Educational Report

Development and Use of a Clinical Algorithm for Wound Biofilm Identification

10/17/2018

OBJECTIVE: This report collates evidence for visual, behavioral, and clinical indicators associated with wound biofilm as well as describes the use of an algorithm to identify wounds where biofilm may have been delaying wound progression.

MATERIALS AND METHODS: The authors’ clinical and scientific insights were combined with literature searches in PubMed (keywords: wound; chronic; biofilm[s]). Indicators of biofilm were classified as direct or indirect observations, and questions around these indicators were formulated to create a step-wise algorithm to aid the clinical recognition of wound biofilm. Subsequently, the algorithm was used to select 16 recalcitrant wounds where biofilm was suspected. Debridement samples were then examined by high-resolution light and electron microscopy.

RESULTS: A number of visual clinical signs associated with wound biofilm were identified, where, on occasion, biofilm may develop into visible substances in the wound bed. This suspected biofilm may be shiny and translucent or be opaque, slimy, pigmented, or gel-like. It may reform quickly and be easier to remove via gentle debridement compared with host-derived slough. However, in most instances, biofilm is likely to be microscopic, so there are clinical cues that may suggest its likely involvement. These include signs of local infection, antibiotic and/or antiseptic failure, culture-negative swabs, and wound recalcitrance despite addressing all other factors. Using the developed algorithm, 12 (75%) of the 16 wound samples were observed to contain biofilm, despite the prior use of antimicrobials.

CONCLUSIONS: Together these visual and indirect clinical signs may be used to form an algorithm to aid clinical recognition of wound biofilm. Subsequent investigation supported the emerging clinical evidence for biofilm presence in chronic wounds. While wound biofilm research is still in relative infancy, such an algorithm will hopefully facilitate effective wound management.

CITATION
Metcalf D, Bowler PG, Hurlow JJ. Development and use of a clinical algorithm for wound biofilm identification. Poster presented at: Symposium on Advanced Wound Care Fall; November 2-4, 2018; Las Vegas, NV.

Products: not available

This abstract was not subject to the WOUNDS peer-review process.

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