Wound Infection in Adults and Children ( PL 193 ) - Leeds Guideline for the Prevention and Management of

Publication: 01/06/2010  
Last review: 01/01/1900  
Next review: 26/11/2017  
Clinical Guideline
CURRENT 
ID: 2029 
Approved By:  
Copyright© Leeds Teaching Hospitals NHS Trust 2010  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Leeds Community Healthcare NHS Trust are responsible for the review process of this document.

Leeds Guideline for the Prevention and Management of Wound Infection in Adults and Children (PL 193)

1. Algorithm for the management of colonised and infected wounds
2. Clinical Features of Infection

3. Patient specific risk factors for infection
4. Action / Rationale

Appendix 1 - Aseptic dressing technique
Appendix 2 - Technique for taking a Wound Specimen for Microbiological Analysis
Scope
Staff Requirements

1.  Algorithm for the management of colonised and infected wounds

Algorithm for the management of colonised and infected wounds

(1) See table 1 for definitions
(2) See Guideline, Section 3 for risk factors
(3) A specialist is defined as a Healthcare Practitioner with expertise in wound management e.g. Tissue Viability, or appropriate medical consultant: Dermatology, Vascular, Plastics or other surgeon

Back to top

2. Clinical Features of Infection

Several signs and symptoms can accompany wound infection, but not all wounds will exhibit these at any one time.  Infection is characterised by an invasion of bacteria into the tissue, whereas colonisation is usually restricted to the wound surface.

Any wound that takes longer than 6 weeks to heal is considered chronic; the presentation of the signs and symptoms below differs between acute and chronic infection, therefore it is important to distinguish between acute and chronic wounds when considering whether or not infection is present.  Laboratory findings such as raised C - Reactive protein (CRP) and raised white cell count are commonly seen in acute infection; however, in chronic infected wounds, raised CRP may not be clinically significant (Kingsley 2009).  For the purposes of this guideline, the terms chronic infection and critical colonisation are synonymous. Table (1) below details a summary of the signs and symptoms associated with different types of infection.

 

Table 1

Acute / local infection

Chronic infection/ critical colonisation

Acute systemic infection

  • Abscess / pus
  • Cellulitis/ excessive inflammation
    • erythema
    • oedema
    • heat
    • pain
  • Unexpected pain /tenderness
  • Abnormal smell
  • Dehiscence
  • Delayed Healing 
  • Discoloration of wound bed or reformation of sloughy /necrotic tissue
  • Friable bleeding of granulation tissue
  • Pocketing/bridging at the base of the wound
  • Increased exudate
  • Wound breakdown
  • Pyrexia/fever
  • Flu like symptoms e.g. aching/  general malaise
  • Sweats / chills
  • Unexplained confusion
  • Raised CRP
  • Raised white cell count
  • Unstable blood sugar (in diabetic patient)

Adapted from Cutting et al (2005), Wysocki (2002)

Kingsley (2001) describes a wound infection continuum, which defines the 5 stages a wound may pass through from sterility to infection.

1. Sterility - Present in acute wounds only normally at the point of incision when there is an absence of microbes at the wound site.
2. Contamination –The presence of microbes, but with little active growth and host defences able to cope with bacterial load.
3. Colonisation - The presence of bacteria on the wound bed which is NOT impacting upon healing.  This is a common phenomenon in chronic wound types such as pressure ulcers and leg ulcers and only affects the surface of the wound as opposed to the deep tissue.
4. Critical colonisation - Where the presence of bacteria, known as the bio-burden, exceeds the ability of the host to respond to the level of bacteria present.  The individual’s risk factors (see section 2 below) will determine if and how quickly critical colonisation occurs.
5. Infection - Host defences are overwhelmed by the numbers of bacteria present and the patient begins to develop significant symptoms which require treatment with systemic antibiotics.

 

Table 2 - Infection Continuum (Kingsley, 2001)

Wound infection
Continuum

Sterility

Contamination

Colonisation

Critical
Colonisation

Infection

Wound type

Acute

Acute and Chronic

Acute and Chronic

Acute and Chronic

Acute and Chronic

Bioburden

Absence of microbes

Presence of microbes but little active growth

Presence of microbes with some active growth

Presence of microbes with excessive active growth

Host defences overwhelmed, cellulitis
(bacteraemia
septicaemia and death)

Time frames/
Impact on wound

Brief period following initial trauma

Present soon after wounding,
progresses quickly to colonisation

Situation normal

Delay in healing

Exacerbation of wound

Action required

No action

No action

No action*

Action

Action

Treatment
Aim (refer to algorithm for specific detail)

Situation will not persist in wound healing by secondary intention

No need to prevent colonisation in chronic wounds healing by secondary intention (with possible exception of burns)

Do not disturb balance
(*with the possible exception of diabetic foot ulcers)

Consider using topical antiseptic dressings to return wound to colonisation

Systemic antibiotics +/- antiseptic dressings

 

Definitions

  • Antimicrobial - these are substances used to treat infections, (which includes antibiotics), and to reduce the quantity of bacteria on surfaces (e.g. disinfectants and antiseptics.  Antimicrobials are substances capable of destroying or inhibiting pathogens and are either derived from micro-organisms or synthetically manufactured.
  • Antibiotics – these are antimicrobial substances that are able to selectively target bacteria rather than viable tissue and are therefore less toxic than antiseptics.
  • Antiseptic - this is a general term used to describe chemical cleansing solutions used to reduce microbial bioburden in living tissues; they are toxic to viable tissues.  Unlike antibiotics, they are not able to act selectively. They need to be used in high concentrations in order to destroy invading pathogens. (Flanagan, 1997).
  • Disinfectant –  a liquid chemical that can be applied to objects to eliminate many or all pathogenic micro-organisms (Mosby 1998)

Back to top

3. Patient specific risk factors for infection

The body has natural barriers to the entry of pathogens e.g. skin and mucous membranes, which protect the sterile parts of the body.  These can be assisted by other mechanisms such as the secretion of fatty acids onto the skin and the action of cilia and mucous in the respiratory tract.  The body also benefits from the balance of resident bacteria, which protect from the invasion of virulent bacteria.  An imbalance of natural bacteria leading to excessive population of a particular microbe could result in it developing virulence.

 Once the integrity of the skin has been damaged there is the potential for micro-organisms to infiltrate into the underlying tissue.  Whilst most wounds heal uneventfully, the possibility of infection exists until the skin integrity is restored.  Whether wound infection occurs depends upon a complex series of interactions and is not easily predictable (Cooper, Kingsley and White 2002).

The development of a wound infection is dependent on the ‘ability to do harm’ and number and rate of spread of the micro-organism in combination with the ability of the host to resist and respond.

Risk factors for infection, in no particular order of importance, include:

  • Stress –physical and/or emotional.
  • Poor nutrition.
  • Deficiencies in the circulatory system e.g. peripheral vascular disease, cardiac failure.
  • Metabolic disorders such as diabetes.
  • Other existing infections e.g. urinary tract infection, chest infection.
  • Immunosuppression e.g. due to drugs or disease.
  • Age – over 70 and neonates.
  • The site of the wound - groin, axillae and skinfolds where high levels of bacteria usually exist.
  • Malnutrition or obesity - adipose tissue impedes haemostasis and has a poor blood supply, emaciation is associated with lack of protein for white cell and antibody production.
  • Hypovolaemia – dehydration.
  • Malignancy.
  • Smoking.
  • Oedema.

Scanlon (2005)

Risk factors specific to surgical wounds have been studied in more depth and include the following:

  • Alcohol consumption.
  • Hypoxia and hypovolaemia.
  • Areas of the body at increased risk of endogenous contamination e.g. bowel.
  • Surgery which increases the risk of exogenous contamination e.g. prolonged surgery with long tissue exposure.
  • Diminished efficacy of general immune response e.g. diabetes, malnutrition, immunosuppressive therapy.
  • Diminished efficacy of local immune response e.g. foreign bodies (including prostheses), damaged tissues or formation of haematomas.
  • Site and complexity of procedure, type of wound (i.e. clean, clean contaminated, contaminated, dirty (Centre for Disease Control and Prevention (CDC) classifications)).

(adapted from NICE guideline CG 74)

Some studies have found reduced infection rates associated with patient warming prior to surgery and peri-operative supplementation of oxygen.  Good surgical techniques such as gentle tissue handling, careful haemostasis and tensionless anastomosis are recommended to reduce post operative wound infection.

Full guidance on prevention of Surgical Site Infection (SSI) is given in the NICE Guideline.

Back to top

4. Action / Rationale

Action Rationale
Assessment / Treatment

An initial assessment of patient specific risk factors (see section 3 ) should be carried out as part of a holistic assessment and should include a baseline wound assessment.
Initial and ongoing comprehensive assessment of a patients’ wound, their individual risk factors and the effectiveness of interventions is essential to detect signs and symptoms of infection and patients’ response to treatment.

Assessment should be in accordance with wound assessment guidelines and should include an evaluation of the effectiveness of any interventions.  If wound infection or critical colonisation is suspected, patients should be reassessed immediately

N.B. where specific documentation is available this should be used (Wound assessment form AS9 Leeds Community Healthcare ( LCH) ) Form  WPG 541 (LTHT)

To improve documentation and to ensure wound specific information is recorded.

If clinical assessment of the wound identifies signs and symptoms of critical colonisation or infection, in line with the infection continuum, (Table 2) then refer to the algorithm

Wound Cleansing see :-
Wound Cleansing Guideline - Leeds PCT
Wound Cleansing Guideline - LTHT

The algorithm and infection continuum will support management of risk and direct treatment.

Aseptic dressing technique should be used if wound infection present or patient at high risk of infection (see Appendix 1 )

To protect clinician and patient by avoiding infection spread and reducing risk of further infection being introduced

The use of antibiotics should be based upon a clinical assessment of the wound bed and clinical signs in line with the infection continuum and algorithm and confirmed by a wound swab.

Antibiotics should only be used if clear signs of infection exist in order to reduce any potential risk of resistance.

The use of topical antiseptics should be based upon a clinical assessment of the wound bed and clinical signs in line with the infection continuum and algorithm. A wound swab may be required if the patient fails to respond.

Topical antiseptics should only be used if clear signs of critical colonisation exist in order to reduce any potential risk of resistance.

A wound swab should only be carried out if indicated by the algorithm. For swabbing recommendations (see Appendix 2 )

Wound swabs are only useful to direct the appropriate use of antimicrobials.  If used inappropriately, they can cause unnecessary discomfort to the patient and are costly.

Dressing choice should be made in line with Wound Assessment and the Wound Management Guidelines.
Wound Management in Adults and Children - LTHT
See BNF BNF.org: BNFC.org: for details of specific products.

In order to ensure that the patient receives evidence based care in line with recognised best practice.

Assess for systemic symptoms of infection (see Table 1).
Where systemic symptoms of infection are present the patients’ baseline observations including BP, pulse and temperature should be taken.

Any clinical deterioration or deterioration in observations will require a medical reassessment.

In order to establish whether or not certain signs of infection are present (see Table 1)

Specific wound types

Management of Leg Ulceration
N.B. where specific documentation is available this should be used (Leg Ulcer Assessment Form AS8 Leeds Community Healthcare ( LCH) Form WPG 541 (LTHT)
Venous Leg Ulcers (VLU) (PL064)

To improve documentation and to ensure wound specific information is recorded.

Infection in venous leg ulcers is rare; however, the open ulcer may be the site of entry for bacteria causing cellulitis.  If the patient develops symptoms of local infection follow cellulitis guidelines.  Compression bandaging or hosiery would be contra-indicated during the acute infection phase.
Cellulitis and Necrotising Fasciitis in Adults
Cellulitis in Children

This is likely to be related to the fact that patients with VLU normally have a healthy arterial supply and are therefore more likely to maintain a healthy host response to the presence of bacteria in the wound.

Due to increased pain and discomfort in the limb which may be aggravated by tight bandages and the need to reassess the limb regularly which cannot be done if bandages are in situ.

A differential diagnosis of the VLU needs to be established in order to exclude confounding factors such as eczema.

A common misdiagnosis of cellulitis is the presence of varicose eczema, which is common in venous leg ulcer patients.  Many of the local clinical signs and symptoms, i.e. pain, erythema and leaking of serous fluid are present; however, the patient is apyrexial and not unwell.

 Please see eczema guidelines Eczema - including use of Topical Corticosteroids - Leeds PCT

Dressings and bandaging

Dressings for venous leg ulcers should be in line with the Venous Leg Ulcer Guideline.  Venous Leg Ulcers (PL064)

Patients with infected/critically colonised venous leg ulcers should be encouraged to elevate the limb.




There is insufficient evidence about the effects of antimicrobial agents on venous leg ulcer healing and therefore they should not be used unless indicated by the algorithm

To facilitate the reduction of any additional oedema which may further impair wound healing and to reduce pain associated with cellulitis.

Arterial Leg Ulcers

Patients with leg ulcers of an arterial aetiology need to have their wounds assessed and dressings changed at least every 48-72 hours.

Surgical debridement of arterial leg ulcers should not be attempted except by a specialist clinician.

Wet debridement via use of hydrogels should be avoided unless under supervision of a specialist. 


To manage infection risk as patients with ischaemia may have an increased risk of infection due to hypoxia.

Due to the risk to underlying structures such as tendons and blood vessels

Contra-indicated due to increased risk of infection

Diabetic Leg Ulcers

Patients with leg ulcers, due to neuropathy or a damaged microcirculation secondary to diabetes, must be reassessed at least every 48-72 hours.

Diabetic patients are at increased risk of infection.

Foot Ulcers

Consult foot pathways on Leeds Health Pathways for patients with foot ulcers.
Diabetes
Diabetes Foot Screening and Referral Pathway
Non-diabetic
Non - Diabetic Feet

Assess the depth of the wound and check for the presence of exposed bone.  If you know or suspect that bone is exposed, refer to specialist clinicians.

 

To ensure the patient follows the appropriate agreed pathway for the type and stage of their wound

 

 

There is a greater risk of developing osteomyelitis in feet because of the close proximity of the underlying bones to the wound surface. This is particularly pertinent at the apices of the toes and inter-digitally The ability to probe to bone is increasingly being used to predict the likelihood of underlying osteomyelitis.

Diabetic Foot Ulcer
Wound Management in Adults and Children - LTHT
Wound Management in Adults and Children (PL170) - Leeds Community

Consult Diabetic Foot Pathway and make appropriate referral. If in doubt, contact Hot Foot Phone
Tel: 07786 250 788.

If managing a diabetic foot ulcer, reassess wound at least every 48-72 hours.

If systemic or local symptoms of infection are identified follow algorithm.

The use of prophylatictic antiseptic dressings in a patient who has diabetes and additional risk factors such as poor circulation and renal failure can be used under specialist supervision.







In Leeds there is an agreed pathway for a foot ulcer in a patient with diabetes  (see foot ulcers)

Delay in management can lead to complications, including amputation and infection is known to spread alarmingly quickly in these patients.

Infection in the diabetic foot often cannot reliably be identified using clinical assessment alone.

Although there is no evidence that the application of prophylactic antiseptics affects healing rates, these patients are at very high risk of infection and its consequences.

 

Pressure Ulcers

Pressure ulcers need to be categorised in line with the Pressure Ulcer Guidelines. NB: Specific documentation is available and should be used (Pressure Ulcer care plan AS7 (LCH)) Form WPG 541 (LTHT)

Pressure Ulcer Prevention Guidelines

If there is no evidence of autolytic debridement within 7 days then refer to specialist for assessment with a view to active debridement

Category 3 and 4 pressure ulcers may be at greater risk of infection due to the presence of devitalised tissue and exposed structures within the wound.

 

The presence of devitalised tissue may increase risk in certain individuals.

Prevention of Surgical site infection

All surgical wounds which require a dressing should be covered with an ‘interactive’ dressing (see Appendix in LTHT Wound Management Guidelines).
Wound Management in Adults and Children - LTHT
Wound Management in Adults and Children (PL170) - Leeds Community

Interactive dressings are those with a film backing which are vapour permeable and allows moist wound healing but protect the wound from bacteria and the external environment from strike through, thus reducing the risk of cross infection.

Dressings should be left in place, a minimum of 48 hours

Re-epithelialisation takes at least 24 hours; local oedema may lead oozing of serous fluid which increases risk of SSI.

All dressing changes should be carried out with an Aseptic Technique (NICE guideline CG 74) Surgical site infection (see Appendix 1)

To reduce the risk of infections.

Use sterile wound cleansing solution for first 48 hours following surgery, thereafter the patient may shower.  Drinking quality tap water may be used after 48 hours if the wound has separated or has been surgically opened to drain pus (NICE CG 74). Surgical site infection 

To safely manage the risk of infection.

Surgical wounds healing by secondary intention should not be treated with EUSOL, gauze or mercuric to prevent SSI.

EUSOL, gauze and mercuric solutions have not been found to prevent SSI and present other risks.

Interactive dressings should be used in line with Wound Management Guideline Wound Management in Adults and Children - LTHT

To ensure patients receive appropriate evidence based care

Refer to a Tissue Viability Nurse for advice where appropriate for wounds healing by secondary intention (NICE CG 74). Surgical site infection 

To ensure patients requiring specialist intervention receive it

Treatment of Surgical Site Infection (SSI)

Where SSI results in the presence of devitalised tissue i.e. necrosis or slough, this should be actively debrided.



Whilst it has not been confirmed that non-viable tissue delays healing, it is thought to increase bacterial growth and result in increased odour and exudate, it also prevents identifying the full extent of the wound.

Do not use EUSOL, gauze, detronomer or enzymatic agents to debride infected surgical wounds (NICE CG 74). Surgical site infection

There is no evidence to say these are beneficial to wound healing.

A structured approach to care should be used; this should include referral to TV services where necessary.

To optimise wound management.

Back to top

Provenance

Record: 2029
Objective:

Objectives
To prevent, diagnose, assess and treat wound infection in line with local microbiological guidance.

Aim/Purpose
Prevention of infection is an important consideration for all Health Care Practitioners, as is the identification and diagnosis of the presence of infection.  Acute and chronic wounds are both at risk of infection and the purpose of this guideline is to support clinicians in the prevention, diagnosis, assessment and management of infection in both acute and chronic wound types.

By recognising patients at risk of wound infection and the signs and symptoms associated with that infection, strategies can be employed to reduce the risks in this vulnerable group. This guideline aims to direct practice with a view to reducing the incidence of both local and systemic infection and therefore the minimising the impact of morbidity and mortality associated with wound infection.

Back totop

Clinical condition:

Patients with wounds

Target patient group:

Client Group – Inclusion
All adults and children with or at risk of wound infection

Client Group – Exclusion
Neonates

Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Primary Care Nurses
Primary Care Doctors
Pharmacists
Adapted from:

Evidence base

Evidence levels:
A. Meta-analyses, randomised controlled trials/systematic reviews of RCTs
B. Robust experimental or observational studies
C. Expert consensus.
D. Leeds consensus

  • Cutting KF, White RJ, Mahoney P & Harding KG (2005) Clinical identification of wound infection: a Delphi approach. European Wound Management Association Position Document. Identifying Criteria for Wound Infection. MEP London - p6-9 C
  • Collier M (2004) Recognition and management of wound infections www.worldwidewounds.com. Jan 04  C
  • Cooper R., Kingsley A. & White R. (2002) Wound Infection & Microbiology, London: Medical Communications UK Ltd C
  • Greif r, Akca O, Horn EP, Kurz A, Sessler DI (2000) Supplemental perioperative oxygen to reduce the incidence of surgical wound infection. Outcomes research group. N Eng J Med 342,3 - p161-67 C
  • Heinzelmann M, Scott M, Lam (2002) Factors predisposing to bacterial invasion and infection Am J surg 183, 2 - p179-90 C
  • Hunt TK (1981) Surgical wound infections: an overview. Am J Med 70,3 - p712-18 C
  • Kingsley A; Leaper D (2009) The Diagnosis of Wound Infection in Clinical Practice Wounds UK Vol 5; Issue 2; Supp/2; p 12-17 C
  • Lansdown A (2004) How Safe is Silver in Wound Care?  Journal of Wound Care, Vol 13, No 4 – p131-136. C
  • Lipsky B (2007) Diabetic Foot Infections : Learnings and ambitions The Diabetic Foot Journal 10 , 3 p118-120 C
  • Melling AC, Ali B, Scott EM, Leaper DJ (2001) Effects of preoperative warming on the incidence of wound surgery after clean surgery: a randomised controlled trial. Lancett 358. A
  • Moore Z. & CowmanS. (2007) Effective wound management: identifying criteria for infection, Nursing Standard 21,24 - p68-76 C
  • Mosby (1998) Medical Nursing and Allied Health Dictionary C
  • NICE Guideline CG 24 (Oct 2008) National Institute for Health and Clinical Excellence http://guidance.nice.org.uk/CG74 A
  • O’Meara S., Cullum N., Majid M. & Sheldon T. (2000) Systemic reviews of wound care management : (3) Antimicrobial agents. Health Techol Assess, 4:21; p1-237 A
  • Pozilli P, Leslie RD (1994) Infections and diabetes: mechanisms and prospects for prevention. Diabet Med 11, 10 - p935-41 C
  • Scanlon E (2005) Wound infection and colonisation. Nursing Standard 19, 24 - p57-67 C
  • Scanlon E StubbsN (2003) To use or not to use? The debate on the use of antiseptics in wound care Trends in Wound Care Vol II C
  • Scanty J (2009). Recognising infection in wounds. Nursing Standard Supplement Nov p19-26.  C
  • The Royal Marsden Hospital Manual of Clinical Nursing Procedures 6th Edition. Specimen collection for microbiological analysis C
  • Wysocki A.B. (2002) Evaluating and Managing Open Skin Wounds: Colonization Versus Infection, AACN Clinical Issues Vol. 13 No. 3 - p 382-397 B

Back to top

Document history

LHP version 1.0

Related information

Appendix 1 - Aseptic dressing technique

Aseptic Dressing Technique Dressing Procedure-refer also to standard precautions policy Standard Precautions Policy - Leeds PCT

Preparation

  1. Explain procedure to the patient before dressing change.
  2. Wash hands in accordance with LCH Policy
  3. Open pack and lay on clean, dry surface.
  4. Apply alcohol hand rub to hands and open sterile pack with minimal touch technique.
  5. Prepare equipment required for procedure, e.g. sterile dressing, solutions, implants, ensuring that non-sterile outer packaging is kept away from sterile areas at all times.
  6. Use yellow/ white bag by putting dominant hand inside to separate equipment for ease of use and apply plastic apron. With hand still in bag, remove old dressing. Apply alcohol hand rub and apply sterile gloves.
  7. Using clean hand, moisten gauze swab and transfer to dirty hand before cleaning wound area if cleaning required.
  8. Dry area by transferring clean swab as before.
  9. Apply sterile dressing by use of clean/ dirty hand as previously indicated.
  10. Dispose of equipment as per LCH recommendations

Back to top

Appendix 2 - Technique for taking a Wound Specimen for Microbiological Analysis

A wound swab should only be taken if the clinical signs of infection are present. There is little evidence to support routine swabbing of wounds which is neither beneficial to the patient nor cost-effective

Action

Rationale

Explain and discuss the procedure with the patient and ensure privacy during the procedure.

To ensure that the patient understands the procedure and gives his/her valid consent

Wash hands with soap and water or cleanse with alcohol gel

Hand hygiene greatly reduces the risk of cross infection

Take the sample before the commencement of antibiotics/topical treatments

These may affect the results of the culture

Use strict aseptic/non-touch technique depending on type of clinical procedure

To reduce sample contamination

If there is sufficient frank pus or infected fluid present, use a sterile syringe (without needle) to collect a sample and transfer to a sterile universal container.

Pus and fluid samples give more reliable microbiology results than swabs.

Cleanse the wound with 0.9% sodium chloride or sterile water immediately before taking a wound swab.

This removes any surface dirt, dried exudates and previous cleansing solutions that may subsequently affect the culture of the specimen.
Removes surface/commensal bacteria so that the bacteria causing the infection can be easily accessed.

Moisten the end of the swab with sterile water or saline if the wound appears dry.

To assist with the collection of micro-organisms in a dry wound environment

Draw and twist the swab across or around the wound as close to the base of the wound as possible

To ensure that as much of the swab tip as possible is in contact with the wound surface

Place swab immediately into the container containing the transport medium.

Reduce the possibility of contamination

Decontaminate hands after removing gloves

To protect yourself and the patient/patient environment from potentially harmful micro-organisms.

Ensure that microbiology form, wound swab and relevant documentation are fully completed, including antimicrobial therapy

To ensure the correct investigation is carried out on the correct patients swab

Dispatch specimen promptly to the laboratory with the completed request form

To ensure the best possible conditions for any laboratory procedures

Back to top

Scope

This Guideline sets out the standards and procedures for any member of staff in Leeds Health economy, irrespective of age, race, colour, religion, disability, nationality, ethnic origin, gender, sexual orientation or marital status, domestic circumstances, social and employment status, HIV status, gender reassignment, political affiliation or trade union membership.

This Guideline is designed to support any Health Care Professional with a responsibility for the management of wounds including: Medical Doctors /Podiatrists/Nurses/ Pharmacists. This Guideline is not designed to diagnose the underlying aetiology of the wound; this must be established beforehand in order to ensure appropriate interventions are put in place.

Equality Impact Assessment (EIA)
Assessed to be Low impact

Staff Requirements

For use by Nurses, Podiatrists, Pharmacists and Medical Doctors

Back to top