Author: Rachel Taylor, National Clinical Nurse Educator, Access Group

Antimicrobial resistance (AMR) presents a growing global health crisis, with significant implications for the management of chronic, hard-to-heal wounds.

In October 2024, wound care experts from the United States and Australia developed a guide for clinicians in the responsible management of microbial burden in wound care. It outlines the core physiological processes involved in wound healing, the role of microbial colonization and infection in healing delays, and the mechanisms by which resistance develops and spreads.

Best practices for wound cleansing, debridement, and the appropriate use of systemic antibiotics, emphasize that systemic agents should only be used when clinically indicated. The use of topical antimicrobials and nonantibiotic alternatives, such as topical oxygen, nitric oxide, probiotics, and chelating agents, will help limit reliance on systemic therapies.

  • Key themes include:
    antimicrobial stewardship (AMS)
  • improving infection surveillance
  • enhancing hygiene practices, and
  • accelerating the development of rapid diagnostics to reduce reliance on broad-spectrum antibiotics.

A cross-sectional survey by Probst et al, 2025 explored infection management, the use of antiseptic cleansing solutions, topical and systemic antimicrobial use and AMS implementation with a focus on wound care. The survey, predominantly responded to by specialist wound nurses revealed:

  1. While 59.4% followed formal infection protocols, 37.2% reported not following AMS guidelines.
  2. Antimicrobial dressings such as silver, iodine, polyhexamethylene biguanide, chlorhexidine gluconate and honey were reported to be used by 88.2% of participants, with 41% reporting ‘just in case’ use of antimicrobial dressings. Antiseptic cleansers were also widely used.
  3. AMS leadership structures varied. Key support needs for decision-making included clinical evidence (77.9%), treatment pathways (71.6%) and guideline development (71.6%).

So, what does this mean for wound care nurses in the community?

A structured approach in managing AMR which is the Antimicrobial Stewardship in Wound Management. Educating healthcare professionals about antimicrobials can improve patient outcomes and minimise the spread of infections.

AMS requires education, a multi-disciplinary approach, care pathways and surveillance.

The AMS structure has 7 tips:

  1. Regular handrub with alcohol-based formulation and proper contact precautions are key to preventing wound infection.
  2. Avoid prescribing antimicrobials when they are not indicated.
  3. When antimicrobial therapy is indicated, prescribe an appropriate regimen.
  4. Order therapy for the correct duration, at the optimal dose and by the appropriate route.
  5. Use an agent that has the least risk for adverse effects for the patient and the community.
  6. Interdisciplinary collaboration helps inform and enforce AMS.
  7. Every healthcare worker is responsible for being aware of local AMR issues and for undertaking AMS.

A good source of further information is EWMA (European Wound Management Association)

References

Blackburn J, Ousey K, Rippon M, Rogers A, Pastar I, Lev-Tov H. Applying Antimicrobial Strategies in Wound Care Practice: A Review of the Evidence. Int Wound J. 2025 Jun;22(6):e70684. doi: 10.1111/iwj.70684. PMID: 40419296; PMCID: PMC12105874.

Cole W, Greenstein E, Herman IM, Lantis J, Milne C, Pastar I, Beaulieu R, Swanson T, Tickner A, Wahab N. Antimicrobial Resistance in Wound Care: Expert Panel Consensus Statements. Wounds. 2025 May;37(5 Suppl):S1-S24. PMID: 40455938.

IWII – Wound infection in clinical practice. Updated from March 2022 as this is a working document.

Probst A, Günther B, Woodmansey E, Bruwer F, Smith G, Woo K, Hoxha K, Idensohn P, Ramos P, Lakshmanan V, Cole W, Merwe ZV. Healthcare practitioners’ perspectives on infection management, antimicrobial resistance and stewardship in wound care practice. J Wound Care. 2025 Nov 2;34(11):910-920. doi: 10.12968/jowc.2025.0518. PMID: 41201876.

Wound Infection Continuum & swabbing techniques – Karen Ousey.