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TIME Framework — SCE Dermatology MCQ

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HardWound HealingTIME FrameworkSCE Dermatology

A venous leg ulcer has slough and a positive swab for mixed skin flora, but there is no spreading erythema, increased pain, fever or systemic illness. During TIME-based wound-bed review, what is the most appropriate infection/inflammation action?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Continue compression and local care, reserving antimicrobials for new clinical evidence of infection

Explanation lettering: D = shown as A · A = shown as B · B = shown as D

E is correct. TIME is a structured assessment framework, not a rule that every colonised wound requires antimicrobial treatment in a fixed sequence. NICE states that most leg ulcers are colonised and antibiotics do not improve healing when clinical infection is absent. Local care should address non-viable tissue, moisture, inflammation and the underlying venous disease, with reassessment if spreading erythema, new or increasing pain, warmth, fever or systemic illness develops. A and D equate culture with infection. B makes sterility a prerequisite for evidence-based compression. C promotes resistance and contact sensitisation without a clinical indication.

Reference: NICE NG152 leg-ulcer infection recommendations: https://www.nice.org.uk/guidance/ng152/chapter/Recommendations