Management of pain and infection in patients with chronic wounds involves a multifaceted approach tailored to the wound type and clinical signs.
Infection management: Systemic antibiotics should only be offered if there is clinical evidence of infection such as spreading cellulitis, systemic sepsis, or underlying osteomyelitis, not based solely on positive wound cultures NICE CG179. The choice of antibiotic should be guided by local microbiology advice to ensure effectiveness against local strains NICE CG179. Topical antiseptics and antimicrobials are not routinely recommended for pressure ulcers NICE CG179. For surgical wounds healing by secondary intention, appropriate interactive dressings should be used, and systemic antibiotics given if surgical site infection is suspected, considering local resistance patterns NICE NG125.
Pain management and wound care: Dressings should be selected in discussion with the patient (and carers if appropriate), considering pain, tolerance, ulcer position, exudate amount, and dressing change frequency NICE CG179. Dressings that promote a warm, moist wound healing environment are preferred for category 2 to 4 pressure ulcers NICE CG179. Gauze dressings should be avoided NICE CG179. Offloading pressure, especially for heel ulcers, is important to reduce pain and promote healing NICE CG179,NICE NG19.
Debridement: Assess the need for debridement considering necrotic tissue, ulcer size, and patient tolerance. Autolytic debridement with appropriate dressings is preferred; sharp debridement may be considered if quicker healing is needed NICE CG179. Larval therapy is reserved for cases where sharp debridement is contraindicated NICE CG179.
Additional considerations: Nutritional assessment and supplementation should be offered if nutritional deficiency is present, as adequate nutrition supports wound healing and may reduce pain NICE CG179. Negative pressure wound therapy is not routinely recommended but may be used to reduce dressing changes in wounds with heavy exudate NICE CG179.