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Evidence-Based Practice
Addressing biofilm as part of a comprehensive patient and wound treatment plan of care proactively addresses many of the factors that result in hard-to-heal wounds. Biofilm occurs in more than 70% of chronic wounds, and is associated with delayed wound healing. Even after disrupting biofilm and adequately preparing the wound bed, biofilm can begin to reform within 24 hours. Protocols of care, such as Wound Hygiene, that regularly address variables that delay wound healing lead to positive healing outcomes. Wound Hygiene best practices include cleansing, debriding, refashioning wound edges, and dressing wounds while incorporating biofilm based wound management treatment strategies.
Methods:
An evidence-based protocol consistent with Wound Hygiene was implemented in 2018 within an academic health system’s hospital outpatient department based wound center in southeastern Wisconsin. Patients received medical advice and recommendations to address any additional disease specific etiologic mechanisms of delayed wound healing including offloading, compression, smoking cessation education, nutritional management, and diabetic counseling.
An audit of protocol implementation and wound healing rates over 1 month time frame in May 2021 was conducted. All wound types and patient presentations during the specified time period were reviewed including those with complicated comorbid disease states, complex and hard-to-heal wounds, or adherence concerns.
Results:
Data collection and analysis included: wound time to heal, wound type, age, gender, wound size at presentation, biofilm based wound management strategies employed, and whether the full Wound Hygiene strategy was implemented.
Discussion:
Real world data (RWD) represents healing outcomes on patient presentations, comorbidities, and wound types that commonly present to wound centers. These patients are typically excluded from clinical trials. RWD on the implementation of Wound Hygiene supports implementing this proactive protocol of care to expedite wound healing in all patient types and situations especially those with complex comorbid disease status, hard-to-heal wounds, and plan of care adherence concerns.
Trademarked Items: Wound Hygiene
References: 1. Murphy C, Atkin L, Swanson T, Tachi M, Tan YK, Vega de Ceniga M, Weir D, Wolcott R. International consensus document. Defying hard-to-heal wounds with an early antibiolm intervention strategy: wound hygiene. J Wound Care 2020; 29(Suppl 3b):S1–28.
2. Wolcott RD, Rumbaugh KP, James G, et al. Biofilm maturity studies indicate sharp debridement opens a time- dependent therapeutic window. J Wound Care. 2010;19(8):320-328. doi:10.12968/jowc.2010.19.8.77709
3. Sakarya S, Gunay N, Karakulak M, Ozturk B, Ertugrul B. Hypochlorous Acid: an ideal wound care agent with powerful microbicidal, antibiofilm, and wound healing potency. Wounds. 2014;26(12):342-350.
4. CDC. Antibiotic Use in the United States, 2018 Update: Progress and Opportunities. Atlanta, GA:
US Department of Health and Human Services, CDC; 2019.
5. Carter MJ, Fife CE, Walker D, Thomson B. Estimating the applicability of wound care randomized controlled trials to general wound-care populations by estimating the percentage of individuals excluded from a typical wound-care population in such trials. Adv Skin Wound Care. 2009;22(7):316-324. doi:10.1097/01.ASW.0000305486.06358.e0