A Guideline for the Assessment and Treatment of Bacterial Biofilms in Chronic Wounds

Bacterial biofilms are a contributing factor to the development and perpetuation of chronic wounds. Thus they add a significant burden to the healthcare system and adversely affect quality of life for many patients. A multi-faceted approach is necessary in order to effectively manage biofilms so that wound healing can progress; this includes the use of accurate diagnostic tests, wound bed preparation with regular debridement and the application of appropriate topical therapies. To date, while there are many studies, most of them in vitro, concerning the diagnosis and treatment of bacterial biofilms in chronic wounds, there is no single guideline or systematic review that provides clinical recommendations for the management of bacterial biofilms in chronic wounds. An evidence-based guideline would help clinicians to select appropriate treatments efficiently, leading to improved patient outcomes and a better quality of wound care. The objectives of this project were to develop an evidence-based guideline for the management of bacterial biofilms in chronic wounds and to disseminate this guideline to local wound care clinicians. A systematic process was followed to review the current literature and grade the available evidence in order to create well-supported recommendations. An algorithm was also generated to facilitate use of the guideline and provide a reference tool for clinicians. A guideline addressing diagnosis, wound bed preparation, and topical management was developed based on the review of the evidence. The guideline was evaluated for quality and clarity by content experts and wound care clinicians using the AGREE II instrument. Because of a paucity of strong clinical research evidence regarding biofilm management, the final product was a systematic review with recommendations rather than a guideline. The finished systematic review with recommendations was then submitted to a local wound care clinic for evaluation and possible implementation. Additionally, a poster was prepared and presented to a regional audience at the Eastern Idaho Regional Medical Center wound care conference.