Infection is a common problem in chronic wounds. Today, the focus on infection management has shifted to effective approaches for the management of biofilm. Arguably, biofilm is responsible for all wound infections and the emergence of resistant bacteria.
What is biofilm? Biofilm is not a visible structure that is often mistaken as the film-like coating on the surface of the wounds. Biofilm cannot be scrubbed away with routine cleansing at dressing changes. Biofilm is a microscopic structure that we might liken to a tiny “condominium,” designed and built by bacteria for their protection, information exchange, and growth. Once biofilm is formed, bacteria are protected and it is difficult for antimicrobial agents to penetrate into the structure and destroy the offending pathogens. When the “condominium” is getting too crowded, some bacteria may wander off (on planktonic state) and establish their own settlement.
The following are a few suggestions on how to manage biofilm:
• recognize signs of increased bacterial burden
• use serial sharp debridement
• use strong antiseptic agent for a short period of time
• use antimicrobial dressings (such as silver, iodine, or honey) to minimize the free-flowing bacteria.
What suggestions can you add?