Beyond the surface: what every healthcare worker must understand about wounds to improve patient outcomes

¹Department of Applied Health Sciences, School of Health Sciences, Kisii University, Kisii, Kenya, ²Microbiology Department, Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya, ³Department of Medical Microbiology and Parasitology, School of Health Sciences, Kisii University, Kisii, Kenya, ⁴CYCLYN Biosciences, Zionsville, Indiana, USA, ⁵Kenya Medical Research Institute, United States Army Medical Directorate-Africa, HJF Medical Research International, Nairobi, Kenya, ⁶Department of Physical and Biological Sciences, Bomet University College, Bomet, Kenya

^&Corresponding author
Silas Onyango Awuor, Department of Applied Health Sciences, School of Health Sciences, Kisii University, Kisii, Kenya

To the Editors Pan African Medical Journal    

Wounds are among the most common reasons for seeking healthcare, yet they remain one of the most underestimated clinical conditions across many healthcare settings. Too often, wounds are viewed merely as localized skin injuries requiring routine dressing changes. This narrow perspective overlooks their complex pathophysiology and their potential to signal underlying systemic disease, infection, vascular insufficiency, diabetes mellitus, malnutrition, or immune dysfunction. Improving patient outcomes requires healthcare workers to recognize that every wound is a dynamic biological process that demands comprehensive assessment and evidence-based management [1-3].

Successful wound care extends beyond selecting an appropriate dressing. It begins with an accurate wound assessment, including evaluation of the wound's etiology, size, depth, tissue viability, exudate characteristics, pain, vascular status, and signs of local or systemic infection. Failure to identify these factors early often results in delayed healing, prolonged hospitalization, repeated surgical interventions, unnecessary antimicrobial use, increased healthcare costs, and preventable disability [1,2,4]. The growing burden of antimicrobial resistance (AMR) has further complicated wound management. Chronic wounds frequently become colonized by multidrug-resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, Acinetobacter baumannii, and extended-spectrum β-lactamase (ESBL)-producing Enterobacterales. Empirical antibiotic prescribing without microbiological confirmation contributes to inappropriate antimicrobial exposure, treatment failure, and the continued emergence of resistant pathogens. Routine wound cultures, antimicrobial susceptibility testing, and adherence to antimicrobial stewardship principles should therefore become integral components of wound care whenever infection is clinically suspected [2-5].

Equally important is distinguishing wound colonization from true infection. The presence of bacteria alone does not justify antibiotic therapy. Clinical decision-making should instead rely on a combination of microbiological findings and patient-specific clinical indicators, including erythema, warmth, purulent discharge, increasing pain, delayed healing, and systemic manifestations of infection. This approach minimizes unnecessary antibiotic use while ensuring timely treatment of genuine infections [3,6]. Optimal wound management also requires multidisciplinary collaboration. Nurses, physicians, microbiologists, surgeons, pharmacists, nutritionists, physiotherapists, infection prevention practitioners, and laboratory professionals each contribute unique expertise throughout the continuum of care. Regular interdisciplinary communication improves diagnostic accuracy, supports individualized treatment plans, enhances antimicrobial stewardship, and accelerates wound healing [2,4]. Healthcare workers should also appreciate that wound healing is influenced by numerous patient-related factors beyond the wound itself. Glycemic control, nutritional status, peripheral vascular disease, smoking, obesity, renal dysfunction, and psychosocial wellbeing all significantly affect healing trajectories. Addressing these determinants alongside local wound care offers patients the greatest opportunity for complete recovery [1,6,7].

Continuous professional education remains essential. Advances in wound diagnostics, biofilm management, point-of-care technologies, negative pressure wound therapy, antimicrobial biomaterials, regenerative medicine, and precision wound care continue to reshape clinical practice. Keeping healthcare workers updated with current evidence ensures that patients benefit from modern, safe, and effective interventions [2,4,8]. Ultimately, improving wound outcomes begins with changing how healthcare workers perceive wounds. A wound is not simply a break in the skin; it is a clinical indicator that reflects the interaction between host immunity, microbial factors, underlying disease, and healthcare quality. Looking beyond the wound surface enables earlier diagnosis, targeted treatment, rational antimicrobial use, and improved patient-centered outcomes [2,3]. We encourage healthcare institutions to strengthen competency-based wound care training, promote multidisciplinary wound management teams, expand access to microbiological diagnostics, and integrate antimicrobial stewardship into routine wound care. By doing so, healthcare systems can reduce preventable complications, limit the spread of antimicrobial resistance, and substantially improve the quality of care delivered to patients with acute and chronic wounds [2,4,9].

Competing interests    

The authors declare no competing interests.

Authors’ contributions     

Conceptualization: Silas Onyango Awuor, Eric Omori Omwenga. Methodology: Silas Onyango Awuor, Eric Omori Omwenga, Eliud Nalianya Wafula, Ibrahim Daud. Resources: Silas Onyango Awuor. Writing-original draft: Silas Onyango Awuor, Richard Mariita. Writing-review and editing: Silas Onyango Awuor, Eric Omori Omwenga, Eliud Nalianya Wafula, Ibrahim Daud, Richard Mariita. Visualization: Silas Onyango Awuor, Eric Omori Omwenga. Supervision: Eric Omori Omwenga, Eliud Nalianya Wafula, Ibrahim Daud. Project administration: Silas Onyango Awuor. All authors have read and approved the final version of the manuscript.

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