Nursing Education Update – Wound Biofilm

Nurses we understand the importance of ensuring that we  do all we can to promote successful wound healing for our patients. Wound care has always  been a core function of Nursing and remains  both challenging and also  rewarding.  Whilst workplaces provide access to Nursing Education and Nursing resources I thought it  useful to highlight  some reminders regarding  Biofilms and Wounds.  The reference for this article  whilst British in origin  contains good information and is titled Wounds UK Best Practice Statement. The use of topical antimicrobial agents in wound management. London Wounds UK, 2013 ( 3rd edition). A copy is enclosed for your information.

In regards to Biofilms the article identifies the following interesting points worth noting by Nurses!

Biofilms are complex polymicrobial communities that develop on or near wound surfaces. Biofilms may not present with clinical signs of infection and are often found in chronic wounds. [i]

Biofilms can consist of a single bacterial or fungal species or can be a combination of different microbes

Did you know that it is thought  60%  of chronic wounds and 6% of acute wounds contain Biofilms[ii]
There is an extracellular polymeric substance  (a matrix) that  supports the structure of the biofilm and allows microbes to exist in close proximity to one another.

 This matrix is impermeable to many antibiotics and is like a thick, slimy protective barrier and attaches the biofilm to a living or non living surface.

Biofilms can be distinguished from slough as wound slough is viscous, yellow and relatively opaque

Biofilms form quickly in 2 – 4 hours and evolve to a fully mature Biofilm  in just 2 – 4 days. They can recover from mechanical disruption ( e.g.. debriding a wound ) and can reform a mature Biofilm in 24 hours
Conditions that impair the immune system or reduce the effectiveness of antibiotics may predispose a wound to developing a Biofilm
When managing Wound Biofilm – the aim is to reduce the Biofilm burden and then prevent the rebuilding of the Biofilm in a Wound
Debridement or vigorous cleansing are the best methods for reducing biofilm burden
Use of topical antimicrobials should only occur after cleansing and debridement has taken place

Interestingly the article does make mention of sustained release cadexomer iodine being more effective than silver in disrupting mixed Biofilms. The article also identifies Polyhexamethylene Biguanide ( PHMB) as being effective in disrupting mixed Biofilms.

The article is great for nursing education regarding the differences in and the uses of different topical antimicrobials in wound care.

Nurses you will be interested to know the document also contains a really easy to use decision making flowchart to support you in working out what action to be taken in wound management.

As Nurses we understand the importance of adhering to your organisations policies and procedures- however you may find this content of interest and  the document could be used as a catalyst for discussion in your workplace regarding current wound management Nursing Practice .

The Nurses for Nurses Network has a great range of Nursing Education and Nursing activities related to wound care. The sessions are focused on Nurses who need to know about managing wound care in the ‘real world’ where Nurses are often time poor and resource limited!

[i] Wounds UK Best Practice Statement. The use of topical antimicrobial agents in wound management. London Wounds UK, 2013 ( 3rd edition)

[ii] Phillips PL,WolcottRD,Fletcher J, Schultz GS. Biofilms Made Easy. Wounds International 2010;1(3)www.woundsinterational .com ( accessed 23rd February 2015)

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