Ostalo
ANTISEPTICS IN THE PREVENTION OF CHRONIC WOUND INFECTION – FACTS AND MISCONCEPTIONS
NASTJA KUČIŠEC-TEPEŠ
orcid.org/0000-0001-5704-8281
; Akademija medicinskih znanosti Hrvatske, Zagreb, Hrvatska
Sažetak
Chronic wounds are a consequence of numerous comorbidity factors, and the predominant pathophysiological processes are ischemia, edema and infection, in addition to age, neuropathy and trauma. With breakdown of the skin integrity, the wound becomes contaminated, followed by colonization irst with the physiological lora of the host and, then with microbes from the environment. All chronic wounds are colonized and infection develops in 5%-40% of cases, depending on the type and localization of the wound, comorbidity factors, duration, medical care and treatment. The consequence of the pathophysiological processes in chronic wound is the persistent chronic inlammatory phase with delayed healing, which may progress to local infection, sepsis, multiorgan failure and death. Various substances have been applied in the treatment of chronic wounds for millennia, unfortunately, without due understanding of their effect, which often remains completely un- clear. Modern researches have pointed to the application of antiseptics in chronic wounds to prevent development of infection and spread of local infection, and as support to targeted treatment. The judgment on the application of antiseptics depends on the clinically deined infection, microbiological analysis of the chronic wound sample, and the chronic wound itself. The aim of antisepsis is to kill or inactivate the microbes, primarily bacteria, in the wound by reducing their number, to prevent their multiplication for as long as possible. Antiseptics are applied for prophylactic purposes once-only, several times a day, or once-only for 5-7 days (dressing). Antiseptics are applied for therapeutic purposes repeatedly for a longer period, i.e. 7-10-14 days or until granulations start appearing. The application of antiseptics is a targeted and limited procedure, especially in the infection of a chronic wound. The infection of a chronic wound is characterized by a large number of microbes (>105 CfU/g), mixed microbial lora and numerous virulence factors, the most important of which is the bioilm. Antiseptics are active substances of different chemical structure, which come in a range of composition, spectrum of activity, eficiency, cytotoxicity, teratogenicity, induction of resistance, and activity on the bioilm. As there is no ideal antiseptic, the choice must be practical with minimum side effects. Practical choice of antiseptics for a chronic wound depends on the indication, expected pathogen or pathogens, local or systemic tolerance, available time of exposure, cumulative or residual activity, and local and systemic safety. An absolute indication for the application of antiseptic is infected acute or chronic wound, chronic colonized wound in an immunologically incompetent and immunocompromised patient, and all forms of injuries, i.e. contaminated wounds. Antiseptics are applied until the appearance of granulations. The following antiseptics are applied for chronic wounds, at the same time being effective on the bioilm: chlorhexidine digluconate, polyhexanides, octenidine dihydrochloride, povidone iodine, and nanocrystal silver. Medical personnel are faced with a lack or inadequately clear instructions on how, when, for how long and which antiseptic to apply in daily clinical practice. In the application of antiseptics, it is necessary to clearly deine the reasons for their use, aims and duration of application.
Ključne riječi
antiseptics; chronic wound; prevention; infection
Hrčak ID:
148118
URI
Datum izdavanja:
8.11.2015.
Posjeta: 2.532 *