Wound infections are among the most serious complications in home care — and early recognition by a caregiver can be the difference between a resolved infection and a hospitalization. You are the eyes of the clinical team at the wound site.
Section 01
Why Wounds Become Infected
- Compromised skin barrier: Any wound creates an entry point for organisms.
- Reduced local blood supply: Damaged tissue has reduced immune cell delivery and oxygen — impairing natural defense.
- Contamination sources: Hands, contaminated supplies, client skin flora, home environment.
- Client risk factors: Diabetes, immunosuppression, malnutrition, steroid use, poor circulation — all increase infection risk.
Section 02
The REEDA Assessment Tool
💡 REEDA: the wound infection assessment framework
R — Redness: Some early redness is normal. Spreading beyond wound margin or increasing after initial improvement suggests infection.
E — Edema: Increasing swelling after first few days or new swelling after reduction is a concern.
E — Ecchymosis: Bruising or discoloration — note and track.
D — Discharge: Most important indicator. Clear/straw = normal. White/creamy or yellow/green (purulent) = infection. Foul odor = infection. Increasing amount after initial decrease = possible infection.
A — Approximation: Are wound edges coming together (healing) or separating (possible infection/dehiscence)?
E — Edema: Increasing swelling after first few days or new swelling after reduction is a concern.
E — Ecchymosis: Bruising or discoloration — note and track.
D — Discharge: Most important indicator. Clear/straw = normal. White/creamy or yellow/green (purulent) = infection. Foul odor = infection. Increasing amount after initial decrease = possible infection.
A — Approximation: Are wound edges coming together (healing) or separating (possible infection/dehiscence)?
Section 03
Systemic Signs — Report Immediately
🚨 These are sepsis warning signs — call immediately
- Fever above 100.4°F (38°C) in a client with a wound
- Chills or shaking rigors
- Confusion or altered mental status beyond baseline
- Rapid heart rate or breathing
- Red streaks extending from the wound (lymphangitis)
- Client reports feeling much sicker than usual
Section 04
Normal vs. Concerning Healing
Normal healing
- Redness improving after day 3-5
- Swelling decreasing after first week
- Clear or straw-colored drainage
- Wound edges approximating
- Pink/red granulation tissue forming
Report these changes
- Redness spreading or worsening
- Swelling increasing after first week
- Purulent (cloudy/colored) drainage
- Wound edges separating
- Wound enlarging rather than shrinking
Section 05
Documenting Wound Observations
✓ Specific language creates clinical value
Document at every dressing change: wound location, edge approximation, drainage (amount/color/consistency/odor), surrounding skin (color/warmth/swelling), comparison to last visit, and client's pain report.
"Wound with moderate purulent yellow drainage and 2cm surrounding erythema — increased from previous visit" gives the nurse actionable information. "Wound looks infected" does not.
"Wound with moderate purulent yellow drainage and 2cm surrounding erythema — increased from previous visit" gives the nurse actionable information. "Wound looks infected" does not.
Knowledge Check
Lesson 1 Quiz
Question 1
In the REEDA assessment tool, the most important infection indicator is:
Question 2
Red streaks extending outward from a wound represent:
Question 3
A previously healing wound now shows increased redness, yellow drainage, and the client reports increased pain. You should:
Question 4
A client with diabetes has a foot wound. Compared to a non-diabetic client, infection risk is:
Question 5
'Moderate purulent yellow drainage with 2cm surrounding erythema, increased from last visit' is better documentation than 'wound looks infected' because: