Defying hard-to-heal wounds with an early antibiofilm intervention strategy: wound hygiene

Abstract

The enormous health and financial burdens incurred by delayed wound healing—often uninspiringly termed ‘chronic wounds’—are acknowledged globally in research documents with alarming frequency. Affected individuals suffer increased pain and are vulnerable to recurrent infections, as they live with a health condition that is poorly understood by many healthcare providers. These wounds are commonly expected not to resolve. It might even be said this outcome is simply accepted.

In recent years, evidence has been growing that a key pathology of non-healing wounds is biofilm, just like plaque in dental disease. In biofilm disorders, pain and infection increase the need for analgesics, opioids and antibiotics, making it highly desirable to address the pathology before the disease escalates. Biofilm management is vital, therefore, to achieving better outcomes and reducing the disease burden. Much like dental hygiene, wound hygiene aims to root out the cause of a common pathology in the global population.

The concept of wound hygiene arose during an expert advisory board meeting held in early 2019. There, the international panel agreed that almost all hard-to-heal wounds contain biofilm, which delays or stalls healing. This led to the publication of an expert opinion article in JWC that posed the important question: is the current standard of care for wound management adequate, given what we now know about biofilm?1

There was a growing perception among the panel that wound care is in crisis. Perhaps it is. Globally, there is a perfect storm brewing in wound care: an ageing population; an increase in age- and lifestyle-associated conditions such as vascular disease, diabetes (which is pandemic) and obesity; economic strains in healthcare systems worldwide; overuse of antibiotics alongside increasing antibiotic resistance; and the ongoing severe impact of wounds on quality of life. Despite all the new products and best practices, the burden of wounds is not getting smaller. There is no magic recipe that rapidly improves non-healing wounds with consistent, reproducible results in all settings.

It is clear that the puzzle is missing a piece. Evidence is mounting that this piece is biofilm management, which is increasingly recognised as a factor in a multitude of chronic disease conditions. It may be time to rethink what constitutes best practice, particularly in wounds that are colonised by biofilm or infected.

At the expert advisory meeting, the panel discussed ways of embedding real change into generalist practice. Hence, it devised the concept of wound hygiene, which is based on the premise that, just as we follow basic hygiene everyday by washing our hands, brushing our teeth and showering to keep clean and ward off germs, so we should apply basic hygiene to wounds.

The panel met in summer 2019 to discuss the structure and content of this concept, with a view to publishing a consensus document in JWC. The result is this publication, which defines wound hygiene, describes how it can help reduce antibiotic usage and advises how it can be implemented into day-to-day practice. The international panel recognises this might need to take into account local standards and guidelines.