The wound infection continuum and its application to clinical practice

Four basic conditions exist in open wounds resulting from the level of bioburden present (bacterial contamination--normal but short-lived state, colonization--normal state, critical colonization--abnormal state, and infection--abnormal state). The two abnormal states have the potential to disrupt the orderly healing sequence, which results in the development of a chronic wound. In addition, the impact of the wound s anatomical position, duration, shape, or presentation; the patient s level of health and control of underlying pathologies; the presence of infection-potentiating factors such as foreign bodies, hematoma, and necrotic tissue; the sources and frequency of exogenous contamination; the considered virulence of the individual micro-flora species; and the potential synergism between different species all require consideration. This article discusses the states of bioburden and other aspects of microbiology relating to wound infection and their application to clinical practice.