across specialties and settings.  All wound organizations are invited to collaborate in developing and updating future guidelines to harmonize multidisciplinary team wound practice.