Biofilm and Infected Wounds

By Luis Fernandez, M.D., KHS, KCOEG, FACS, FASAS, FCCP, FCCM, FICS

Complex wounds have plagued humankind for thousands of years, and the search for methods to combat infectious agents has been met with limited success. Although silver, iodine, and honey still hold a place in a long list of treatments employed today, in general, these and other antimicrobials have at least one thing in common: unlike pure hypochlorous acid (HOCL), none of them are native to humans (iodine is not present in humans in an antimicrobial role).

Surgical site management in the post-operative time frame is paramount in preventing infection and wound dehiscence. It is essential to use practical knowledge in good wound cleansing and skin care and in providing moisture balance in surgical site wound care management.

Surgical site infections (SSIs) are a risk for the more than 10 million patients who undergo inpatient surgical procedures every year in the United States. Between 300,000 and 500,000 Americans develop SSIs annually. SSIs are defined as infections related to an operative procedure that occur at or near the surgical incision within 30 days of the procedure, or within 90 days if prosthetic material is implanted.

By Temple University School of Podiatric Medicine Journal Review Club

An appropriate timeline to initiate biofilm-based wound care (BBWC) has been a topic of question since the incorporation of biofilm therapy was introduced. In hard-to-heal delayed wounds, it is largely agreed upon that biofilms are a significant barrier to healing, and that removal is essential. By definition, hard-to-heal wounds are wounds that have failed to respond to evidence-based standard of care and contain biofilm. Biofilms are polymicrobial communities residing in an extracellular matrix produced by bacteria, which is well-hydrated and resistant against antimicrobial agents and host defenses. Biofilm can form within hours, can reach maturity within 48-72 hours, and has the ability to regrow within 24-48 hours. A first critical step to BBWC is debridement, though it requires additional suppression methods, as well as considerations of a patient’s risk factors. Risk factors include peripheral vascular disease, infection, diabetes, and pressure off-loading, which encourage biofilm development by delaying wound healing. Risks and costs with early BBWC are most likely less than those associated with biofilm-related wound complications. Thus, in March 2019, a panel of nine experts met in London for an Advisory Board Meeting, where they developed solutions to barriers preventing early BBWC and methods of appropriate “wound hygiene” for all health professionals. They reconvened in the summer of 2019 to create a clinical consensus document published in the Journal of Wound Care supported by ConvaTec Limited.

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 Cheryl Carver, LPN, WCC, CWCA, DAPWCA, FACCWS

I am into my 20th year working as a wound care specialist. I must admit, I never thought much about wound management in the prison population until my son's wound care experiences during his incarcerations. I am quite transparent with this blog, and after you finish reading it, I hope you will have a different perspective on wound care in prison populations. I want to point out that this was my son's experience, which he encouraged me to share to help others. This blog is my view and does not define correctional nurses or wound care management in all prisons. I have the utmost respect for correctional nurses because I know that I could not do it. Through my son's experience, I identified various gaps in education and factors affecting quality of wound care that led to my interest in researching this area of wound care.

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.