References
Defying hard-to-heal wounds with an early antibiofilm intervention strategy: ‘wound hygiene’
Abstract
Biofilm has been implicated as a barrier to wound healing and it is widely accepted that the majority of wounds not following a normal healing trajectory contain biofilm. Therefore, strategies that inform and engage clinicians to reduce biofilm and optimise the wound tissue environment to enable wound progression are of interest to wound care providers. In March 2019, an advisory board was convened where experts considered the barriers and opportunities to drive a broader adoption of a biofilm-based approach to wound care. Poor clarity and articulation of wound terminology were identified as likely barriers to clinical adoption of rigorous and proactive microbial decontamination that is supportive of wound healing advancement.
A transition to an intuitive term such as ‘wound hygiene’ was proposed to communicate a comprehensive wound decontamination plan with an associated message of expected habitual routine. ‘Wound hygiene’, is a relatable concept that supports meticulous wound practice that addresses barriers to wound healing, such as biofilm, while aligning with antimicrobial stewardship programmes.
A biofilm-based approach to wound care has already been defined.1,2 However, it has previously been questioned if we are waiting too long before starting biofilm-based wound care (BBWC).3 It is widely accepted that biofilm is present in the majority of hard-to-heal wounds and is a barrier to healing.4,5,6 While biofilm is not necessarily visible to the naked eye, the clinical signs and symptoms associated with its presence are broadly accepted.2,5 Delayed wound healing is considered a notable, recognised, indirect sign of biofilm presence.5,7,8
Biofilm is a complex polymicrobial community of microorganisms embedded in a self-produced hydrated extracellular matrix (ECM) that provides protection from antimicrobial agents and host defences.9 Biofilm can contain bacteria with genetic resistance to antibiotics. In addition, biofilm can display phenotypic tolerance to antibiotics as a consequence of being in the biofilm structure.10 Biofilm forms rapidly in wounds, with extensive regrowth demonstrated within 24–48 hours.11,12
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