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Zakażenie rany – jak je rozpoznać i jak mu zapobiegać? Wywiad z ekspertką

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Zakażenia ran utrudniają proces leczenia się ran i mogą prowadzić do groźnych powikłań. O tym, jak rozpoznać zakażenie i jak zapobiegać powstawaniu zakażeń w ranach, mówi w rozmowie z Forum Leczenia Ran specjalistka w dziedzinie leczenia ran, mgr Elżbieta Szkiler.

Objawów zakażenia rany jest wiele i wbrew temu, co niektórzy sądzą, to klasyczne objawy stanu zapalnego ograniczone do łożyska rany rzadko oznaczają jej zakażenie. Objawy takie jak zaczerwienienie, obrzęk, zwiększona miejscowo ciepłota tkanek i ból mogą być oznaką zakażenia, ale często są także wynikiem reakcji tkanek na uraz i uaktywnienia się metaloproteinaz i wolnych rodników, a także czynników zapalnych.

Jakie są pierwsze objawy zakażenia rany?

– Do objawów zakażenia należy zmiana wyglądu łożyska rany, które w ranie czystej jest gładkie, różowe do jasnoczerwonego i lekko wilgotne. Objawami zakażenia są:

  • zmiana koloru, np. na mleczny, bursztynowy, krwisty, ropny;
  • zmiana ilości wysięku, kiedy rana jest bardzo sucha lub bardzo mokra;
  • zmiana konsystencji wysięku na gęstą lub wodnistą;
  • pojawienie się w łożysku rany grudkowej ziarniny albo włóknika.

Brzegi rany gojącej się prawidłowo powinny być gładkie i pokryte nieuszkodzonym naskórkiem w kolorze otaczającej ranę skóry. W przypadku zakażenia brzegi mogą być:

  • pozbawione naskórka,
  • pokryte hiperkeratozą,
  • uniesione (czasem zwane wałowatymi) lub wywinięte niczym klapy marynarki.

W okalających ranę tkankach może się pojawić:

  • obrzęk,
  • zaczerwienienie,
  • silna bolesność.

Ewidentnym objawem zakażenia jest wydzielina ropna, a w przypadku zakażenia bakteriami beztlenowymi – nieprzyjemny zapach.

Czasem tylko brak cech gojenia albo zatrzymanie gojenia są oznaką zakażenia rany i najczęściej dotyczy to zakażenia tkanek położonych głębiej.

Czy objawy zakażenia w ranach ostrych i trudno gojących się są różne?

Objawy zakażenia tkanek w ranach ostrych i niegojących się są podobne. Różnica polega na tym, że w ranach ostrych, takich jak rany chirurgiczne i pourazowe, zakażenie rzadko dotyczy tkanek okalających, a zmiany chorobowe są ograniczone wyłącznie do miejsca urazu.

Jakie działania powinien podjąć pacjent, gdy zauważy u siebie niepokojące objawy?

– Chory powinien się skontaktować ze specjalistą w dziedzinie leczenia ran. Objawy zakażenia mogą oznaczać niestabilność choroby podstawowej, a nie problem z samą raną.

W postępowaniu z zakażeniem niezbędne jest oczyszczanie rany, które można wykonać bezpiecznie pod prysznicem, a następnie wytrzeć to miejsce do sucha ręcznikiem papierowym i założyć przymoczek (mokry gazik) z antyseptykiem. Dalsze postępowanie musi dobrać specjalista leczenia ran, ponieważ będzie ono różne dla ran o różnej głębokości uszkodzenia tkanek, niezależnie od etiologii rany.

Czy da się zapobiegać powstawaniu zakażeń? Jak pielęgnować ranę, żeby uniknąć zakażenia?

Nie da się całkowicie uniknąć zakażeń. Drobnoustroje własne pacjenta, pochodzące z flory jelitowej, gardła, a także ze skóry, przemieszczają się wraz z krwią i wywołują objawy zakażeń szczególnie w owrzodzeniach (zakażenia endogenne). W ranach ostrych zakażenie jest najczęściej spowodowane zakażeniem miejsca operowanego, złą techniką zabiegu lub źle przeprowadzoną zmianą opatrunku i są to zakażenia egzogenne (zewnętrzne).

W pielęgnacji ran najważniejsze jest utrzymanie higieny, właściwy dobór opatrunku. Zarówno w ranach ostrych, jak i w owrzodzeniach zawsze powinien być stosowany nowoczesny opatrunek, a nie opatrunek gazowy. Gaza nie izoluje wysięku ani drobnoustrojów, nie utrzymuje właściwej temperatury tkanek, często przykleja się do łożyska, a nawet wrasta w tkanki i jest traktowana jak ciało obce, a fizjologiczną reakcją właściwą dla wszystkich tkanek jest wówczas wtórny stan zapalny.

Czego zdecydowanie nie wolno stosować w leczeniu ran zakażonych lub zagrożonych infekcją?

– Zdecydowanie nie wolno stosować opatrunków hydrokoloidowych, ale równocześnie bardzo ostrożnie należy stosować opatrunki samoprzylepne. Każdy opatrunek samodzielnie przyklejający się do skóry, ale także żelujący, w kontakcie z wysiękiem powoduje okluzję i ułatwia rozwój bakterii beztlenowych. Co więcej, zakażeń nigdy nie leczymy antybiotykiem, a szczególnie antybiotykiem o działaniu miejscowym. Zamiast tego należy stosować prawidłowo dobrane antyseptyki lub ich kombinację.

 

mgr Elżbieta Szkiler, pielęgniarka, specjalistka w dziedzinie leczenia ran

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