Biofilm and Infected Wounds

Emily Greenstein, APRN, CNP, CWON-AP, FACCWS

Pseudomonas aeruginosa (PA) is a common gram-negative aerobic bacilli bacterial infection in chronic wounds. PA is often present in soil, water, humans, and on the surface of medical devices, plants, and animals. PA is an opportunistic infection that can cause serious disease. Patients with an immunocompromised state will often have PA infections.

Wounds affect patients across the global health continuum. In 2019, one study found that approximately 2% of the United States’ population has been affected by chronic wounds. Proper wound hygiene remains one of the most important tenets to optimize healing outcomes in hard-to-heal wounds. Proper wound hygiene may help reduce the likelihood of infection, accelerate healing times, and decrease the resources required for wound care. This routine could lead to limited health care resources—such as personnel, supplies, time, and effort— being used more effectively. In addition, the protocol is suitable for use across multiple wound care professional types and care settings.

Introduction

Disruption of biofilm in the wound bed has been a concept that medical professionals have considered for centuries. Even before we understood the underlying concepts of microbiology, cleaning and wound debridement have been included in wound care.¹

It is estimated that between 2% and 6% of the global population currently live with wounds, a figure that is expected to increase as more people age. The cost of wound care in the United States is approximately $60 billion annually. This figure is also expected to increase unless wound care strategies adapt.

The concept of wound hygiene has grown traction recently as clinicians increasingly adopt an antibiofilm-oriented approach to wound care. Despite the increase in recognition of wound hygiene as a four-step protocol, many definitions for wound care terminology evolve as clinical understanding grows and new wound care protocols continue to emerge.

Bacterial load or burden: Presence of bacterial pathogens in an open wound contributing to wound chronicity and persistence of inflammatory cycle. There are several points along the spectrum of bacterial presence in chronic wounds: contamination, colonization, critical colonization, infection, and sepsis.

By Shannon Solley, Assistant Editor

When it comes to wound care, many experts agree that hands-on education stands out as an effective teaching model.^1,2 "Hands-on opportunities provide a rounded experience that is more meaningful and longer lasting than in a pure lecture format," says Dr. Paul Kim. These workshops present an opportunity for clinicians not only to obtain CME credits but to acquire wound management skills that can be applied to their practice tomorrow.

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.