Wounds, whether minor cuts or severe burns, are susceptible to a complex phenomenon known as biofilm formation. Biofilms pose a significant challenge in wound management and can interfere with the healing process if not addressed effectively. In this guide, we look at the impact of biofilm in wound care, exploring what biofilms do in a wound, how to remove them, the best removal methods, suitable dressings, and the importance of quickly addressing biofilm concerns.
Where do we find biofilms in daily life?
Biofilms are pervasive in various environments and can be commonly found in day-to-day life in numerous settings. Common locations where biofilms occur include:
- Bathroom surfaces: biofilms often form on surfaces such as shower walls, bathtub liners, sink drains, and toilet bowls due to the presence of moisture and organic matter. These biofilms may appear as slimy or discoloured patches and can contribute to the development of mould and mildew.
- Kitchen appliances: biofilms can accumulate on kitchen surfaces, particularly in areas prone to food spills or moisture buildup. Refrigerator drip pans, cutting boards, dish sponges, and sink drains are common sites for biofilm formation in the kitchen.
- Dental plaque: this is a biofilm that forms on the surface of teeth and along the gum line due to the colonization of oral bacteria. If left untreated, dental plaque can lead to tooth decay, gum disease, and other oral health issues.
- Medical devices: biofilms frequently develop on medical devices such as catheters, implants, and prosthetic devices. These biofilms can increase the risk of device-related infections and complicate treatment outcomes for patients.
- Water systems: biofilms thrive in water systems, including plumbing pipes, water storage tanks, and water distribution networks. These biofilms can harbour pathogenic microorganisms and contribute to waterborne illnesses if not effectively managed.
- Food processing equipment: biofilms can form on surfaces within food processing facilities, including conveyor belts, storage tanks, and processing machinery. These biofilms can contaminate food products and compromise food safety if not adequately controlled.
- Aquatic environments: biofilms play essential roles in aquatic ecosystems, where they colonize surfaces such as rocks, submerged vegetation, and aquatic animals. These biofilms contribute to nutrient cycling, water filtration, and habitat formation in rivers, lakes, and oceans.
- Air conditioning systems: biofilms can develop within air conditioning systems, particularly in cooling coils, drip pans, and air ducts. These biofilms can impair system efficiency, promote mould growth, and contribute to indoor air quality issues.
While healthy individuals with intact skin and robust immune systems may be less susceptible to biofilm-related infections, certain factors such as prolonged exposure, compromised immunity, or underlying health conditions can increase the risk of infection from biofilms. This exposure can result in respiratory infections, urinary tract infections, oral health issues, gastrointestinal illness, and skin & eye infections.
What do biofilms do in a wound?
Biofilms are communities of microorganisms, including bacteria, fungi, and other microorganisms, who adhere to surfaces and form a protective matrix called mucopolysaccharide, or slime. In the context of wounds, biofilms can develop on the wound bed, within the wound cavity, or on medical devices such as catheters or implants.
Once established, biofilms create a microenvironment that promotes microbial growth and persistence. The slime shields microorganisms from the body's immune response and antimicrobial treatments, making them highly resistant to conventional therapies. This resilience allows biofilms to perpetuate chronic inflammation, delay wound healing, and increase the risk of complications such as infection and tissue damage.
How to remove biofilm from a wound?
Effective removal of biofilm is crucial for promoting wound healing and preventing complications. Strategies are traditionally employed to disrupt and eradicate biofilms from wounds:
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Mechanical debridement: physical methods such as sharp debridement, irrigation, and scrubbing can mechanically disrupt biofilms and remove them from the wound surface. Sharp debridement involves the surgical removal of necrotic (dead) tissue. A wound brush or sponge can further aid in biofilm removal.
Mechanical debridement may inadvertently disrupt healthy, healing tissue if performed aggressively or inappropriately. It should be avoided or used with caution in wounds with fragile or healing tissue to prevent further damage and promote optimal wound healing. A gentler approach to mechanical debridement should be considered to minimise trauma to the wound bed.
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Chemical debridement: enzymatic agents and antimicrobial solutions are often used to chemically degrade biofilm matrix components and kill embedded microorganisms. Enzymatic debriding agents such as collagenase or papain-based formulations break down the proteinaceous matrix of biofilms, facilitating their removal.There are drawbacks to this form of debridement:
- Delayed action: chemical debridement may take longer to achieve desired results compared to mechanical debridement. Enzymatic agents and antimicrobial solutions typically require extended contact time with the wound to break down biofilm components and facilitate debris removal.
- Potential irritation: chemical debridement agents may cause irritation or allergic reactions in sensitive individuals. This can manifest as redness, itching, or discomfort at the wound site, necessitating discontinuation of the product and alternative treatment options.
- Limited efficacy: certain types of biofilm or wound conditions may be less responsive to chemical debridement alone. Thick, mature biofilms or wounds with extensive necrosis may require additional interventions, such as mechanical debridement or surgical intervention, to achieve complete biofilm removal and promote healing.
- Cost: chemical debridement agents can be costly, especially if they need to be used frequently or in copious quantities. This may pose a financial burden for patients or healthcare facilities, particularly in resource-limited settings.
- Potential harm to healthy tissue: while chemical debridement agents are designed to target necrotic tissue and biofilm, there is a risk of unintentional damage to surrounding healthy tissue if applied excessively or inappropriately. Careful monitoring and appropriate application techniques are essential to minimise the risk of adverse effects.
- Resistance development: prolonged or repeated use of antimicrobial agents in chemical debridement may contribute to the development of antimicrobial resistance among microorganisms in the wound. This can limit the effectiveness of future treatment options and pose challenges in managing infections.
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Biofilm-disrupting agents: certain compounds, such as Surfactants and chelating agents, have been shown to disrupt biofilm structure and enhance the efficacy of antimicrobial treatments. Surfactants work by destabilising biofilm matrix components, allowing for easier penetration of antimicrobial agents. Chelating agents sequester metal ions required for biofilm formation, inhibiting biofilm growth, and promoting dispersal.These agents have their own potential drawbacks however:
- Limited penetration: biofilm-disrupting agents may have difficulty penetrating the dense matrix of mature biofilms, reducing their efficacy in fully eradicating biofilm-associated microorganisms.
- Potential toxicity: biofilm-disrupting agents may have cytotoxic or irritant effects on host tissues, particularly if used in high concentrations or for prolonged periods. This can lead to tissue damage, delayed wound healing, or adverse reactions in sensitive individuals.
- Risk of resistance: prolonged or repeated exposure to biofilm-disrupting agents may promote the development of resistance among biofilm-forming microorganisms. This can limit the effectiveness of treatment options and pose challenges in managing biofilm-related infections,
- Cost: certain biofilm-disrupting agents may be costly, especially if they are proprietary formulations or require specialized delivery systems. This can pose financial barriers to access for patients or healthcare facilities, particularly in resource-limited settings.
- Potential for disruption of beneficial microbiota: biofilm-disrupting agents may not discriminate between pathogenic and beneficial microorganisms, potentially disrupting the natural microbiota balance and increasing the risk of secondary infections or dysbiosis.
- Patient compliance: biofilm-disrupting agents may require frequent or prolonged application to achieve desired outcomes, which can pose challenges in terms of patient compliance and adherence to treatment protocols.
What is the best way to remove biofilm?
Trifectiv Plus Wound & Burn Care is a versatile wound care solution formulated to remove biofilm and promote healing in acute and chronic wounds gently yet effectively. The active ingredient, namely non-toxic medical-grade hypochlorous acid, penetrates biofilm, reduces microbial load, and accelerates wound healing. Trifectiv Plus Wound & Burn Care is suitable for a wide range of wound types, including burns, ulcers, and surgical wounds, making it an ideal choice for comprehensive wound management.
To date, there are no documented reports of pathogen resistance to hypochlorous acid (HOCl). Hypochlorous acid is a potent antimicrobial agent that is effective against a broad spectrum of microorganisms, including bacteria, viruses, and fungi. Its mechanism of action involves disrupting cell membranes, denaturing proteins, and interfering with essential cellular processes, making it difficult for microorganisms to develop resistance.
Studies have shown that pure hypochlorous acid exhibits rapid and broad-spectrum antimicrobial activity, making it an effective disinfectant and wound care agent. Additionally, because hypochlorous acid is a naturally occurring substance produced by the human body's immune system in response to infection, pathogens may be less likely to develop resistance to it compared to synthetic antimicrobial agents.
Combining Trifectiv Plus Wound & Burn Care with a simple woven gauze dressing to manage exudate levels in wounds while maintaining a moist wound environment conducive to healing offers a simple and cost-effective way of removing biofilm in wounds.
Should we be concerned about biofilm in a wound?
Biofilm formation in wounds is a significant concern due to its adverse effects on wound healing and the risk of complications. Untreated biofilms can prolong inflammation, delay tissue repair, and increase the likelihood of infection and chronic wound development. Understanding the mechanisms of biofilm formation and employing strategies to disrupt and remove biofilms are critical steps in wound management. By using Trifectiv Plus Wound & Burn Care and selecting the appropriate wound dressing, patients and healthcare providers can effectively manage biofilm-associated wounds and promote optimal healing.