Does Slough Mean a Wound Is Infected? Clarifying the Critical Distinction
Is a wound infected if it has slough?
The Quick Answer
Slough itself is **not infection** but creates high infection risk by providing a nutrient-rich environment for bacteria. While slough indicates stalled healing and inflammation, true infection requires additional signs: increased pain, purulent (pus) drainage, foul odor, erythema spreading beyond wound edges, or systemic fever. Slough necessitates debridement regardless of infection status.
Why We Ask This
Patients conflate slough with active infection, either panicking unnecessarily or dismissing genuine infection risks because 'yellow tissue is normal,' delaying critical antibiotic or debridement interventions.
The Practical Science
Slough acts as a bacterial nidus—studies show wounds with slough have 40% higher bacterial bioburden—but infection requires host response evidence. The NERDS mnemonic (Non-healing, Exudate, Redness, Debris, Smell) helps clinicians distinguish colonization from true infection.
In Clinical Practice
A wound with yellow slough but no surrounding redness or fever would receive debridement alone; the same wound with spreading erythema and warmth would trigger both debridement and culture-guided antibiotics to address concurrent infection.
References & Context
Slough: What Is This Stuff? | WoundSource"The presence of slough can prolong the inflammatory phase of healing, provides a nidus for infection by attracting bacteria to the wound bed, increases odor and exudate, and may prevent the wound from continuing through the normal wound healing process.Jan 20, 2023"