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Wound Infection  
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Impetigo of Elbow
Impetigo of Elbow

Lymphangitis - Left Forearm
Lymphangitis - Left Forearm

Wound Infection - Suture Site
Wound Infection - Suture Site

Definition
  • Traumatic wound (break in the skin) shows signs of infection
  • Includes sutured wounds, puncture wounds, scrapes
  • Most contaminated wounds become infected 24 to 72 hours after the initial break in the skin

Signs of Wound Infection

  • Pus or cloudy fluid draining from the wound
  • Pimple or yellow crust formed on the wound (impetigo)
  • Scab has increased in size
  • Increasing redness around the wound (cellulitis)
  • Red streak is spreading from the wound toward the heart (lymphangitis)
  • Wound has become extremely tender
  • Pain or swelling increasing after 48 hours since the wound occurred 
  • Wound has developed blisters or black dead tissue (gangrene and myonecrosis)
  • Lymph node draining that area of skin may become large and tender (lymphadenitis)
  • Onset of widespread bright red sunburn-like rash
  • Onset of fever
  • Wound hasn't healed within 10 days after the injury

CA-MRSA: Community Acquired Methicillin-Resistant Staphylococcus aureus

  • Staphylococcus aureus is a bacteria that can cause a variety of skin infections including pimples, boils, abscesses, cellulitis, wound infections, and impetigo.
  • In the 1960's strains of Staphylococcus aureus that were resistant to penicillin-type antibiotics started appearing in hospitals and health care settings. These were referred to as Methicillin-Resistant Staphylococcus aureus (MRSA) Infections.
  • More recently, strains of penicillin-resistant Staphylococcus aureus have increasingly become the cause of skin infections in healthy individuals in the community. These are now being referred to as Community Acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA) Infections. There have been outbreaks in athletes (e.g., wrestling teams) and in prison populations.
  • CA-MRSA requires treatment with specific types of antibiotics.
  • More information about CA-MRSA is available at http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.aspxl.

If not, see these topics

When to Call Your Doctor

Call Your Doctor Now (night or day) If
  • You feel weak or very sick
  • Bright red, sunburn-like rash on you body
  • Fever occurs
  • Red streak runs from the wound
  • Increasing redness around the wound
  • Severe pain in the wound
  • Face wound with signs of infection
  • Finger wound, where finger has sausage shaped swelling and pain
Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If
  • You think you need to be seen
  • Pus or cloudy drainage from the wound
  • Pimple where a stitch comes through the skin
  • Wound becomes more tender after the second day
  • Taking an antibiotic for more than 3 days and wound infection not improved
Call Your Doctor During Weekday Office Hours If
  • You have other questions or concerns
Self Care at Home If
  • Wound doesn't look infected and you don't think you need to be seen
HOME CARE ADVICE FOR MILD REDNESS OF WOUND

  1. Warm Soaks or Local Heat: If the wound is open, soak it in warm water or put a warm wet cloth on the wound for 20 minutes 3 times per day. Use a warm saltwater solution containing 2 teaspoons of table salt per quart of water. If the wound is closed, apply a heating pad or warm, moist washcloth to the reddened area for 20 minutes 3 times per day.
  2. Antibiotic Ointment: Apply an antibiotic ointment 3 times a day. If the area could become dirty, cover with a Band-Aid or a clean gauze dressing.
  3. Pain Medication:
    • For pain relief, take acetaminophen or ibuprofen.
    • Acetaminophen (e.g., Tylenol): The dose is 650 mg by mouth every 4 hours or 1000 mg by mouth every 6 hours. Maximum dose per day = 4000 mg.
    • Ibuprofen (e.g., Motrin, Advil): The dose is 400 mg by mouth every 6 hours or 600 mg by mouth every 8 hours.
    • People who are over 65 Years of age: Acetaminophen is generally considered safer than ibuprofen. Acetaminophen dosing interval should be increased to every 8 hours because of reduced liver metabolism. Maximum dose per day = 3000 mg.
    • CAUTION: Do not take ibuprofen if you have stomach problems, kidney disease, are pregnant, or have been told by your doctor to avoid this type of anti-inflammatory drug. Do not take ibuprofen for more than 7 days without consulting your doctor.
    • CAUTION: Do not take acetaminophen if you have liver disease.
    • Read the package instructions thoroughly on all medications that you take.
  4. Expected Course: Pain and swelling normally peak on day 2. Any redness should go away by day 3 or 4. Complete healing should occur by day 10.
  5. Contagiousness: For true wound infections, you can return to work or school after any fever is gone and you have received antibiotics for 24 hours.
  6. Call Your Doctor If:
    • Wound becomes more tender
    • Redness starts to spread
    • Pus, drainage or fever occurs
    • You become worse

And remember, contact your doctor if you develop any of the "Call Your Doctor" symptoms.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.


Author and Senior Reviewer: David A. Thompson, M.D.

Last Reviewed: 1/19/2009

Last Revised: 4/5/2008

Content Set: Adult HouseCalls Online

Portions Copyright 2000-2009 Self Care Decisions LLC; Copyright LMS, Inc.

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