Biofilm and Infected Wounds

By Thomas E. Serena, MD, and Khristina Harrell, RN

With apologies to Nietzsche: "What kills you makes you dead." The slow painful death of large and expensive in-person conferences has begun. Technological evolution has selected against these lumbering dinosaurs, but, rather than a massive asteroid, the parlous event came as a microscopic virus. Lockdowns and social distancing enacted in response to COVID-19 pushed us all deeper into a virtual world, a world that will persist long after COVID resolves.

By the WoundSource Editors

Antifungal cream is a broad term used to describe a range of products containing antifungal agents that are topically applied to the skin to control and manage fungal infections. These products may be formulated with a moisture barrier to protect and condition the skin. Antifungal creams are used both as a palliative treatment for existing fungal infections and as a prophylactic measure in cases where there is a risk of fungal infection.

By the WoundSource Editors

The venous leg ulcer (VLU) is the most common type of chronic leg wound, and it can be challenging to manage. VLUs account for up to 90% of all chronic leg ulcers. Proper diagnosis and treatment planning are key to wound healing outcomes. This fact is particularly true for older adults, who have an annual VLU prevalence of 1.7%.

By Alton R. Johnson, Jr, DPM

I can hear it now: "Alton! Don't forget to wash your hands." That's the voice of my grandmother I hear anytime I needed to wash my hands after using the lavatory, before and after treating patients, and before eating. However, I also have the voice of my residency director in my head issuing a similar reminder. I recall one of the very first emergency room consults I had as an intern and excitedly calling her about the patient presentation. I specifically told her the wound is very pungent and malodorous. She quickly replied, with over 30 years of wound care experience, "Alton, did you wash the wound?" and that was when it hit me. I told her, "No, I did not wash the wound." She responded, "Well, call me back when you wash it; then we can better assess if it's truly infection or not." It was at this very moment I learned the very first step of wound care. This step is known as "Please Wash Your Wound!" and it is equally important for both health care providers and patients to understand the basic steps for cleaning a wound.

By the WoundSource Editors

Antimicrobial dressings: Dressings that contain substances with antimicrobial properties, such as silver, chlorhexidine, honey, or iodine. These dressings can be effective in reducing bioburden and promoting healing.

Antimicrobial stewardship: Collective measures that are taken to slow the evolution of multidrug-resistant organisms.

Bacterial resistance: The capacity of bacteria to withstand the effects of antibiotics that are meant to kill them; this term is commonly used interchangeably with antibiotic resistance.

By the WoundSource Editors

The Centers for Disease Control and Prevention (CDC) define a surgical site infection (SSI) as "an infection that occurs after surgery in the part of the body where the surgery took place." The CDC go on to say the infection can be superficial involving just the skin or more serious infections can occur that involve deeper structures, such as tissue under the skin, organs, or implanted devices or materials. The CDC offer tools and guidelines to prevent SSIs and provide education to the public. Public education includes tips and advice on how to prevent patient surgical sites from becoming infected. Although such steps may not always prevent a surgical wound from becoming infected, it is always important to involve the patient in postoperative care.

By the WoundSource Editors

With an associated cost of $3.5 billion to $10 billion spent annually on surgical site infections (SSIs) and complications in the United States, it is important to know how to assess for surgical wound complications. There is a difference between the normal cascade response and a brewing infection. Symptoms of infection are often the first clue that there is more occurring in the wound than meets the eye.

By the WoundSource Editors

Biofilm: this term is frequently used in the wound care space, but biofilm continues to be largely undertreated in wound care. What do the bedside nurse or clinician need to know about biofilm? Should clinicians care less about biofilm on a maintenance or palliative wound versus a wound they are actively trying to heal? Let's address these questions and get to the root of the biofilm in managing complex wound cases.

By Gregory Schultz, PhD

In my recent WoundSource webinar on the assessment and treatment of chronic wounds and biofilms, I discussed the pathogenesis of chronic wounds and offered a biofilm-based wound care protocol to promote healing.

by the WoundSource Editors

Advancements in molecular microbiology, microscopy technology, and techniques for study of bacteria have increased the ability to identify the existence of biofilms, but there still remains the unknown, such as differentiating between planktonic bacteria and biofilm.¹ Chronic non-healing wounds harbor bacteria across the wound etiology classification.^2–4 Malone et al. determined that the prevalence of biofilms in chronic wounds was 78.2% (confidence interval, 61.6–89, P < 0.002).² The development of biofilms moves through a common pattern: attachment, microcolony formation, maturation, and dispersion. The initial attachment is reversible, but the attachment becomes stronger as cells multiply and change their gene expressions. This cell communication process is referred to as quorum sensing, allowing cells to survive.