Identifying and managing biofilms have become two of the most critical aspects of wound care. Biofilms can have a significant impact on wound healing. Biofilms can contribute to bacterial infection, inflammation, and delayed wound healing.
Over 60% of chronic wounds contain biofilm. Many health care professionals are still not able to identify the formation of biofilm formation in their patients. To effectively manage biofilms, health care professionals must understand what biofilms are, how to identify them, and the necessary steps to take to reduce their impact on wound healing.
What are biofilms
Biofilms are microbial communities that are usually composed of bacteria, fungi, yeasts, algae, and other microorganisms. Biofilm is formed when certain types of microorganisms accumulate and attach themselves on the surface of a wound.
Biofilms are usually not seen with the naked eyes at their early stages because they are microscopic. They are much easier to identify when they become larger. They often take the appearance of a viscous, shiny film. The film protects the microorganisms that are living within it and also prevents antibodies from getting to them.
Biofilms can delay wound healing and increase the risk of infection. This is because the film protects the microorganisms from the body’s natural immune response. The immune system is not able to attack the microorganisms due to the protection of the film. However, the immune system still tries to fight the biofilm through an inflammatory response. During this process, the body may actually help the biofilm by providing nutrition to the biofilm in the form of exudate. This then creates a situation whereby the body is no longer fighting the biofilm in the right way, which could damage the healing tissue and delay wound healing.
Development of biofilms
Biofilms develop in three distinct stages.
Stage I – At the first stage, they are composed of a small community of bacteria and other microorganisms that attach themselves to the surface of a wound. At this early stage, health care professionals can easily reverse the development of the biofilms by debridement and cleaning the wound.
Stage II – At the second stage, the community of bacteria and other microorganisms would have formed a more permanent attachment to the surface of the wound and create a more cohesive symbiotic community. This happens after a period of time.
Stage III – At the last stage, the community of bacteria and other microorganisms will begin to produce extracellular polymeric substances. This extracellular polymeric substance is the viscous substance that forms the foundation of the biofilm. It creates a protective barrier that makes it more difficult to clean the wound and remove the community of bacteria. At this stage, it becomes increasingly difficult for the patient’s immune system to effectively fight the biofilms.
Management and treatment of biofilms
Health care professionals must understand best practices in biofilm management to combat the growth and reformation of biofilms.
Currently, the most effective ways of managing and treating wounds with biofilms are debridement and cleaning.
Identifying biofilms are their early stage provides an easy and more effective way to manage and treat the wound.
Management and treatment of wounds with biofilm include:
- Inspect wounds for biofilms – It is important to inspect and recognize biofilms at their early stage. Although biofilms are difficult to see at their early stages, there are indications that biofilms are forming on a wound if inspected properly. For example, if the progress of the wound is stagnant for multiple weeks. This may be an indication that a colony of bacteria has formed which is impeding the natural healing process of the wound. If the wound is not inspected properly and early enough, the biofilm may progress to the last stages whereby you can see a more obvious shiny, well-established film covering the surface of the wound.
- Debridement – Biofilms create a thick coverage over the surface of the wound. Debriding the wound and removing all the outer debris from the surface of the wound makes it possible for the wound to be cleaned. Debriding the wound is removing the biofilm material covering the surface of the wound.
- Debridement – is a key component of removing necrotic, devitalize tissue and remove microorganisms from the surface of the wound.
- Cleaning and applying antimicrobials – After debridement, the wound should be properly cleaned with topical surfactant-based wound cleansing solutions. These surfactant-based products lower the surface tension and aid removal. When biofilms are removed, it makes antimicrobials more effective. Applying antimicrobials on the wound helps to prevent biofilm reformation and kill microbial cells.
- Dressing – After cleaning and applying antimicrobials, you should dress the wound with dressings containing antimicrobials agents such as silver, acetic acid, honey and iodine. These antimicrobials help to kill bacterial and other microorganisms and also prevent the reformation of biofilm. A barrier dressing and applying topical antimicrobials can also help to reduce the risk of recontamination.
- Increase frequency of debridement and cleaning – Biofilms can reform after debridement and cleaning within as little as 24 hours. It is very important that wounds are debrided and cleaned regularly. The frequency of debridement and cleaning should be increased when biofilm is suspected or formed on a wound.