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Biofilm Based Wound Care
Biofilms form when bacteria adhere to surfaces by excreting a thick, slimy, glue-like substance known as the Extracellular Polymeric Substance (EPS).
This substance forms a protective layer, where the bacteria are no longer free to move (planktonic) but adhere to the wound bed. New bacteria are produced and the colony grows under the protection of the EPS.
Biofilms are often difficult to detect visually but delay wound healing due to the protection they provide to the bacteria in the wound bed.
Over 0%
of chronic wounds have a biofilm present which is a major barrier to wound healing.1
The epidermis is the outer layer of the skin. It holds some nerves and immune cells, but no blood vessels. The dermis is made up of connective tissue and contains numerous blood vessels and nerves. The subcutis is mainly made up of loose connective tissue and fat cells.
All chronic wounds have biofilm, making chronic wounds much harder to treat than acute wounds. Why?
Biofilms are an aggregate of microorganisms (e.g. bacteria or fungi) invisible to the naked eye and tolerant to treatment and the host defense. The aggregate of microorganisms is encased by a thick, glue-like matrix of “extracellular polymeric substance” (EPS), which is composed of water, polysaccharides (sugars), nucleic acid (extracellular DNA) and proteins.
Any wound (abrasions, lacerations, incisions, puncture wounds, burns) is initially considered an acute wound, as long as is it follows the expected stages of healing. In the absence of significant evidence of healing within about four weeks, the wound has likely entered the chronic stage.
The most common form of chronic wounds are ulcers of the lower extremities: around 0.6-3% of people aged > 60 years and 5% of the > 80-year-olds are affected. In the course of a lifetime, almost 10% of the population will develop a chronic wound, with a wound-related mortality rate of 2.5%. In the US, the annual costs of chronic wounds is estimated at around 30 billion $US.2,3
The short answer is: no, not really. The longer answer is: it’s complicated, and ultimately it does not matter, given the evidence-based assumptions that can be made about biofilm. Some clinicians promote what they believe are ‘clinical cues’ of biofilm presence, using naked-eye observations including a ‘shiny’, ‘translucent’, ‘slimy’ layer on the non-healing wound surface. However, although it is arguable that these ‘signs’ may represent manifestations of the presence of biofilm, biofilm itself cannot in fact be seen with the naked eye. The new “World Union of Wound Healing Societies” position statement notes that ‘all non-healing chronic wounds potentially harbor biofilms’ and, therefore, relying on anecdotal visual cues is unnecessary. Clinicians should assume that ‘all non-healing, chronic wounds that have failed to respond to standard care have biofilm’. Consequently, all treatments should be targeted towards effective disruption of biofilms and prevention of their formation and reformation.
[1] Pacella, Rosanna (2017) Chronic Wounds in Australia (Issues Paper). Australian Centre for Health Services Innovation (AUSHSI), Australia.
[2] https://advancedtissue.com/2018/12/what-is-the-difference-between-acute-and-chronic-wounds/ accessed on 05.10.2021.
[3] Agale SV. Chronic Leg Ulcers: Epidemiology, Aetiopathogenesis, and Management. Ulcers 2013; doi: 10.1155/2013/413604.
[4] Chronic Wounds: Economic Impact & Costs to Medicare | Alliance of Wound Care Stakeholders accessed on 05.10.2021.
[5] Bjarnsholt T, Eberlein T, Malone M, Schultz G. Management of wound biofilm. Wounds International 2017;8(2):1-6.
[6] Duale Reihe 2003, „Dermatologie“, Hrsg: Ernst G. Jung, Ingrid Moll.
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