Medical Chronicle November/December 2013 | Page 47

WOUND CARE

Biofilm-based

wound management
The successful management of
chronic and complicated wounds
requires a seamless integration of
sound infection control principles with
an understanding of the wound bed
‘microbiome’.
Not only is it in the best interests of
individual patient safety and healing
outcomes, but also impacts on a broader community and environmental level,
supporting the principles of antimicrobial stewardship and reducing long-term
‘selective pressure’ for the development
of resistant microorganisms.
The prophylactic and unnecessary
use of topical antiseptics, antimicrobial
dressings and antibiotics on uncomplicated, colonised, normally progressing
wounds is cause for concern, evidenced
by an increasing number of CA-MRSA
(community-associated strains of
methicillin-resistant Staphylococcus
aureus, which are also resistant to
mupirocin) and multidrug-resistant
gram-negative isolates.

abbreviation for either ‘extracellular
polymeric substance’ or ‘exopolysaccharide’.) This matrix not only
facilitates the adherence of bacteria
and fungi to the wound bed, but also
provides a medium for chemical

signalling (‘quorum sensing’) and
sophisticated protection from the
action of antibodies, neutrophils and
antimicrobials.
Biofilm formation commences within
hours of initial wound contamination

HELEN LOUDON Independent
Infection Prevention Practitioner and
Risk Management Specialist, Durban
and subsequent colonisation, and the
social structure (cooperation, mutual
protection vs competition) within a
biofilm will depend largely on the types
of microbial species present.
As the number of cells and chemical

The objectives of biofilmbased wound management
include:
• Appreciating the value of polymicrobial colonisation and its positive
influence on healing.
• Performing a risk assessment of
the most likely microbial strains at
wound bed level, which are usually
representative of local flora and the
patient’s physical environment.
• Understanding that superficial sampling are of limited diagnostic value,
i.e. the growth of bacteria from swabs
is not synonymous with infection and
treatment based on culture results
alone is not warranted.
• Using the ‘NERDS’ vs ‘STONEES’ assessment criteria in conjunction with
other infection markers (such as FBC,
PCT, CRP) and patient comorbid risk
factors to select appropriate topical
antimicrobial products and/or justify
the use of systemic antibiotics.
• Using a rational approach to the selection and use of topical antimicrobial
products for ‘maintenance’ wounds
(malignant, fungating or critically ischaemic), where long-term control of
bioburden, exudate, odour or prevention of drug-resistant opportunistic
infect ion are the primary goals.

What is a biofilm?
Biofilms are everywhere. Biofilm
comprises a complex matrix
of microbial secreted polymer
compounds called EPS. (EPS is an

ALLEVYN™ Ag

Total wound therapy to help
patients recover their lives

Highly Absorbent,
Hydrocellular Foam Dressing

• Designed for use on exuding wounds which are at risk
of infection, suspected of being infected or displaying
early signs and symptoms of infection

IODOSORB™

• Provides sustained antimicrobial activity for up to
72 hours
• Has been shown to disrupt and substantially eradicate
mature biofilms1,2

Cadexomer Iodine Paste

• Cochrane Reviewed Product. Cochrane Reviews are
systematic reviews of primary research in human
health care and health policy, and are internationally
recognized as the highest standard in evidencebased health care2
References:
1. Phillips PL, Yang Q, Sampson EM, Schultz GS. Effects of antimicrobial agents on an in vitro biofilm model of skin wounds. Adv Wound Care 2010;1:299-304.
2. Cochrane Review.
S0 IODOSORB Paste. Reg. No.: 37/14/1/0427. Contains 0.6g of Cadexomer Iodine equivalent to 0.591g of Cadexomer and 0.09g of Iodine.
Smith & Nephew (Pty) Ltd.,
30 The Boulevard,
Westend Office Park,
Westville, 3630.

T + 27 31 242 8111.
F + 27 31 242 8106.
www.smith-nephew.com
02CAL.01

™Trademark of Smith & Nephew
© Smith & Nephew 2011

For full prescribing information, please refer to the package insert
approved by the Medicines Regulatory Authority.

CINGULATE 9330/MC

MEDICAL CHRONICLE NOVEMBER/DECEMBER 2013 47