What is the Significance of Biofilms?

Submitted by Jean Archer DPM, FACCWS, FASPS, CWS on February 25,2023

Abstract

Biofilms have a significant impact on wound healing by contributing to bacterial infection, prolonged  inflammation and delayed healing. Therefore, it is important to identify and manage biofilms becoming the most important aspects of wound care.(1) The truth is although 60% of chronic wounds contain biofilms, they are not easily recognized and managed.(2) The identification and management is crucial in promoting wound healing.

What are Biofilms?

Biofilms are complex colonies , microbial communities, encased in a protective extracellular polymeric substance ( EPS), which helps them to adhere to suitable surfaces.( 3) These films become easily identifiable and visible when they grow larger taking on the look of a shiny film. The film  prevents antibodies from reaching them . The presence of the biofilms not only increases risk of infection but also prolongs the inflammatory phase further delaying wound healing(1,2,3,4)

What are the Next Steps for Managing Biofilm Formation?

Debridement and cleansing are the most effective methods for preventing and reversing biofilms. 

Wound Inspection

First steps involve the early recognition of the biofilm and then taking steps to address this problem. Biofilms are difficult to see but if a wound has been existent for multiple weeks , this may be a sign a biofilm is forming. The obvious sign would be  a visible shiny film.( 2)

Cleansing and Debridement Methods

Next steps involve frequent cleansing and frequent debridement of the wound, choosing the most effective means suitable for the particular patient and their needs. Keep in mind, biofilms can reform in as little as 24 hours and so this takes the commitment of the wound care clinician and patient in addressing biofilm formation.  Extensive debridement using scalpels, forceps and scissors proves to be most effective, however barrier dressings and topical antimicrobials may also go a long way.(2)

Ultimately, the goal of biofilm management should be  to reduce biofilm formation and reduce the risk of delayed wound healing and improve patients’ outcomes.

 References:
1. Phillips PL, Wolcott RD, Fletcher J, Schultz GS. Biofilms made easy. Wounds Int. 2010;1(3).
2. Carver C. How to identify biofilm in a wound. WoundSource. http://www.woundsource.com/blog/how-identify-biofilm-in-wound. Published August 18, 2015. Accessed December 20, 2017.
3. Donlan RM. Biofilms: microbial life on surfaces. Emerg Infect Dis. 2002;8(9):881-90

4. Roche ED Renick PJ, Tetans SP, et al. Increasing the presence of biofilm and healing delay in porcine model of MRSA-infected wounds. Wound Repair Regen 2012;20:537-43.