Background & Challenges
Despite advances in both dressing technology and clinical best practice, wound care remains to the greater part ‘In Crisis’. With conditions such as such as Diabetes in pandemic status and increasing incidence of vascular disease combined with the misuse and overuse of antibiotics alongside microbial resistance, the impact oF ‘Hard To Heal’ wounds on both health economics and quality of life is severe and to date there is clearly no quick solution to hand. As a result hard to heal wounds continue to pose and increasing challenge for both wound care practitioners and patients alike.
Biofilm Formation In A Wound
A biofilm can be defined as a complex community of different species of bacteria and fungi that causes a sustained subclinical wound infection, but can protect itself from the host’s immune response and is tolerant to antibiotics and antiseptics. Biofilm can form within hours and can reach maturity in 48–72 hours.
The Role Of Biofilm
In Hard to Heal Wounds
A wound is considered to be ‘Hard To Heal’ when it has failed to respond to evidence-based standard of care. When a wound is hard-to-heal, the interruption in the healing process is largely associated with the presence of tenacious biofilm (a community of multispecies microbes).
Although other underlying host factors may also present
obstacles to healing, it is increasingly acknowledged that a majority—if not all—non-healing wounds contain biofilm, which is a key barrier to healing.
By implication the disruption and removal of a wound biofilm is necessary for the initiation and healing of a non healing wound.
This is the key concept underlying the new approach to ‘Wound Hygiene’
The image opposite illustrates how biofilm develops.
A Novel Approach to Hard to Heal Wounds
In early 2019 following a meeting of panel of international wound care experts chaired by Christine Murphy published an opinion article in the Journal Of Wound Care posing the question: is the current standard of care for wound management adequate, given what we now know about Biofilm?
Despite increases in wound care technology and practice the crisis of hard to heal wounds remain and with the mounting evidence it was clear that the missing piece is the management of wound biofilm. The concept of ‘Wound Hygiene’ has emerged in an effort to to effect tangible and effective change into both the generalist and specialist approach to the management of Hard To Heal Wounds.
The resulting document published with the support of Convatec Ltd. entitled – International Consensus: Defying hard-to-heal wounds with an early antibiofilm intervention strategy: wound hygiene, defines wound hygiene, describes how it can help reduce antibiotic usage and outlines how it’s primary concepts can be integrated into day to day practice and represents a significant step forward in clinical wound care practice.
The 4 Steps In 'Wound Hygiene'
CLEANSE - DEBRIDE - REFASHION - DRESS
Consensus Statement Summary Points
- Wound hygiene is a fundamental aspect of care for all patients with an open wound
- It should be assumed that all hard-to-heal wounds contain biofilm.
- Non-healing should be regarded as a pathology that can be successfully addressed with the right tools, provided that the underlying aetiology is managed with gold standard care.
- Wounds should be triaged by level of risk, regardless of their duration.
- Wound hygiene should be performed at every dressing change.
- The skills, materials and time required to carry out wound hygiene make it a cost-effective approach, especially given its potential to promote faster healing.
- Assess and manage the patient’s pain expectations.
- Even if the wound does not ‘look’ like it has biofilm, wound cleansing must be a priority.
- When cleansing the periwound skin, concentrate on the area that is 10–20 cm away from the wound edges, or that is covered by the dressing, whichever
- Use an antiseptic wash or surfactant for cleansing, if possible, and avoid cross-contamination.
- Debridement is an integral part of wound hygiene; the choice of method should be based on assessment of the wound bed, periwound skin and patient tolerance.
- Any instrument used for debridement must be sterile.
- To avoid risk of injury, exercise caution when
considering debriding lower extremity wounds in patients with poorly perfused limbs and autoimmune conditions, such as pyoderma gangrenosum.
- Wound bed fragility is rarely an issue: removing all devitalised and even some healthy tissue from the wound edges will result in regrowth of healthy tissue.
- Any undermining, no matter how slight, needs to be addressed either by loosely packing with a dressing material or refashioning the wound edges.
- By disrupting and clearing biofilm, and preventing its reformation, wound hygiene is expected to reduce the risk of infection. This could, in turn, reduce antibiotic usage in wound care.
- Antimicrobial dressings alone are not sufficient to disrupt and remove biofilm. They should be used as
an adjunct to address residual biofilm and prevent its reformation. This can only be done if effective wound hygiene is carried out.
Clinical Focus Summary
Wound Hygiene Consensus Document - Essential reading for all
Generalist & Specialist Wound Care Practitioners
This new consensus document defining the concept of ‘Wound Hygiene’ provides a novel and very practical based clinical pathway to improve healing outcomes for both generalist and specialist wound care practitioners. The document is clearly developed by wound care practitioners for wound care practitioners, evidenced by the practical focus of the information and recommendations contained within and can be easily followed by wound care practitioners in any setting. This concept of Wound Hygiene is underpinned by consistency of approach across all active lesions whether defined as acute or hard-to heal and challenges numerous wound care myths providing a defined rationale for the approach to be taken at each step of a clearly interrelated process of wound care. The implementation of these guidelines could see a major shift in Wound Care and Healing Outcomes in the future while providing a clearly roadmap for the development of wound care technology going forward.
Product Focus - Cleansing
Microdacyn60 is a unique Bio-Compatible Wound Cleaning Solution proven to significantly prevent and manage wound Bio-Burden, Biofilm & Infection while accelerating healing.
MICRODACYN60 – Triple Mode Of Action
Promotes the bodies natural healing process.
- Bactericidal Reduction of Wound Bio-Burden preventing and treating active wound infection
- Rapid Anti Inflammatory Effect
- Active Tissue Regeneration
The unique properties of Microdacyn facilitate the following:
- A reduction in the requirement for Antibiotics for the treatment of wound bed Infection
- unlike other topical treatments such as Silver it is completely safe for healthy tissue.
Safe & Effective Wound Cleasnsing Solution
Microdacyn60 offers potent wound and surgical incision cleansing without the risk of Cytotoxicity. Microdacyn’s HOCl (Hypochlorous Acid) safely eradicates Biofilm and other irritants, reduces discomfort and itching, reduces inflammation activity and increases oxygen to the area to accelerate the body’s own wound healing process
Learn More About Microdacyn60
Microdacyn60 is distributed in Ireland by Biofact Pharma Ltd. and is now available on as part of the current HSE Wound Care product list.
If you feel some of your patients will benefit from the unique combination of actions provided by Microdacyn60 or would like additional information you can contact Biofact Pharma Ltd. via the details opposite who will be happy to facilitate your evaluation of this unique cleansing solution first hand.