Guidelines
Wound Infections

Wound Infections

Notes

  • Fill out NELHIN Wound Care Services form
  • Refer to SAH Wound Care Clinic
  • Consider involving Wound Care RN prior to discharge if available

Evaluation of Wounds

Any 3 and there is likely increased bacterial burden or superficial infection (positive NERDS):

  • Non-healing
  • Exudate increase
  • Red and bleeding
  • Debris
  • Smell

Any 3 and there is likely deeper infection requiring systemic antibiotics (positive STONEES):

  • Size is bigger
  • Temperature increase
  • Os (probes to bone or bone exposed)
  • New breakdown
  • Exudate increase
  • Erythema increase/Edema increase
  • Smell

JAMA Rational Clinical Exam:

  • Ulcer area > 2 cm + LR = 7.2
  • Probe to bone + LR = 6.4
  • ESR > 70 mm/h + LR = 11

N.B. A negative X-ray does not rule out acute osteomyelitis

More Information

  1. Lipsky BA, Berendt AR, Cornia PB, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 2012;54:e132-73.
  2. Sibbald RG, Woo K, Ayello E. Increased bacterial burden and infection: NERDS and STONES. Adv Skin Wound Care. 2006;19(8):447-61.
  3. Butalia S, Palda VA, Sargeant RJ, Detsky AS, Mourad O. Does this patient with diabetes have osteomyelitis of the lower extremity? JAMA. 2008;299(7):806-13