Biofilm and wound exudates management

Wound exudate is produced by the body as part of the natural healing process and also
due to the body's immune response, however, sometimes it can be problematic for many patients because it indicates an infection and causes tissue damage which may decrease the quality of life.

When adequate wound management and quality dressing choices are not used, it inevitably
results in delayed healing. Moreover, excessive volumes of exudate lead to biofilm formation,
which can also delay wound healing (Atkin, Stephenson, and Cooper, 2020, p.382). Many
factors lead to the production of excessive exudate.

Improper dressing and management, underlying conditions that increase capillary leakages, pathology of the wound, medication such as steroids, the development of edema, increased bacterial burden, and lymphatic functioning failures all can contribute to a less than optimal outcome (Ellis, 2017, p.454). Therefore, effective management is essential to ensure timely wound healing without complications.

The crucial step for managing highly exuding wounds and biofilm formation is a thorough assessment procedure. The assessment procedure includes a clear elaboration of wound exudate type and quantity and identifying the main approach to be utilized in creating an accurate treatment plan (Barrett, Rippon, and Rogers, 2020, p.345). In addition, assessment has an impact on wound diagnosis, treatment, and management (Binkanan, 2019, p.24). The presence of exudate indicates wound infection, an underlying bleeding disorder, trauma, and discharge (Nerenberg, 2016, p.134). All this information combined with appropriate techniques should be used in choosing the right dressing and materials.

The primary approach to managing high exudate wounds and biofilm formation is dressing selection. Different dressing methods have distinct characteristics, and the materials utilized differ in their capability and quality of handling fluid  (Gianino, Miller and Gilmore, 2018, p.51). The characteristics of suitable dressing material that can manage a large quantity of exudate include absorbency, leakage eradication between dressing variations, hindrance of strikethrough, and protection against maceration and excoriation. According to Bowler and Parsons (2016, p.10), the material used for dressing should be utilizable under compression to stay intact or left under the wound for a long time. Likewise, the material should be easily removable to minimize trauma and pain. It should also be relatively affordable and comfortable. Apart from proper dressing selection, wound drainage bags and vacuum-assisted closures are required because they collect large quantities of exudate.

Additionally, a wound that has biofilm infection needs treatment that does not damage the healing mechanism. Treatment choices include wide-spectrum antibiotics, topical agents, and debridement. All these treatments should be utilized concurrently instead of consecutively. Debridement will remove biofilm partially and result in gene expression that will raise virulence (Lindholm and Searle, 2016, p.13). The biofilm will become adaptive and more active. Thus, an intensive approach to managing biofilm is needed, and it should be a repetitive debridement done at least once each week (Beldon, 2016 p.34). Fast removal of exudate from the wound would stop biofilm formation, and there would be less utilization of nutrients in the biofilm. For instance, gelling fiber dressing is used to effectively absorb and retain large amounts of exudate, thereby preventing maceration especially in full-thickness pressure injuries and diabetic foot ulcers.

Another strategy for managing high exudate wounds and biofilm focuses on appropriate wound cleansing. Wound cleansing is performed to eradicate contaminants, debris, dressing remains, and superficial slough (Edwards-Jones, 2018, p.719). Scrubbing of the wound is not recommended because it could lead to trauma (Bowler and Parsons, 2016, p.9).

Patient engagement and preference should also be considered, especially if the patient understands the treatment plan's integral strategies. Some patients may have underlying medical, social, and psychological issues that may go against the proposed wound management plan (Meyer and Enax, 2019, p.287). All medical practitioners should collaborate to determine the best care that reflects the client's needs (Curtis, 2020, p.78). This type of holistic strategy for dealing with exudate and biofilm management is essential and will result in patient concordance and satisfaction.

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