Scope
Assessment of possible infection in a chronic leg ulcer using the exact Queensland PCCM chronic-wounds chapter and the Pan Pacific venous-leg-ulcer assessment guideline.
The Bottom Line
- Document wound size, depth, exudate, odour, surrounding skin, pain, oedema, circulation and change from baseline.
- Bacterial colonisation of a chronic ulcer is common and is not itself an indication for systemic antimicrobials.
- Spreading erythema, warmth, increasing pain, purulent change or systemic illness supports clinical infection and requires the local antimicrobial pathway.
- Assess arterial supply and ulcer cause because ischaemia, pressure, diabetes and malignancy alter treatment and healing.
Practical clinical workflow
1
Clean and assess the wound using an aseptic approach and compare with prior measurements or photographs.
2
Take a wound specimen only when the current pathway indicates and after appropriate cleaning, and assign responsibility for the result.
3
Use dressings, oedema management and antimicrobial care matched to wound cause, perfusion and infection severity.
4
Review clinical response and refer to wound, vascular, podiatry or diabetes services when healing is poor or complexity exceeds local scope.
Safety boundaries and escalation
- Sepsis, rapidly spreading infection, critical ischaemia, exposed deep structure or severe disproportionate pain requires urgent hospital assessment.
- Atypical or non-healing ulcer with rolled edge or abnormal tissue requires specialist assessment for malignancy or inflammatory disease.
Implementation
Queensland PCCM chronic wounds is a Queensland source. It supplies an Australian implementation example, not a national rule. Confirm the equivalent pathway, referral destination and medicine policy in the patient’s state or territory. Check current TGA product information for medicines. Offer culturally safe care and use the NACCHO–RACGP National Guide where Aboriginal and Torres Strait Islander preventive or chronic-care recommendations differ.
Clinical use boundary
This independently written summary is not an official guideline. Check the linked source version, current TGA-approved product information where medicines are involved, and the applicable state, territory and local pathway at the point of care.
Source documents
Use the linked source documents for complete recommendations, evidence grading, exclusions and implementation detail.
- Wounds Australia, New Zealand Wound Care Society, Hong Kong Enterostomal Therapists Association and Wound Healing Society of SingaporeClinical Practice Guideline for Venous Leg Ulcers: AssessmentApril 2025 guideline; first instalment of the current VLU guideline update · accessed 2026-08-20view source
- Queensland Health and Royal Flying Doctor Service Queensland SectionPrimary Clinical Care Manual, 12th edition: Chronic wounds — adultISBN 978-1-876560-22-5; Chronic wounds — adult, pp. 317–320 · 12th edition 2025, v1.03 with updates through 21 July 2026; exact chapter at printed pages 317–320 · accessed 2026-08-20view source
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