The International Wound Infection Institute (IWII) is a volunteer group of interdisciplinary health professionals dedicated to advancing and improving practice relating to the prevention and control of wound infection. The second edition of Wound infection in clinical practice is an update of the first edition published in 2008 and was endorsed by the World Union of Wound Healing Societies (WUWHS). The original document was authored by leading experts who were in wound management, many of whom formed the inaugural committee of the IWII.

For the second edition, the IWII collaborative team undertook a comprehensive review of contemporary literature, including systematic reviews and meta-analyses when available. In addition, the team conducted a formal Delphi process to reach consensus on wound infection issues for which scientific research was minimal or lacking. This rigorous process provided a document with an update on the science and expert opinion regarding prevention, diagnosis and control of wound infection. The updated document outlines new definitions relevant to wound infection, presents new paradigms and advances in the management and diagnosis of a wound infection, and highlights controversial areas of discussion. The intent is to provide a practical, updated resource that is easy to use and understand.

The way we view bacteria and how they cause infection has changed significantly since the era of Louis Pasteur (France, 1822–1895) and Robert Koch (Germany, 1843–1910), early pioneers of modern vaccination. This review article will present a reflective perspective on the thoughts of today’s leading researchers and clinicians, in addition to reviewing evidence on chronic wound infection, both past and present.

There has been extensive ongoing debate on the application of aseptic technique in wound management over the previous decades and changes to the way in which theory is applied to clinical practice have occurred regularly. Clinicians often express confusion over the way various techniques should be applied, particularly when practising in clinical settings in which maintenance of strict asepsis is inherently difficult (for example, community-based wound management). Wound cleansing, use of open but unused wound dressings and storage of wound management equipment are frequent issues on which clinicians request guidance. A systematic review using Joanna Briggs Institute methods was undertaken in order to establish the current state of the scientific literature on this topic and inform the development of recommendations for practice in this field. All levels of evidence were included in the review, including opinion papers. Findings from the 20 quantitative studies were reported in narrative summary and findings from 37 qualitative research papers were aggregated in a thematic synthesis. Although high-level evidence on wound cleansing solutions was identified, the review concluded that there is a paucity of scientific literature on most topics related to asepsis in wound care.

Chronic wounds, with their polymicrobial nature, put a significant burden on health budgets worldwide. Bacterial presence in the wound bed is associated with poor healing. The role of anaerobic bacteria in wound healing impairment has not been definitively established, mainly due to lack of reporting resulting from culture-based limitations. Advanced molecular methods are more reliable and the presence of anaerobic bacteria can be detected.

We have analysed 207 wound swab samples from 38 non-healing wound patients. Samples were collected at the Queensland University of Technology (QUT) wound clinic (Brisbane) over a period of 12 weeks. Next Generation Sequencing (NGS) technology was used for determining bacterial diversity and abundance in these wound samples. We found multiple types of bacteria residing on the non-healing wound bed. Bacterial diversity results are discussed in this paper with a focus on the importance of anaerobic bacteria. Overall, different patients’ wounds harbour diverse bacterial populations. Similarly, the presence of anaerobic bacteria in the wound bed was also detected. Molecular methods are reliable and useful, particularly for organisms requiring special conditions for growth such as anaerobes. It is clinically important to determine the major microbes present in the wound bed and their relationship with wound chronicity.

Antimicrobial resistance is now a global threat. Its emergence rests on antimicrobial overuse in humans and food-producing animals; globalisation and suboptimal infection control facilitate its spread. While aggressive measures in some countries have led to the containment of some resistant Gram-positive organisms, extensively resistant Gram-negative organisms are pan-resistant. The achievements of modern medicine are put at risk by antimicrobial resistance. Without effective antimicrobials for prevention and treatment of infections, the success of organ transplantation, cancer chemotherapy and major surgery would be compromised. Inappropriate use of antimicrobials drives the development of drug resistance. Both overuse, underuse and misuse of medicines contribute to the problem. The Australian government has launch Australia’s First National Antimicrobial Resistance Strategy; however, without urgent, coordinated action, the world is heading towards a post-antibiotic era, in which common infections and minor injuries, which have been treatable for decades, can once again kill.

Bacterial biofilms remain a topic of critical importance for wound care clinicians. This brief update will describe important new research being done in laboratories and in clinical studies that is increasing our understanding of the roles that biofilms play in preventing wounds from healing. Improved detection and treatments of biofilms will ultimately lead to better and faster healing of chronic wounds.