A biofilm, or a community of several species of microorganisms, is usually the cause behind a hard-to-heal wound. Despite the fact that other underlying host factors may also pose a hindrance to healing, it has been recognized that most non-healing wounds contain biofilm that acts as a barrier to healing.

Biofilm management is therefore a promising approach to manage challenging wounds. Biofilm management encompasses regular debridement followed by antibiofilm re-formation intervention, including the use of topical antimicrobial dressings. A consensus document published recently in the Journal of Wound Care advocates the implementation of a novel strategy, termed wound hygiene. This approach involves two additional stages, viz. a viz., cleansing the wound and periwound skin, and refashioning the wound edge. The concept of wound hygiene states that to promote healing, the biofilm must be managed early with a strategy that encompasses cleansing of the wound and periwound skin; debridement; refashioning the wound edges; and dressing the wound.

Wound hygiene is aimed at removing or minimizing the unwanted materials, including biofilm and debris from the wound, targeting any residual biofilm, and preventing biofilm re-formation. Wound hygiene must be established as the core component of wound care.

Summarized below are the key statements on wound hygiene from the consensus document:

• Wound hygiene is central to the care of all patients with an open wound.
• All hard-to-heal wounds should be considered as containing biofilm.
• Consider non-healing as a pathology that can be addressed using the right tools, given the underlying etiology is managed with gold standard care.
• Triage the wounds by level of risk, irrespective of duration.
• Perform wound hygiene at every dressing change.
• The skills, materials and time required to carry out wound hygiene make it a cost-effective approach.
• Patient’s pain expectations should be evaluated and managed.
• Even if the wound does not look like it has biofilm, wound cleansing should be a priority.

Source: Murphy C, Atkin L, Swanson T, et al. International consensus document. Defying hard-to-heal wounds with an early antibiofilm intervention strategy: wound hygiene. J Wound Care 2020; 29(Suppl 3b):S1–28.