Joachim Dissemond1, Veronika Gerber2, Ralf Lobmann3, Axel Kramer4, Diego Mastronicola5, Eric Senneville6, Cécile Moisan7, Valerie Edwards-Jones8, Kirsty Mahoney9, Adam Junka10, Marzenna Bartoszewicz10, José Verdú-Soriano11, Robert Strohal12. 1. Department for Dermatology, Venerology and Allergology, University School of Medicine, Essen, Germany. 2. ICW (Initiative Chronische Wunden) e.V., Quedlinburg, Germany. 3. Department for Endocrinology, Diabetology and Geriatrics, Klinikum Stuttgart - Bad Cannstatt, Germany. 4. Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Germany. 5. Outpatient Wound Care Centre, Local Health Care System Frosinone, Frosinone, Italy. 6. Department of Infectious Diseases, Tourcoing Hospital, France. 7. Department of Vascular and Endocrinology Surgery, Hopital Yves Le Foll St-Brieuc, France. 8. Department of Medical Microbiology, Manchester Metropolitan University, UK. 9. Department of Wound Healing, Welsh Wounds Innovation Centre, Primary, Community and Intermediate Care Division, Rhondda Cynon Taf, UK. 10. Department of Pharmaceutical Microbiology and Parasitology, Wroclaw Medical University, Poland. 11. Department of Community Nursing, Preventive Medicine, Public Health and History of Science, Faculty of Health Sciences, University of Alicante, Alicante, Spain. 12. Department of Dermatology and Venerology, Federal Academic Teaching Hospital, Feldkirch, Austria.
Abstract
OBJECTIVE: Local wound infections are a major challenge for patients and health professionals. Various diagnostic and therapeutic options are available. However, a generally accepted standard is still lacking in Europe. The aim was to develop an easy-to-use clinical score for the early detection of local wound infections, as a basis for decision-making on antiseptic therapy or decolonisation. METHOD: An interdisciplinary and interprofessional panel of experts from seven European countries was brought together to discuss the various aspects of diagnosing local wound infections. RESULTS: The result was the adoption of the Therapeutic Index for Local Infections (TILI) score, developed in Germany by Initiative Chronische Wunden e.V., specifically for health professionals not specialised in wound care. Available in six European languages, the TILI score could also be adapted for different European countries, depending on their specific national healthcare requirements. The six clinical criteria for local wound infection are erythema to surrounding skin; heat; oedema, induration or swelling; spontaneous pain or pressure pain; stalled wound healing; and increase and/or change in colour or smell of exudate. Meeting all criteria indicates that antiseptic wound therapy could be started. Regardless of these unspecific clinical signs, there are also health conditions for the clinical situation which are a direct indication for antimicrobial wound therapy. These include the presence of wound pathogens, such as meticillin-resistant Staphylococcus aureus, septic surgical wound or the presence of free pus. CONCLUSION: The development of the new internationally adapted TILI score, which could also be used by any caregiver in daily practice to diagnose local infections in acute and hard-to-heal wounds, is the result of expert consensus. However, the score system has to be validated through a clinical evaluation. This is to be performed in expert centres throughout Europe.
OBJECTIVE: Local wound infections are a major challenge for patients and health professionals. Various diagnostic and therapeutic options are available. However, a generally accepted standard is still lacking in Europe. The aim was to develop an easy-to-use clinical score for the early detection of local wound infections, as a basis for decision-making on antiseptic therapy or decolonisation. METHOD: An interdisciplinary and interprofessional panel of experts from seven European countries was brought together to discuss the various aspects of diagnosing local wound infections. RESULTS: The result was the adoption of the Therapeutic Index for Local Infections (TILI) score, developed in Germany by Initiative Chronische Wunden e.V., specifically for health professionals not specialised in wound care. Available in six European languages, the TILI score could also be adapted for different European countries, depending on their specific national healthcare requirements. The six clinical criteria for local wound infection are erythema to surrounding skin; heat; oedema, induration or swelling; spontaneous pain or pressure pain; stalled wound healing; and increase and/or change in colour or smell of exudate. Meeting all criteria indicates that antiseptic wound therapy could be started. Regardless of these unspecific clinical signs, there are also health conditions for the clinical situation which are a direct indication for antimicrobial wound therapy. These include the presence of wound pathogens, such as meticillin-resistant Staphylococcus aureus, septic surgical wound or the presence of free pus. CONCLUSION: The development of the new internationally adapted TILI score, which could also be used by any caregiver in daily practice to diagnose local infections in acute and hard-to-heal wounds, is the result of expert consensus. However, the score system has to be validated through a clinical evaluation. This is to be performed in expert centres throughout Europe.
Entities:
Keywords:
TILI score; antiseptic wound decolonisation; antiseptic wound therapy; hard-to-heal wounds; local wound infection
Authors: Joachim Dissemond; Anke Bültemann; Veronika Gerber; Martin Motzkus; Christian Münter; Cornelia Erfurt-Berge Journal: Dermatologie (Heidelb) Date: 2022-06-09