title: A clinical investigation into the relationship between increased periwound skin temperature and local wound infection in patients with chronic leg ulcers.
abstract: OBJECTIVE
  Increased local temperature is a classic sign of wound infection, and its quantitative measurement has the potential to assist with assessment and diagnosis of chronic deep wound and surrounding skin infection at the bedside. Evidence supporting such use in chronic wound care is very limited. This clinical pilot study was conducted in an attempt to quantify the relationship between increased periwound skin temperature and wound infection, as well as validate use of a handheld infrared thermometer for the wound care practitioner.
  
  
  METHODS
  Using a cross-sectional design, 2 groups of participants were recruited from a chronic wound clinic: without wounds (n = 20) and with chronic leg ulcers (n = 40). Participant and wound characteristics were documented. All skin temperatures were documented using a handheld infrared thermometer under consistent environmental conditions within the clinic. Data analysis was based on the difference (Delta) in skin temperature (in degrees Fahrenheit) between a target or wound site and an equivalent contralateral control site. Wound infection was identified using the combination of a validated assessment tool and clinical judgment. Supplemental semiquantitative bacterial swabs were collected from all wounds.
  
  
  METHODS
  Descriptive statistics were analyzed using the chi-squared calculation. A Pearson r calculation of test-retest skin temperature data collected from nonwounded participants initially determined reliability of the infrared thermometer. Correlation of increased periwound skin temperature to wound infection was determined by calculation of a 1-way analysis of variance.
  
  
  RESULTS
  The infrared thermometer was found to be reliable (r = 0.939, P = .000 at a 95% confidence interval). A statistically significant relationship between increased periwound skin temperature and wound infection was identified (F = 44.238, P = .000 at a 95% confidence interval). Neither patient nor wound characteristics were significantly different between the participants with noninfected or infected wounds.
  
  
  CONCLUSIONS
  The results of this study demonstrate that incorporating quantitative skin temperature measurement into routine wound assessment provides a timely and reliable method for a wound care practitioner to quantify the heat associated with deep and surrounding skin infection and to monitor ongoing wound status. Study limitations may reduce transferability of these findings to wound types other than chronic leg ulcers. Further research is needed to support and strengthen these results.
authors.affiliation: Humber River Regional Hospital, Toronto, Ontario, Canada.
authors.forename: Marjorie
authors.initials: M
authors.lastname: Fierheller
authors.forename: R Gary
authors.initials: RG
authors.lastname: Sibbald
mesh_terms: D002908:Chronic Disease; D003430:Cross-Sectional Studies; D006801:Humans; D007871:Leg Ulcer / Q000382:microbiology* / Q000503:physiopathology* / Q000628:therapy; D010865:Pilot Projects; D012881:Skin Temperature / Q000276:immunology; D013821:Thermometers; D014945:Wound Healing; D014946:Wound Infection / Q000175:diagnosis* / Q000503:physiopathology