Transcript

Thanks for joining me today. My name is Emily Greenstein, APRN. I'm a certified wound and ostomy nurse practitioner at Essentia Health in Fargo, North Dakota. Today I'm going to talk to you a little bit about biofilm and biofilm management.

What is the difference between when biofilm and infection are present in a wound?

Oftentimes when people ask about biofilm, they ask, does a wound that has biofilm also have infection? Is that wound infected? That's oftentimes a misconception between people. Just because a wound has a biofilm doesn't necessarily mean that it's clinically infected or needed to be clinically treated as an infection.

Meaning, biofilm is just an organization of bacteria and microorganisms that build up in a wound. If a biofilm is not managed correctly, it's not treated. If it goes on, it can lead to infection. But biofilm, the presence of biofilm, doesn't necessarily mean that there is a clinical infection in the wound.

How do biofilm and infection relate to each other?

When we talk about biofilm, like I said, biofilm and infection relate because a biofilm that goes untreated can lead to an infection. It's very important when we talk about biofilm management, how we're addressing that and treating it in our hard-to-heal wounds. Making sure that we're doing really good wound bed preparation, that we're debriding wounds, that we're cleaning wounds. The thing with biofilm is that it can reform within 24 hours. So, making sure that we are, once we're treating that biofilm, utilizing a dressing or some type of modality or advanced wound care to prevent that biofilm from forming so quickly, and making sure that we are doing good debridement and wound bed preparation.

How can clinicians approach each of these scenarios and how do those interventions differ?

A hard-to-heal wound that is clinically infected, means you have a wound that has all those signs. The patient themselves might have a fever, chills, they might complain of just aches, and when you look at the wound, it will have redness around it, purulent drainage, spreading redness, very unhealthy granulation tissue, etc, those are usually signs of clinically infected wounds. But when we're talking about a wound that just has a high biofilm in it, you might notice that the wound is stalled, it's not progressing, it might have that slime looking layer on it, that unhealthy granular tissue, it might just not be progressing like we would think.

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And the reason behind that is, is if there is a biofilm or high bioburden within that wound bed, our body thinks that wound is in a chronic inflammatory state. Our body is sending out those cellular mediators saying that they're attacking or making sure that they're in that high inflammatory response. When we talk about biofilm, we want to manage it, we want to get rid of it so that our body can get out of that inflammatory state and progress on to the healing phase for that hard-to-heal wound.

What do you feel is the top thing that clinicians can do in their practices today to improve outcomes related to biofilm and infection?

When we talk about a hard-to-heal wound, some of the top things or the best things that we can do to prevent biofilm formation or prevent infection in wounds is to make sure that every time we are treating that wound, that we're doing good wound bed preparation. That doesn't mean just the wound itself, that also means the periwound skin. So, making sure that we are cleansing that 4-5 cm area around the wound and that we're debriding our wound beds properly, not just the wound bed itself but that surrounding skin also to help bring down that bioburden or the bacteria on the skin.

Those are probably the biggest things. The other things that you can do as a clinician is making sure that we're identifying those signs of infection early, treating those especially in our patients that are high risk, our diabetics, immunosuppressed patients, that we are doing a good job of assessing the wound at each dressing change and that we're doing a good job at either managing that biofilm or identifying those early signs of infection.