Biofilm and Infected Wounds

Wound healing typically progresses through four phases: hemostasis, inflammation, cell proliferation or granulation and repair, and epithelialization and remodeling of scar tissue. Clinicians should achieve wound closure through a standardized framework such as the TIMERS (tissue management, infection or inflammation, moisture balance, edge or epithelialization, regeneration, and social factors) tool, which provides a comprehensive approach to wound management and optimizes the wound bed and conditions to support progression of wounds through the healing process.

Wound healing is a complicated process that restores the skin's barrier function to prevent further damage or infection. The healing process normally progresses through 4 phases: hemostasis, inflammation, proliferation, and remodeling. However, a chronic wound may result when a wound fails to progress through the normal phases of healing.

Wound bed preparation is the systematic approach clinicians use to identify and remove barriers to the healing process of the wound. The approach aims to create an optimal wound healing environment by focusing on all critical components, including debridement, bacterial balance, and exudate management, as well as taking into account the patient's overall health status and how this may impinge on the wound healing process.

Wound bed preparation is a vital element of wound care. It ensures that the wound has the best environment for closure by addressing the needs of the wound and removing barriers. Wound bed preparation is usually achieved by following a systematic approach such as the TIMERS mnemonic, which consists of tissue, infection/inflammation, moisture management, edge of wound/epibole, repair/regeneration, and social factors. These steps do not necessarily need to occur in order, and some or all of them may need to be repeated as the wound changes and progresses toward closure.

Wound bed preparation is the concept that provides clinicians with a framework for treating hard-to-heal wounds by assessing the patient as a whole and not focusing only on the characteristics of the wound. Moisture management is essential for a wound to heal correctly, so clinicians must regularly assess the wound because excess moisture or exudate can be an indicator of ongoing inflammation or other complicating factors.

Wound bed preparation is vital to treating biofilm. Resistant to antibiotic treatment, biofilm not only stalls the healing process of chronic wounds but also puts patients at greater risk for amputation. Clinicians should follow the process of successful wound healing described in the TIMERS framework (Tissue, Inflammation/infection, Moisture imbalance, Epithelial edge advancement, Repair/regeneration, and Social factors) to guide wound care. Proper wound bed preparation recognizes that biofilm prevention and treatment in chronic wounds incorporate aggressive wound debridement to suppress biofilm regrowth, disrupt the bacterial burden, and promote a healthy wound bed environment

By the WoundSource Editors

The process of wound healing ideally progresses from inflammation to epithelialization and, finally, remodeling. If at any point bacterial (or fungal) colonization becomes prominent, the process of wound healing is disrupted. The creation of biofilm is a microbial defense mechanism that stalls the trajectory of healthy wound healing and can contribute to the development of a chronic wound. It is estimated that 90% of chronic wounds and 6% of acute wounds contain biofilms generated by microbes. Epidemiologically, chronic wounds impact 2% of the entire US population. Because of this large impact, knowledge of proper wound healing and use of clinical tools to assist the wound healing process are essential.

By the WoundSource Editors

Moist wound healing is the current cost-effective, evidence-based modality to achieve faster wound healing rates and decreased pain and infection. As part of the wound healing process, acute wounds produce reparative exudates consisting of growth factors to support extracellular matrix production; in contrast, chronic wounds contain inflammatory-producing exudates studded with cytokines and proteases that may help maintain the inflammatory phase but can exert destructive effects on the fragile wound bed and may extend to the periwound surface.

By Liping Tang, PhD

Infection is the single most likely cause of delayed healing in chronic wounds. In most cases, identification of chronic wound infection (e.g., diabetic foot ulcers and venous leg ulcers) is not obvious because chronic wounds do not exhibit the same classic inflammatory signs of infection as those found in acute wounds. More arduously, those common signs of infection—pain, erythema, heat, and purulent exudate— vary as we age and occur differently in those with underlying diseases or weakened immune systems. Diagnosis is generally based on the doctors’ experience and could be confirmed with microbiological culture of tissue biopsy. However, culture could take a few days, and the results may not always be reliable because of sampling error. A fast and accurate diagnosis of wound infection would relieve the patient of significant discomfort and improve the treatment outcome.

The incorporation of silver into wound dressings has been a breakthrough to combat the effects of antibiotic resistance, despite silver safety concerns. Regardless of its recent popularity, silver is not a new tool in health care.