Healthcare practitioners' perspectives on infection management, antimicrobial resistance and stewardship in wound care practice

Abstract

Objective: Antimicrobial resistance (AMR) poses a significant global health threat, particularly in wound care, where non-healing wounds often harbour pathogens that complicate healing and reduce treatment efficacy. Despite available guidance, antimicrobial use remains inconsistent and often lacks alignment with antimicrobial stewardship (AMS) principles. This study aimed to assess global practices in, and awareness of, infection prevention, management and AMS in wound care.

Method: A cross-sectional survey was distributed to a global database of more than 66,000 healthcare professionals. A total of 712 responses were collected between August and September 2025. The survey contained 27 questions, exploring infection management, the use of antiseptic cleansing solutions, topical and systemic antimicrobial use and AMS implementation from across a wide range of healthcare professions globally, with a focus on wound care.

Results: Participants represented diverse clinical roles and settings, with most identifying as specialist wound nurses. While 59.4% followed formal infection protocols, 37.2% reported not following AMS guidelines. 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. AMS leadership structures varied. Key support needs for decision-making included clinical evidence (77.9%), treatment pathways (71.6%) and guideline development (71.6%).

Conclusion: Findings highlight both strengths and gaps in infection prevention, management and AMS implementation. High use of antimicrobial dressings in general and as a precautionary measure may indicate a lack of adherence to AMS principles. The lack of consistency in AMS leadership reported within clinical settings may indicate a variation in protocols and practice across wound care. Greater integration of evidence-based guidance, education and leadership as part of wider AMS structures and teams are needed to support consistent antimicrobial use and mitigate AMR in wound care.

Keywords: acute wounds; antimicrobial resistance; antimicrobial stewardship; infection management; non-healing wounds; wound infection.