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It has been demonstrated that when bacterial growth reaches a critical threshold of 105 bacteria per gram of tissue, bacterial toxins can cause tissue damage in the superficial wound compartment, delaying healing. This phenomenon is referred in the literature as critical colonization, increased bacterial burden, covert infection, or localized infection. It is estimated that half of chronic wounds exhibit signs that are consistent with local infection, which is often caused by biofilm that is defined as a community of microorganisms living in an extra cellular polysaccharide matrix and attached to a substrate or surface. The prevailing opinion supports the notion that biofilm may be one of the primary causes for wounds that do not progress to complete healing. There are ways to remove biofilms. Sharp debridement is effective in physically removing and disrupting the biofilm structure rendering bacteria more susceptible to antimicrobial treatment. It has been demonstrated that biofilm and bacterial count can be significantly reduced after wound debridement. The recent Quick Poll questioned on this website asked readers’ opinion whether biofilm would reform in 24 hours. Indeed, there is evidence that if the wound is left without any treatment of topical antimicrobial agents after debridement, the biofilm can be reformed within 24-48 hours. The questions are:
• Does early use of antimicrobial agents could prevent biofilm from forming?
• If biofilm is ubiquitous in wounds, how often should antimicrobial dressings be used to promote healing?
• What kind of antimicrobial dressings should be used to treat biofilm infection?
Further research is needed to provide answers to the questions. Feel free to share your thoughts and practice with your colleagues. We’d love to hear your feedback!
Kevin Y. Woo, PhD, RN, ACNP, GNC(C), FAPWCAKevin Y. Woo, PhD, RN, ACNP, GNC(C), FAPWCA, is Director of Nursing/Wound Care Specialist, Villa Colombo, Homes for the Aged, Inc, Toronto, Ontario, Canada; Wound Care Consultant, West Park Healthcare Centre, Toronto; Assistant Professor, Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; and Associate Director, Interprofessional International Wound Care Course, MScCH program, University of Toronto.
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