This document discusses wound biofilms and their impact on wound healing. It begins by defining biofilms and planktonic cells. Biofilms are bacterial communities enclosed in an extracellular matrix that are adherent to surfaces. They are resistant to antibiotics and host immune responses. The presence of biofilms in wounds can trigger chronic inflammation and inhibit wound healing by damaging tissue through reactive oxygen species. There are no definitive diagnostic tests for biofilms but tissue biopsies may reveal them. Treatment involves thorough debridement combined with antibiofilm agents like lactoferrin or quorum sensing inhibitors, along with preventing their formation in at-risk wounds through proper care.

1. WOUND CARE COURSE: NEVER TOO LATE- part 2
Dr. Khadijah Nordin

3. • What is biofilm?
• How biofilm form?
• What are the function of biofilm?
• How biofilm affected in wound healing?
• Did you know there are some criteria that are suggestive that the
wound may have biofilm?
• How to diagnose wound with biofilm?
• How to treat biofilm?

5. • Planktonic cells
 defined as “free flowing bacteria in suspension”
• Biofilm
which is defined as “a structured community of bacterial cells enclosed in a
self-produced polymeric matrix (extracellular polymeric substance-EPS) and
adherent to an inert (non living thing) or living surface
 EPS is composed of proteins, polysaccharides, anionic and cationic ions and extracellular
DNA (eDNA) among other micro and macro components
are reported to be composed of 10–20% microorganisms and 80–90%
extracellular material
present in most chronic wounds and are likely to be located both on the
surface and in deeper wound layers, but may not be present uniformly across
or within the wound
response to them are associated with delayed wound healing.

6. Biofilms in chronic wounds are likely to be more established or mature .
The biofilm structure may promote the presence of anaerobic bacteria
The microbiota of chronic wounds is often polymicrobial; however, wound
biofilms may consist of single or multiple bacterial species .
Microbial diversity in a wound (planktonic and biofilms) can be influenced by
location and wound characteristics .
Biofilms in wounds may progress to contain fewer, more dominant species over
time but more research is needed to verify this
Biofilms are more tolerant to the host immune response and can evade
phagocytosis due to community defenses

7. Biofilm formation

8. Biofilm in wound

16. Biofilm affected wound healing

18. • Biofilms are thought to play a key role delayed wound healing and
are believed to be found in the majority of chronic wounds.
• Biofilms trigger a chronic inflammatory response in a wound which is
an attempt to rid the wound of the biofilms.
• This response results in large numbers of neutrophils and
macrophages grouping around the biofilms.
• Neutrophils and macrophages secrete high levels of reactive oxygen
species (ROS) and proteases to help to break down the attachments
between the wound tissue and the biofilms.
• The problem is that the ROS and proteases injure normal granulating
tissue and impact proteins and immune cells which then results in
delayed wound healing and the wound seemingly ‘stuck’ in a
prolonged inflammatory wound healing phase.

21. Did you know there are some criteria that are
suggestive that the wound may have biofilm?
• Failure of appropriate antibiotic treatment;
• Recalcitrance to appropriate antimicrobial treatment;
• Recurrence of delayed healing on cessation of antibiotic treatment;
• Delayed healing in spite of optimal wound management and health
support;
• Increased exudate/moisture;
• Low level chronic inflammation

22. How to diagnose wound with biofilm?
• There are currently no routine diagnostic tests available to confirm
biofilm presence
• Wound biofilms are difficult to visualize macroscopically and slough,
debris, and exudate may be visually mistaken for biofilm by
clinicians/healthcare professionals
• Tissue biopsies are more reliable than swabs to reveal biofilms in
wounds. However, routine culture techniques do not necessarily
identify biofilm presence.

23. Biofilm treatment strategy
Biofilms should be considered in the treatment of poorly healing wound
Antibiofilm strategies should continue to be used until the wound bed is
visibly clean, displaying healthy granulation tissue, and/or on a healing
Debridement is one of the most important treatment strategies against
biofilms, but does not remove all biofilm, and therefore cannot be used
alone—this is one of the critical principles of wound bed preparation
(tissue, infection/inflammation, moisture balance, and edge of wound)
Systemic antibiotics cannot eradicate a wound biofilm; therefore,
antibiotic stewardship must be considered with controlled use to help
manage planktonic bacteria, acute infection, and prevention of associated
systemic infections

24. When considering topical antiseptics, those that are known to have
antibiofilm properties are preferred
Prevention and treatment of biofilms should be considered in early
surgical wounds when there is a high risk of surgical site infection and
dehiscence (open colorectal surgery, cesarean section, and major
joint replacement serve as examples)
Biofilm treatments may be aligned across different types of chronic
wounds, as similar dominant microflora are usually implicated—
assuming the wound-specific factors are addressed with other
treatment strategies

27. Antibiofilm Agents
Short Term
Lactoferrin
Xylitol
Gallium
Farnasol
Deferoxamine
EDTA
Dispersin B
Fatty Acid Gel
Nitric Oxide
Long Term
Quorum Sensing
Inhibitor
RNA III Inhibitory Peptide
Furanones
Autoinducer

28. Biofilm Based Wound Care
Debridement- Frequent and aggressive
Selective biocides
Silver, Iodosorb, Hydrofera Blue
Antibiofilm Agents
Lactoferrin, Xylitol, Farnasol
Plant Products, Fatty Acid Gel
Antibiotics
Adjunct
Strong and long
Multiple Concurrent Strategies

30. Thank you