The role of podiatry in wound healing is indispensable. Along with treating more complex foot problems including preventing, diagnosing and treating injuries related to sports, podiatrists should also recognize and treat any wound infections in patients. Key symptoms of an infected wound are – yellow or foul-smelling drainage from the wound, pain, swelling, or redness in or near a wound, a change in the color or size of a wound, red streaks in the skin around the wound or fever. Certain practices also prescribe wound care kits for patients for dressing at home.
Surgical site infections (SSIs) are also getting common, which include infections in the area of the skin where the incision is made. The presence of postoperative wound infections often delays the recovery of surgical patients. Surgical wound infections and other complications can be caused by many factors such as malnutrition, dehydration or anemia. Science Daily has reported that surgical site infections (SSI) occur in an estimated 2 percent to 5 percent of patients undergoing inpatient surgery.
In podiatry practices, wound infections can be prevented to a great extent with:
Proper Wound Inspection
Proper inspection of wounds in the practice as well as home helps in avoiding infections. Inspecting the wound will provide ideas about the etiology of the wound site and reveal any erythema, lymphangitis, drainage, exposed deep tissues or necrosis. Podiatrists should also advise their patients to perform a daily visual inspection of their wound and make them aware of how it helps in preventing uncontrollable foot infections. Diabetic patients must be very careful, as they are prone to developing peripheral arterial disease, which causes poor circulation throughout the toes and feet. Loss of sensation in the feet makes it difficult for them to know when they have an injury or ulcer.
Right Wound Dressings
Appropriate wound dressings can promote healing and prevent infection. Choose those dressing materials that will ensure that the wound remains — moist with exudate but does not get macerated, free from clinical infection and necrotic tissue, free from toxic chemicals and allows gaseous exchange.
Irrigation is a form of mechanical debridement, commonly utilized at the time of surgery and during dressing changes. When performed properly, wound irrigation can enhance wound healing by reducing infection and its attendant morbidities. Flush irrigation under pressure is more effective in reducing the bacterial count than low-pressure flush.
Removing necrotic tissue on a regular basis can expedite wound healing and has been shown to increase the probability of attaining full secondary closure. One should repeat debridement of the ulcer or infected postoperative wound site as needed if new necrotic or infectious tissues continue to form.
Surgical debridement plays an important role in managing infected wounds, while other forms of debridement help in reducing the risks associated with a wound infection.
Infection Prevention Programs
Wound care practices must also implement infection prevention programs. Also, at least one individual with training in Infection Prevention and Control (IPC) should be employed in the facility to manage this IPC program. Such programs also ensure the availability of all necessary equipment and supplies such as hand hygiene products, and PPE (Personal Protective Equipment) in the practice. Written policies and procedures should be in place, which clearly reflect the measures to be taken to prevent disease transmission when performing services and procedures.
Reassess all infection prevention policies and procedures at least annually. Ensure the same standard of care is provided by podiatrists in the off-site care setting as in the office setting.
CDC’s Standard Wound Infection Control Tips
According to the CDC, certain standard precautions to prevent wound infection include
- Good hand hygiene – To maintain good hand hygiene, CDC recommends using alcohol-based hand rubs (ABHR), hand wash with soap and water, or surgical hand antisepsis to reduce the risk of spreading infections in outpatient settings. Supplies necessary for adherence to hand hygiene should be readily accessible in all areas where patient care is being delivered, including podiatric office settings and off-site podiatric care locations. Each podiatric facility should routinely audit (monitor and document) adherence to proper hand hygiene practices and provide feedback to staff regarding their hand hygiene performance.
- Use of personal protective equipment (PPE)– Based on the nature of the patient interaction and potential for exposure to blood, body fluids, or infectious agents, podiatrists must use PPE that includes gloves, gowns, face masks or shields, respirators, and goggles. Also, make sure to clean your hands soon after the removal of PPE. The podiatric facility should periodically monitor and record adherence to PPE use and provide feedback to personnel regarding their performance.
- Respiratory hygiene and cough etiquette – Infection prevention measures must be taken at the first point of a patient’s encounter with the facility. Practices must take necessary measures to identify patients and accompanying family members with respiratory infections. Post visual alerts at practice entrances with instructions for patients such as – cover mouth and nose when sneezing and appropriately dispose tissues. Offer masks to coughing patients and other symptomatic persons upon their entry to the facility.
- Safe injection practices – Train your staff about the consequences of unsafe injection practices. Make sure that the medications are drawn up in a designated clean medication area that is not nearby any potential sources of contamination. All staff personnel who use or handle medications and related supplies should be aware of labeling and storage requirements. Never administer medications from the same syringe to multiple patients, even if the needle is changed or the injection is administered through an intervening length of intravenous tubing. Do not reuse a syringe to enter a medication vial or container. Staff must maintain accurate and timely records of all aspects of medication storage and handling in the office or an off-site setting.
- Environmental cleaning – Practices must establish policies and procedures for routine cleaning and disinfection of environmental surfaces. Staff should also be trained to ensure prompt and appropriate cleaning and decontamination of spills of blood or other potentially infectious materials. In any patient care area, podiatrists and other healthcare staff must wear appropriate PPE, avoid dusting methods that disperse dust, avoid contamination of cleaning carts and other supplies and adhere to the principle of clean to dirty when cleaning and disinfecting rooms.
For proper reimbursement for the services provided, practices can rely on an experienced podiatry billing company in the U.S. Each podiatric practice should also maintain accurate and timely records of care provided to its patients, whether the care takes place in the office or in an off-site setting.