Determining the Biological and Biochemical Characteristics of “Slough”

Background: The debate over identification of wound infection, slough, and biofilm is increasingly apparent. There is a universal color system for wound bed classification but this generic system has its limitations. In recent years several articles have hypothesized that “slough is equivalent to biofilm”. However, there is also evidence that they are not equivalent and that for most practitioners it can be difficult to distinguish between slough (dead host tissue) and viable biofilm. The International Wound Infection Institute (IWII) has formed a research group to address this issue directly. Ultimately, our goal is to guide clinical practice for the identification and diagnosis of wound slough and biofilm.

Purpose: The goal of this project is to comprehensively characterize slough material while concurrently evaluating the presence of biofilm that may or may not be associated with slough.

Methods: Briefly, patients are enrolled in clinics with matched testing laboratories at multiple sites. Chronic wounds are photographed to obtain high resolution pictures of the wound, slough, before and after cleansing. Samples are collected by curettage or punch biopsy then analysed using testing protocols that have been standardized between each lab for immunohistochemistry, proteomics for protein composition, qPCR for bacterial burden, and biofilm assessment. Seven clinical sites with matched testing laboratories are onboard. 

Conclusion: At the completion of this analysis an educational database will be created for the wound care community and will include pictures, clinical, biochemical, and microbiological data linked to each sample. This presentation will inform participants of the latest paradigms on biofilm, the burden and impact of wound infection and details on the protocols for this significant global research project. The protocols were developed through a consensus from leading scientists and IWII panel members. Presentation of this project will open for debate to occur regarding the merits and benefits of this project for the wider community.