title: Calm, irritated or infected? The experience of the inflammatory states and symptoms of pin site infection and irritation during external fixation: a grounded theory study.
abstract: OBJECTIVE
  To explore patients' experiences of the symptoms of suspected wound infection in external fixator pin sites.
  
  
  BACKGROUND
  Pin site infection is painful and distressing and can threaten the success of treatment. It is difficult for patients and clinicians to differentiate between pin site infection and irritation or foreign body reaction to the pin. There is no validated outcome measure for infection that enables the success of interventions for prevention and management to be evaluated. There is a need to develop accurate patient-orientated assessment criteria.
  
  
  METHODS
  Qualitative design, using grounded theory.
  
  
  METHODS
  Following written informed consent, a theoretical sample of 16 adults with an external fixation device that had been in situ for at least 12 weeks was recruited. They had experienced a pin site infection in the previous four weeks. Data were collected using semistructured interviews, and data collection was stopped when saturation was achieved. Analysis took place using constant comparative analysis.
  
  
  RESULTS
  Participants described three 'clinical states' of pin site wounds: calm, irritated and infected. They described the differences in each state in relation to pain, redness, swelling, discharge and general symptoms. Symptoms were absent or varied in intensity depending on whether the pin sites were calm, irritated or infected.
  
  
  CONCLUSIONS
  This study provides insight into patients' experiences of the symptoms of pin site infection resulting in an emerging theory based on conceptualisation of this experience, which is that of dimensions of inflammatory pin site states. The detail given will enable clinicians and researchers to be more accurate in recognising infection and begins to clarify the difference between a wound that is irritated and a wound that is infected. The findings will enable the development of a patient-orientated outcome questionnaire for pin site infection.
  
  
  CONCLUSIONS
  There is a need for patients and clinicians to be able to differentiate between infected, not infected and irritated pin sites.
authors.affiliation: Faculty of Health and Social Care, The University of Hull, Hull, UK. j.santy@hull.ac.uk
authors.forename: Julie
authors.initials: J
authors.lastname: Santy-Tomlinson
authors.forename: Maria
authors.initials: M
authors.lastname: Vincent
authors.forename: Nicola
authors.initials: N
authors.lastname: Glossop
authors.forename: Julie
authors.initials: J
authors.lastname: Jomeen
authors.forename: Patricia
authors.initials: P
authors.lastname: Pearcey
mesh_terms: D000328:Adult; D016267:External Fixators / Q000009:adverse effects*; D006801:Humans; D017053:Infection Control; D008962:Models, Theoretical