Top 5 Questions Writers Ask About Wound Infections

Writers love wounding their characters – and not just emotionally. Any wound that penetrates the protective barrier of the skin can get infected. Wound infections are a great way for writers to up the stakes, making a previously minor wound suddenly becomes life-threatening. But there are some important parameters writers should know.

1) How long will infection take to set in?

          It might take a while for your character’s wound to become infected. I see a lot of writers having their character wake up the day after getting wounded with a massive, life-threatening infection, but that just isn’t how it works. Wound infections are caused by bacteria, and those bacteria need time to grow and multiply. Wound infections after surgery usually take 5-7 days for the infection to take root and grow into a problem. Dirty wounds, particularly if there is particulate matter (like dirt, gravel or wood) lodged inside the wound, can become infected much faster. Even then, it’ll still take 2-3 days before the initial infection sets in, and a few days more before the infection can get to the blood and become life-threatening.

            Certain wounds are more likely to become infected than others. If your character’s wound is large, deep, or has torn or jagged edges, infection is more likely. Contamination with foreign objects, such as dirt, wood, rocks, or glass, also increases the risk. Animal bites, human bites, and wounds from objects that were dirty or rusty are at particularly high risk of nasty infections.

2) What do infected wounds look like?

Infected wounds start out looking red, painful and swollen. Red streaks appear on the skin, and the wound may begin to smell. An infected wound may produce pus – thick white, yellow, or green fluid. As the infection spreads, your character may develop a fever, along with chills, body aches, and nausea. Severely infected wounds can lead to sepsis.

3) What is sepsis?

Sepsis occurs when the infection reaches the bloodstream. Once this happens, your character can go downhill really fast. Symptoms of sepsis include a high fever (<101 degrees Farenheit), a fast heart rate, and fast, shallow breathing. Blood tests will show bacteria in the bloodstream.

As the infection progresses, your character should become progressively weaker, sleepier, and/or confused. Once their blood pressure drops to below 90/60mmHg, your character is in septic shock; their blood pressure has dropped low enough that they are no longer getting enough blood flow to important organs, such as the brain. Septic shock is a dangerous condition with mortality ranging from 30-50%, even with aggressive treatment.

Sepsis needs to be treated in the hospital. Your character will need intravenous (IV) antibiotics, as well as IV fluids and medications to keep their blood pressure up. And they’ll need to be on those antibiotics for a long time. Depending on several factors (the source/extent of infection, bacteria involved, etc.) a course of IV antibiotics can take anywhere from 7 days to several weeks. So, if you’re giving your character sepsis, don’t expect them to go home any time soon.

4) How should my character prevent infection?

            If your character wants to prevent an infection in their wound, they should start by pulling out all the foreign objects – dirt, gravel, glass, etc – that they can see, then washing the wound liberally with lots and lots and lots of water. Ideally, they’d use sterile water, if that’s available. Then, after the wound has fully dried, they should apply an antibiotic ointment if they have it. Finally, your character should loosely bandage the wound using sterile bandaging to prevent further sources infection.    

If your character is on their own, this is probably all they’re going to be able to do. However, if they have access to medical care, they may also get a tetanus shot and antibiotics, if needed. If the wound is really messy, with lots of dead tissue surrounding it, they may need a procedure called debridement – surgical removal of dead tissue surrounding the wound.       

5) What complications can arise from an infected wound?

  If your character doesn’t get treatment, the infection can spread, causing cellulitis (inflammation of the surrounding skin and deep tissues) and osteomyelitis (infection of the bone). If the infection enters the bloodstream, it can cause sepsis – a life-threatening reaction of the body’s immune cells against the pathogen that can cause a dangerous drop in blood pressure and multi-organ failure.  

  Tetanus, or “wound botulism,” is a particularly nasty complication of wounds. It is caused by a type of bacteria that lives in spore-form that is found in dirt and rust. The spore enters the body through a wound – often penetrating wounds or trivial injuries that go untreated – the bacteria emerge and multiply. Once that happens, they produce a toxin that produces extreme contractions of the muscles. Every muscle in your character’s body will stiffen, causing their jaw to lock and their muscles to spasm. These spasms are incredibly painful and can be strong enough to break bones. Vocal cord spasms can lead to difficulty speaking and spasms of the muscles surrounding the trachea (breathing tube) can cause your character to be unable to breathe. They’ll have sweating, fevers, and a racing pulse. If the infection is severe, their spine may arch backward, a startling bodily position called opisthotonos. Some believe that tetanus infection may have been the cause of historical “demonic possessions.” 

Tetanus infection requires treatment in the hospital, often in the ICU. It’s treated with an antitoxin, along with antibiotics, antispasmodics, and wound debridement. Luckily, tetanus can be prevented with a vaccine. But if your character hasn’t had a booster shot of tetanus in the last ten years, or if your story is set before the invention of the vaccine, they can still get the disease!