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How to prevent and manage biofilm

Preventing and managing biofilm is an important part of wound management. This is the case for two reasons:2

  1. biofilm are present in most chronic wounds; and
  2. the presence of biofilm is a leading cause of delayed wound healing.

One of the most important ways to avoid biofilm from forming is to reduce exudate pooling.2

How to manage biofilm

Once you’ve established that biofilm are likely present in the wound, you need to lay out an appropriate treatment strategy. For your treatment strategy to have the maximum effect, there are two basic steps you can take:2

  • do what you can to strengthen your patient’s immune system; and
  • always work in a clean environment.

The best strategy for biofilm-based wound care is the ‘clean and cover’ approach. This approach relies on:2

  • adequate debridement to disrupt biofilm; and
  • the use of antimicrobial dressings between debridement. This reduces the planktonic bacteria’s ability to re-establish biofilm.
Wound cleansing Mechanical debridement

Why: To remove non-viable tissue, debris, foreign matter and excess exudate

When: Each dressing change

How: Irrigation with a force of 4-15 psi has been demonstrated as effective and safe4

Why: To remove and disrupt biofilms and make them more susceptible to antimicrobials1

When: Each dressing change (sharp debridement as required)

How: Physical disruption with gauze or pad by gentle circular motion in the wound bed


Manage the gap Use topical antimicrobials Re-assess regularly

Why: Gaps may lead to exudate pooling, bacterial growth, and development of biofilms5

When: Each dressing change

How: Dressings that conform to the wound bed or wound fillers with a secondary dressing

Why: Antimicrobials such as silver have been shown to kill biofilms in vitro1

When: Directly after disruption by mechanical debridement

How: In particular, both silver and cadexomer iodine have been shown to kill biofilms

Why: To ensure wound progression and enable change oftreatment if the wound is not gealing

When: At every dressing change or at least once per week

How: Re-assess the questions presented above

Continuous re-assessment necessary

To prevent wound infection or biofilm re-formation, you need to continuously reassess the wound at every dressing change.

Remember always to refer the patient to a specialist if you observe:1

  • a less than 20% improvement in the wound area over a period of four weeks;
  • increased pain levels;
  • unexpected increase in exudate;
  • suspected infection or biofilm;
  • a decline in the patient’s health and wellbeing