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Learn how clinical protocols can help battle biofilm—and chronic wounds

When you help a chronic wound turn the corner to healing, it’s a well-deserved victory. But wounds can be stubborn, and wound care experts are now realizing that one of the biggest barriers to healing is the presence of biofilm.

Biofilm may be “the single most important cause of delayed wound healing.”

Biofilm formation

To understand what biofilm is, it’s useful to explain how it forms.2 There are essentially three stages to biofilm development:

Stage 1

Planktonic, or free-floating, bacteria attach to a surface in a moist environment and begin to produce a slimy, protective layer referred to as the extracellular polymeric substance (EPS).

Stage 2

EPS holds the biofilm together and allows it to develop a complex community of sometimes up to hundreds of types of bacteria.

Stage 3

Groups of cells detach and form new attachments, leading to continued growth of the biofilm.

For wound healing, biofilm poses several challenges:3

  • Stimulates inflammation
  • Elevates levels of proteases to harmful levels
  • Increases exudate and fibrin slough

Learn more

Management of Chronic Wounds
In his webinar “Management of chronic wounds: chronic wounds are chronic infections caused by biofilm,” leading wound care expert and Medline consultant Dr. Randall Wolcott points out that biofilm is tough to manage, having survived catastrophic events on earth for billions of years. “You don’t live 4 billion years by being lucky,” Dr. Wolcott says.

Managing biofilm requires aggressive action. “No half measures will be successful.”
Dr. Randall Wolcott, leading wound care expert and Medline consultant

Stepped approach

To effectively manage biofilm, there are experts such as Dr. Wolcott who suggest a “Step down, step up” approach.¹ It starts with debridement.

A surfactant-based wound care gel such as PluroGel helps with debridement, removing necrotic tissue and slough—and removing barriers to healing. Its distinctive formulation creates a gentle rinsing effect on a molecular level. The result is a softening and loosening of debris on the wound bed.

Product photo of PluroGel

Proven science4
In an ex vivo study on pig skin, researchers compared bacterial biofilm levels using two different methods:

  1. A surfactant-based wound gel
  2. Traditional wiping with saline-moistened gauze

After a three-day regimen of either surfactant or gauze, total bacteria in the surfactant-treated explants steadily decreased, with no detectable bacteria on day three. The wiping-only control bacteria counts initially decreased, but by day three were back to original counts.

Battle the toughest biofilms
Discover a proactive strategy to fight biofilm in acute and chronic wounds using two innovative tools.
Learn how

Combination therapies

Debridement is essential to reducing biofilm, but it doesn’t get rid of it completely. After seeing improvement in a wound, it’s time to step down to individual and customized healing therapies that may include an antibacterial such as IoPlex Iodopher Foam Dressing.

IoPlex is a hydrophilic absorbent foam dressing complexed with slow-release iodine for biofilm management. It’s been shown to manage biofilm in-vitro5 and reduce bacterial burden within the wound dressing. Its unique controlled-release system allows for regulated and sustained infection management through the slow release of iodine within the wound dressing.

Keep checking in

Throughout the process of healing, be sure to regularly reassess each individual wound to make sure your plan is still working. Each patient is different and may have varied colonization and comorbidities. You may need to step back up and down multiple times. Your persistence and efforts with hard-to-heal wounds can help keep biofilm at bay and allow the wound to heal.

Key takeaway

Biofilm presents arguably the greatest barrier to healing challenging wounds. It’s important to understand the mechanisms of biofilm in order to manage it and help those difficult wounds heal. Using products specifically designed for biofilm management will help you make skin health second nature.


  1. Consensus guidelines for the identification and treatment of biofilms in chronic nonhealing wounds
  4. Yang Q, Larcose C, Porta AD, Della Porta AC, Schultz GS, Gibson DJ. A surfactant-based wound dressing can reduce bacterial biofilms in a porcine skin explant model. International Wound Journal. 2017;14(2):408-413
  5. Data on file