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Effect of Polyhexamethylene Biguanide Solution on Bacterial Load and Biofilm in Venous Leg Ulcers: A Randomized Controlled Trial

Borges, Eline Lima; Frison, Susiane Sucasas; Honorato-Sampaio, Kinulpe; Guedes, Antônio Carlos Martins; Lima, Vera Lúcia de Araújo Nogueira; Oliveira, Olga Maria Medeiros de; Ferraz, Aidê Ferreira; Tyrone, Ana Carolina

Journal of Wound Ostomy & Continence Nursing: September/October 2018 - Volume 45 - Issue 5 - p 425–431
doi: 10.1097/WON.0000000000000455
Wound Care

PURPOSE: The purpose of this study was to investigate the effect of polyhexamethylene biguanide (PHMB) solution as a wound cleanser on bacterial load and bacterial biofilm in venous leg ulcers.

DESIGN: Randomized controlled trial.

SUBJECTS AND SETTING: The target population was adults attending the dermatology outpatient clinic of the Clinical Hospital of the Federal University of Minas Gerais, Brazil. The sample comprised 44 patients with venous leg ulcers recruited over a 6-month period.

METHODS: Participants were divided into 2 groups: the intervention group had their wounds cleansed with PHMB, and the control group had their wound cleansed with a 0.9% saline solution. Tissue fragments of the wounds were collected for bacteriological analysis; transmission electron microscopy was used to identify the presence of biofilm.

RESULTS: The bacterial load was reduced in both groups compared to baseline values; no significant difference was found when groups were compared. Correlation analysis between wound duration (months), wound area (cm²), necrosis (%), variables, and bacterial count (colony forming units [CFUs]/g) after cleansing showed a significant relationship between area of the wound and CFUs/g (P = .0070, r = 0.51). Transmission electron microscopy revealed the presence of bacterial biofilm in the wounds after cleansing with both solutions.

CONCLUSIONS: The results of this study indicate that both PHMB and saline solution are effective in reducing the bacterial load in venous leg ulcers. However, bacterial biofilm was present after cleansing with both solutions. These findings provide important evidence regarding effectiveness of 2 common wound cleansers on bacterial presence in wounds.

Eline Lima Borges, PhD, Escola de Enfermagem da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

Susiane Sucasas Frison, MSc, WOC Nurse, Escola de Enfermagem da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

Kinulpe Honorato-Sampaio, PhD, Faculdade de Medicina da Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, Brazil.

Antônio Carlos Martins Guedes, PhD, Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

Vera Lúcia de Araújo Nogueira Lima, BSc, WOC Nurse, Escola de Enfermagem da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

Olga Maria Medeiros de Oliveira, MS, Pontifícia Universidade Católica de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

Aidê Ferreira Ferraz, PhD, Escola de Enfermagem da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

Ana Carolina Tyrone, BSc, WOC Nurse, Escola de Enfermagem da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.

Correspondence: Eline Lima Borges, PhD, Departamento de Enfermagem Básica, Escola de Enfermagem, Universidade Federal de Minas Gerais, Av. Alfredo Balena, 190, Santa Efigênia, CEP 30.130-100, Belo Horizonte, Minas Gerais, Brazil (elineufmg@gmail.com).

The authors declare no conflict of interest.

© 2018 by the Wound, Ostomy and Continence Nurses Society.