[Prevention of chronic wound infection]

An integral follow-up of the patient starting with medical history, present status and the wound itself will lead us to decide which plan of prevention, care and treatment will be efficient. The interaction of host immune abnormalities and growth of the microbial population invading the wound have a significant impact on the clinical presentation and direction of the development of the wound. Infection of a chronic wound is a consequence of a large number and composition of microbe populations in the tissue, along with the presence of virulence factors depending on the type and representation in the biofilm as a factor of greatest importance, the synergy of various microbial communities of aerobes-anaerobes in various combinations, and the host immune response. The basic procedures in preventing the development of infection from the colonization status are reduction of the total mass of microbes along with necrotic tissue, removal or destruction of virulent factors such as the biofilm, destruction of the synergy of various microbial communities, and increasing the level and quality of the host immune response. Prevention of the chronic wound infection demands numerous strategies or procedures, which should be applied simultaneously, but must rapidly and frequently follow each other in succession. Therefore, various methods are being applied depending on the indications, such as mechanical washing and cleaning, application of antiseptics, debridement, vacuum-assisted closing of the wound, oxygenation, moist wound healing - active and passive compresses, methods of removal or destruction of the biofilm, application of specific cells, i.e. factors of growth, and removal of mechanical stress. Antibiotics are not used in the prevention of chronic wound infection. They are used only in a targeted fashion when infection has been proven and the agent identified, as well as its sensitivity to antibiotics obtained from target samples. An ideal prevention would be a method that would prevent the development of the wound and be applied while the skin is still intact. Irrespective of all knowledge accumulated so far, the good clinical practice has not yet fully defined preventive measures for the care and prevention of chronic wound infection, and, likewise, these measures are not universally accepted. The aim of preventive procedures is at the same time the battle against microbes and the underlying disease that caused the development of chronic wound, with the aim of preventing the development of infection.