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Wound Infection - Guidelines and Quality Measures

Wound Infection - Guidelines and Quality Measures

Wound Infection - Guidelines and Quality Measures

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INTRODUCTION 

Overview

    This topic provides a list of Guidelines, Quality Measures and other resources on Wound Infection. For guidance on how institutions can minimize misuse and/or overuse use of antimicrobial medications and establish an antimicrobial stewardship program, see topic "Antimicrobial Stewardship In Wound Care". For evidence-based guidance on diagnosis of wound infection, when and how to perform wound cultures, how to choose sampling techniques, documentation, coding, coverage and reimbursement, see topic "Wound Culture - Swabs, Biopsies, Needle Aspiration". For sample policies and procedures on how to collect a wound swab see topic "How to Collect a Wound Swab (Levine Technique) for Culture". For guidance on when and how to perform wound biopsies see topic "How to Perform a Wound Biopsy". 

    Background

    • By default, chronic wounds are contaminated by several types of bacteria.[1][2] When the host (patient) does not adequately respond to bacterial contamination, this contamination can turn into colonization, which can further turn into infection.[3][4] 
    • Wound infection has been regarded as the one of the most important causes of delayed healing of chronic wounds.[5] 

    Figure 1. Infected diabetic foot ulcer on toe. By Lebedinskaya N. RN, BSN, CWOCN 


    EVIDENCE-BASED CLINICAL GUIDELINES

    Below is a list of the some of the most recent evidence-based guidelines on Wound Infection:     

    Evidence-based guideline, year Publishing Organization, country Links Comments
    Wound Infection In Clinical Practice - Principles of Best Practice (International Consensus), 2022
    		International Wound Infection Institute, United Kingdom
    		Consensus (Free)Chronic and Acute wounds, consensus
    NICE Human and animal bites: antimicrobial prescribing, 2020 [6]
    		United KingdomGuideline (Free)
    		Surgical site infection and acute wounds
    NICE Surgical site infections: prevention and treatment, 2020 [7]
    		United Kingdom
    		Guideline (Free)
    		Surgical site infection and acute wounds
    Global Guidelines for the Prevention of Surgical Site Infection, 2018 [8]
    		World Health Organization, multiple countries
    		Guideline (Free)
    		Surgical site infection and acute wounds
    Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017 [9]
    		United States
    		Guideline (Free)Surgical site infection and acute wounds
    APSIC guidelines for the prevention of surgical site infections, 2019 [10]
    		Asia Pacific Society of Infection Control, multiple countries
    		Guideline (Free)Surgical site infection and acute wounds

    AAWC Wound Infection Guideline Recommendations-Feb.20.2018 (AAWC 2018) [11]

    AAWC Wound Infection Guideline Checklist 11.17 (AAWC 2018) [12]

    AAWC The Development and Content Validation of a Multidisciplinary, Evidence-based Wound Infection Prevention and Treatment Guideline [13] 

    		AAWC, United StatesGuideline (Free)
    		Chronic wounds in general

    Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America, 2014 [14] 

    		Infectious Diseases Society of America, United States
    		Guideline (Free)
    		Chronic wounds in general
    University of Michigan Inpatient Adult Diabetic Foot Infections Guideline, 2020 [15]
    		University of Michigan, United States
    		Guideline (Free)
    		Chronic wounds - specific condition
    IWGDF Guideline on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 Update) [16]
    		IWGDF, multiple countries
    		Guideline (Free)
    		Chronic wounds - specific condition

    Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update) [17]

    		IWGDF, multiple countries
    		Guideline (Free)
    		Chronic wounds - specific condition

    QUALITY MEASURES

    Setting CMS Program Developed by Measure ID Title Description
    Acute care inpatient setting

    Hospital Acquired Condition Reduction Program

    		CMS
    		CMIT Measure ID: 135
    		Postoperative wound dehiscence rate (part of the CMS PSI 90)Postoperative reclosures of the abdominal wall per 1,000 abdominopelvic surgery discharges for patients ages 18 years and older. Excludes cases in which the abdominal wall reclosure occurs on or before the day of the first abdominopelvic surgery, cases with an immunocompromised state, cases with stays less than two (2) days, and obstetric cases. Cases are included if they have a diagnosis code of disruption of internal surgical wound with a reclosure procedure. Part of the CMS PSI 90. CMS PSI 90 was developed to provide a simple and transparent single metric that can be used to better understand, communicate and track patient safety in US hospitals. The indicator is comprised of ten component PSIs that are calculated using readily available, routinely collected administrative data. The composite is conceptualized as a formative composite, meaning that the indicator is formed from a set of component indicators that assess different harms and aspects of patient safety.
    OutpatientQuality Payment Program - Merit-based incentive payment system (MIPS) (***)
    		American College of Surgeons
    		MIPS 357
    		Surgical Site Infection (SSI)
    		Percentage of patients aged 18 years and older who had a surgical site infection (SSI).

    *** The Quality Payment Program (QPP) was implemented in the U.S. by Medicare in 2017. Merit-based incentive payment system (MIPS) is designed for eligible clinicians who bill under Medicare Part B. 

    RESOURCES

    • CMS Measures Inventory Tool 
    • US Wound Registry
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    NOTE: This is a controlled document. This document is not a substitute for proper training, experience, and exercising of professional judgment. While every effort has been made to ensure the accuracy of the contents, neither the authors nor the Wound Reference, Inc. give any guarantee as to the accuracy of the information contained in them nor accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omissions in the contents of the work.

    REFERENCES

    1. Stallard Y. When and How to Perform Cultures on Chronic Wounds? Journal of wound, ostomy, and continence nursing : official publication of The Wound, Ostomy an.... 2018;volume 45(2):179-186.
    2. Maillard JY, Kampf G, Cooper R et al. Antimicrobial stewardship of antiseptics that are pertinent to wounds: the need for a united approach. JAC-antimicrobial resistance. 2021;volume 3(1):dlab027.
    3. International Wound Infection Institute. Wound Infection in Clinical Practice - Principles of Best Practice Wounds International. 2022;.
    4. Swanson T, Keast D, Bain K, Bai M et al. Preventing and treating infection in wounds: translating evidence and recommendations into practice Wounds International. 2020;.
    5. Leaper D, Assadian O, Edmiston CE et al. Approach to chronic wound infections. The British journal of dermatology. 2015;volume 173(2):351-8.
    6. NICE. Human and animal bites: antimicrobial prescribing . 2020;.
    7. NICE. Surgical site infections: prevention and treatment . 2019;.
    8. World Health Organization. World Health Organization. Global guidelines for the prevention of surgical site infection. . 2018;.
    9. Berríos-Torres SI, Umscheid CA, Bratzler DW, Leas B, Stone EC, Kelz RR, Reinke CE, Morgan S, Solomkin JS, Mazuski JE, Dellinger EP, Itani KMF, Berbari EF, Segreti J, Parvizi J, Blanchard J, Allen G, Kluytmans JAJW, Donlan R, Schecter WP, Healthcare Infection Control Practices Advisory Committee. et al. Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA surgery. 2017;volume 152(8):784-791.
    10. Ling ML, Apisarnthanarak A, Abbas A, Morikane K, Lee KY, Warrier A, Yamada K et al. APSIC guidelines for the prevention of surgical site infections. Antimicrobial resistance and infection control. 2019;volume 8():174.
    11. AAWC. Major Recommendations for the International Consolidated Wound Infection Guideline (ICWIG) . 2018;.
    12. AAWC. AAWC Wound Infection Guideline Checklist . 2018;.
    13. Zakhary SA, Davey C, Bari R, Bean J, Reber T, Gallagher K, Couch K, Hurlow J, Laforet K, McIssac C, Napier K, Vilar-Compte D, Zakhary E, Hermans M, Bolton L et al. The Development and Content Validation of a Multidisciplinary, Evidence-based Wound Infection Prevention and Treatment Guideline. Ostomy/wound management. 2017;volume 63(11):18-29.
    14. Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL, Hirschmann JV, Kaplan SL, Montoya JG, Wade JC et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. Clinical infectious diseases : an official publication of the Infectious Diseases Society of Am.... 2014;volume 59(2):147-59.
    15. University of Michigan. Inpatient Adult Diabetic Foot Infections Guideline . 2020;.
    16. Lipsky BA, Senneville É, Abbas ZG, Aragón-Sánchez J, Diggle M, Embil JM, Kono S, Lavery LA, Malone M, van Asten SA, Urbančič-Rovan V, Peters EJG, International Working Group on the Diabetic Foot (IWGDF). et al. Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes/metabolism research and reviews. 2020;volume 36 Suppl 1():e3280.
    17. Hinchliffe RJ, Forsythe RO, Apelqvist J, Boyko EJ, Fitridge R, Hong JP, Katsanos K, Mills JL, Nikol S, Reekers J, Venermo M, Zierler RE, Schaper NC, International Working Group on the Diabetic Foot (IWGDF). et al. Guidelines on diagnosis, prognosis, and management of peripheral artery disease in patients with foot ulcers and diabetes (IWGDF 2019 update). Diabetes/metabolism research and reviews. 2020;volume 36 Suppl 1():e3276.
    Topic 1714 Version 2.0

    RELATED TOPICS

    Antimicrobial Stewardship In Wound Care P

    INTRODUCTIONOverviewThe inappropriate use of antimicrobial medications contributes to antibiotic resistance and adverse drug events, and improving antimicrobial prescribing practices is a patient safety priority.[1] The Centers for Disease Control and Prevention (CDC) estimates that annually at least 2 million illnesses and 23,000 deaths are caused by antibiotic-resistant bacteria in the United Stat

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