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Leg ulcer - venous - Management
When should I take a wound swab for an infected venous leg ulcer?

  • Take a swab for all suspected infected venous leg ulcers before prescribing an antibiotic.
  • Clean the infected ulcer with tap water or saline prior to taking the swab.
  • Note that venous leg ulcers should not routinely be swabbed unless there is clinical evidence of infection.
Clarification / Additional information
  • Ideally, clean the ulcer with tap water or saline first, and remove unhealthy tissue. Then place the swab onto viable tissue displaying signs of infection and rotate gently to pick up any loose material.
Basis for recommendation
  • These recommendations are based on clinical guidelines: The nursing management of patients with venous leg ulcers published by the Royal College of Nursing (RCN) [RCN, 2006], Management of chronic venous leg ulcers published by the Scottish Intercollegiate Guidelines Network (SIGN) [SIGN, 2010], and guidelines from the Health Protection Agency (HPA) [HPA, 2006].
  • The HPA recommends taking wound swabs from clinically infected ulcers before starting antibiotics. Taking swabs after starting antibiotics may affect the swab results. Although swabs alone cannot determine the presence of an infection due to the high number of colonized bacteria, sensitivity results can help guide the appropriate use of further antibiotics if the ulcer is not clinically improving on empirical treatment.
  • There is no evidence for the routine use of wound swabs in the management of uncomplicated ulcers, as all venous leg ulcers will be colonized by bacteria at some point, and colonization in itself is not associated with delayed healing [SIGN, 2010]. The RCN based their recommendations on one randomized controlled trial and one prospective study. The studies were considered small, and further research is recommended [RCN, 2006].

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