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Diabetic foot ulcer infection severity can markedly influence the outcome for the client. Did you know that approximately ‘ 56% of Diabetic Foot Ulcers become infected and overall about 20% of patients with an infected foot wound will undergo a lower extremity amputation? We have created an infographic on the infection severity criteria for you to download below.

What increases the risk of infection in a Diabetic Foot Ulcer?

A positive probe-to-bone test
Ulcer  present for more than 30 days
History of recurrent Diabetic foot ulcers
A traumatic foot wound
Presence of Peripheral Arterial Disease in the affected limb
A previous lower extremity amputation
Loss of protective sensation
The presence of renal insufficiency
A history of walking barefoot

When caring for a diabetic patient remember that arterial insufficiency, an immunocompromised state and a loss of pain sensation can result in or patients not having the classic signs of infection such as redness, heat and swelling. Practitioners should therefore

Nurses need to be aware of the more subtle ‘secondary’ signs suggestive of infection which include friable granulation tissue, wound undermining, malodour or wound exudate.A diagnosis of

A diagnosis of diabetic foot infection must be made using clinical signs and symptoms, not just microbiological results.  There have been validated clinical criteria for recognising and classifying diabetic foot infections and the criteria are listed below.

Clinical criteria Grade/severity

Grade 1 / Uninfected  No clinical signs of infection
Grade 2/mild

Superficial tissue lesion with at least two of the following
— Local warmth
— Erythema >0.5–2cm around the ulcer
— Local tenderness/pain
— Local swelling/induration
— Purulent discharge
Other causes of inflammation of the skin must be excluded

Grade 3/moderate
Erythema >2cm and one of the findings above or:
— Infection involving structures beneath the skin/
subcutaneous tissues (eg deep abscess, lymphangitis,
osteomyelitis, septic arthritis or fascitis)
— No systemic inflammatory response

Grade 4/severe
Presence of systemic signs with at least two of the following:
— Temperature >39°C or <36°C
— Pulse >90bpm
— Respiratory rate >20/min
— PaCO2 <32mmHg
— White cell count 12,000mm3 or <4,000mm3
— 10%

You can download the  reference paper below!

Download Resource

The Nursing CPD Institute  provides great information and CPD  on an array of nursing topics including wound care in a range of easy learning ways including webinars and quizzes on the latest information that Nurses need to know – remember  it was created by Australian Nurses for Nurses!

Source: International Best PracticeGuidelines: Wound Management in Diabetic Foot Ulcers.Wounds International, 2013