mplementation of the TIME framework (Tissue
management, control of Inflammation/Infection, Moisture
balance, and advancement of the wound Edges), as part
of wound bed preparation, is regarded as a prerequisite
for achieving a moist healing environment and thus a good
clinical outcome (Dowsett and Newton, 2005). In order to
implement TIME, it is necessary to have a good understanding
of the infection continuum and to appreciate why an
increased wound bioburden will impair healing. All wounds
are colonised by bacteria, but it is only when the immune
system is unable to keep the bacterial proliferation in check
that healing is impaired. The occurrence of this is evidenced
by the host response, which will vary depending on whether
the wound is critically colonised (healing is delayed) or locally
infected (the bacteria are multiplying to the extent that healing
is disrupted and tissue damage occurs) (Chamanga et al, 2015).
Clinical signs of local infection include:
■ Increased or new pain
■ Excessive or increased serous exudate
■ Localised erythema
■ Delayed healing
Wound infection: a knowledge
deficit that needs addressing
Maria A Hughes, Tissue Viability Lead Specialist Nurse and
Queens Nurse, Wirral Community NHS Trust
Accepted for publication: March 2016