Biofilm and Infected Wounds

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.

By the WoundSource Editors

Wound biofilms not only impede healing but also increase the risk of infection. It is essential that wound biofilms be addressed and treated in a prompt, consistent manner. Biofilms have been an ongoing challenge because of the majority of resistant bacteria. Research in antibiofilm technology continues to grow, and it is essential to keep up on the most recent evidenced-based practice literature for improving patients’ outcomes.

by the WoundSource Editors

Wound infection is a complex process that can be affected by a variety of factors, some of which inhibit the ability to heal. The first stage of healing, the inflammatory stage, is particularly susceptible to chronicity. Chronicity can be influenced by many factors, with a common contributor being the presence of infection. The wound infection continuum begins with contamination and, if left unchecked, will progress to systematic infection.

by the WoundSource Editors

The human skin microbiome is incredibly diverse and can contain up to one billion microorganisms on a single square centimeter, including bacteria, fungi, viruses, and arthropods. These dynamic environments often become more complicated when wounds are present, and the types of microorganisms present near the dead and damaged tissue reduce the ability to eliminate them through normal immune responses and with standard antimicrobials.

by the WoundSource Editors

Aerobic microorganisms: Organisms thriving in an oxygen-rich environment.

Anaerobic microorganisms: Organisms thriving in an oxygen-depleted environment.

Autolytic debridement: A selective process by which endogenous phagocytic cells and proteolytic enzymes break down necrotic tissue, occurring in varying degrees in the presence of a moist wound healing environment and dependent on the patient's having a functioning immune system.

by the WoundSource Editors