Biofilms are structured, highly-organized, communities of microorganisms.6, 7 and 8 Biofilm poses a challenge by allowing heterogenic bacterial colonies p38 protein kinase to evade host defense mechanisms under a protective polysaccharide covering, serving both to evade host defense mechanisms and provide a climate ripe for genetic cassette exchange to promulgate antibiotic resistance.9 Biofilm,
in the case of the wound environment, presents challenges for the host in terms of clearing pathogens, and subsequently requires advanced wound healing techniques.10 Biofilm adheres not only to wounds and living tissues, but also to medical equipment for example, WP surfaces and catheters, where biofilms allow bacteria to evade antiseptics, antimicrobials, and sterilization procedures.9 Biofilm formation can singularly prove devastating for healing progression both from the perspective of providing a source for potential patient cross contamination as well as delaying individual wound healing. Infection occurs when the concentration of pathogenic microorganisms exceeds a tolerable level for normal wound healing to occur. Clinically, an infection is defined as exceeding the “critical level” of 100,000 pathogenic microorganisms per gram of tissue.11 and 12 Infection delays angiogenesis and granulation, thereby
delaying wound healing.12 and 13 Another barrier to normal wound healing is the presence of eschar, which acts as a physical barrier to impede epithelialization and facilitates wound infection by providing a nutrition source for bacteria.12 An acute wound defines Metformin nmr a wound that heals normally Apoptosis Compound Library cell assay (typically complete within 21–41 days) with predictable progression through the phases of healing. The term chronic wound defines a wound that does not heal within the expected time frame and does not exhibit orderly progression of healing phases.2, 14 and 15 The wound halts in a pro-inflammatory state and presents with uncoordinated phases of healing such that different areas within the same wound are found in different phases of healing.13 For normal wound healing to occur, the following are needed: early, appropriate intervention,16 functioning immune system,17, 18 and 19
adequate blood flow,20 control of bacterial bioburden,21 chronic disease management,22 and 23 and understanding of expected timing of the process.9, 13, 24, 25, 26, 27, 28 and 29 The evidence using WP as a means to facilitate the healing process, while addressing the removal of biofilm, debris and eschar while simultaneously mitigating pain is presented below. Removing gross contaminants and toxic debris, as well as diluting surface bacterial content are the premise of WP’s cleansing effects. While this is theoretically sound, there are no double-blind, randomized studies to demonstrate these effects.2 and 30 In 1982, Bohannan31 found that WP therapy and rinse removed up to four times more bacteria than WP itself in a venous stasis ulcer.