Wound bed preparation against biofilm formation

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Biofilm - a major issue in wound healing

The presence of biofilm is reportedly present in 60-100% of non-healing wounds (WUWHS Biofilm Position Paper, 2016). While the role that biofilm plays in the chronicity of wounds is still not fully investigated, it is becoming widely accepted that hard-to-heal wounds contain biofilm - and somehow its presence delays or prevents healing. 

Therefore the management of biofilm in chronic wounds is rapidly becoming a primary object of wound care. 

Why are biofilms such a problem and what kind of solution is available?

Wound bed preparation taken seriously

Only a clean wound can heal

The concept of  ”Wound bed preparation“ was first described by Falanga et al (2000) and can be defined as the global wound management procedure to accelerate endogenous healing and enhance the effectiveness of advanced wound care products. The ultimate aim is to ensure healthy granulation tissue formation resulting in complete wound closure.

Correct Chronic "Wound bed preparation" is achieved by:

  • Reducing bacterial bioburden e.g. biofilm in the wound bed
  • Removing necrotic tissue and slough
  • Controling exudates
  • Managing cellular dysfunctions and biochemical imbalances

Trust in Prontosan® for wound bed preparation

With Prontosan®  we provide a leading concept for wound bed preparation based on an unique combination of Polihexanide and Betaine. Several clinical studies prove faster wound closure, less complications and better quality of life. Prontosan® helps manage infection prevention, cleansing/debridement as well as wound bed moistening. Prontosan®  is your partner in preventing and treating the formation of biofilms.

Prontosan® for biofilm removal

Prontosan removes debris, slough, bioburden and biofilm*

Wound irrigation with Prontosan® removes debris, slough, bioburden and biofilm*

Glide over the biofilm without removing it*

Traditional irrigation solutions are likely to glide over the biofilm without removing it.*

Mechanical wound debridement

Mechanical wound debridement with Prontosan® Debridement Pad

The latest addition to the Prontosan® product family is the Prontosan® Debridement Pad. It has been designed to support the Wound Bed Preparation by providing rapid, effective and safe debridement of the wound. 

Chronic wounds generally require repeated debridement. The Prontosan® Debridement Pad has been designed to support the Wound Bed Preparation with Prontosan® Wound Irrigation Solution. The Pad consists of a front layer with microfibers that debride and an absorbent backing layer for rapid, effective and safe debridement. Prontosan® Debridement Pad frees the wound from coatings and dead cell residues (debris) and absorbs excess exu­dates and slough. Intact tissue is spared. Prontosan® Debridement Pad produces good results even with scaly and necrotic coatings, if they are subject to prior autolytic treatment.

The unmarked side of the pad has to bee moistured with 15 – 20 ml of Prontosan® wound irrigation solution*. If local guidelines exist, they have to be followed. Apply gentle pressure, wipe the moiste­ned side over the wound and / or adjacent skin in a circular motion.

Following debridement, it is advisable to irrigate the wound thoroughly for a second time with Prontosan® Wound Irrigation Solution and to continue with standard treatment.

How do microfibers work?

Microfibers are able to attach themselves to even the smallest, most microscopic particles—ones that normal monofilament fibers (positively giant in comparison) crudely brush past. If forces were visible, you‘d be able to see that there are adhesive forces between microfibers and the particles. There are millions of microfibers in a pad, so the overall sticking effect is magnified dramatically. That‘s why cell residues (debris), exudate and slough can be «hoovered up» by microfiber cloths. 

Product Information & Case Studies

Description Document Link
Debridement Pad_IC2750_3064_05.19.indd For soft mechanical debridement of slough and debris. Product presentation.
pdf (2.6 MB)
Wounds UK Publication - Prontosan Debridement Pad Case Studies Advances in wound cleansing: an integrated approach
pdf (1.7 MB)
Prontosan® Debridement Pad made easy Wounds International publication
pdf (1.5 MB)

Valuable information about Prontosan®

Description Document Link
Prontosan® product range
pdf (2.1 MB)
Wound bed preparation taken seriously
pdf (2.9 MB)
Prontosan® master pathway
pdf (793.4 KB)

Understanding wound bed preparation - interviews

In this '5minutes, 5 questions' series of talking heads, Professor Keith Harding, Professor Marco Romanelli and Dr Bjorn Behr answer key questions about the concept of wound bed preparation. 

Interviews with Professor Marco Romanelli

  • How does wound bed preparation facilitate the use of advanced therapies?

  • How does wound bed preparation help to accelerate healing?

  • What are the key components of wound bed preparation?

  • When was WBP introduced and how does it differ from good wound care?

  • What factors contribute to a wound’s chronicity?

Interviews with Professor Keith Harding

  • How do topical antimicrobials assist wound bed preparation?

  • How do you select the preferred method of debridement?

  • What procedures do you use to reduce the bacterial bioburden/biofilms in a wound?

  • How can you tell when the wound has a biofilm and what role do biofilms play in delaying wound healing?

  • Prevention and management of infection is an integral part of wound bed preparation. How does it help early recognition of the signs and symptoms of infection?

Publications

Description Document Link
Cleansing versus tailored deep debridement, a fresh approach to wound cleaning; Ricci; 2018
pdf (155.8 KB)
Effect of a wound cleansing solution; Bellingeri; 2016. Saline or water is ineffective at removing fibre, debris and biofilm and therefore not optimal for wound cleansing. Up to 90 % of chronic wounds have biofilm (according to Wolcott R and Attinger C, 2011) which is a major barrier to wound healing. Prontosan® is proven to disturb biofilms in wounds which leads to quicker wound healing and antimicrobial cost reduction. Read the single-blind RCT-study of Bellingeri A et al. about the effect of a wound cleansing solution on wound bed preparation and inflammation in chronic wounds.
pdf (107.3 KB)
Study summary: Bellingeri; 2016.
pdf (99.0 KB)
Re-evaluation of polihexanide use in wound antisepsis in order to clarify ambiguities of two animal studies; Kramer; 2019
pdf (1.4 MB)
Manage and prevent wound infections during COVID-19: Practical Patient Care.; 2020
pdf (41.7 KB)
Effective wound bed preparation: Practical Patient Care; 2020
pdf (2.8 MB)
IWII: Wound infection in clinical practice
pdf (650.5 KB)
Biofilm position paper, 2016 Wounds Internatonal elaborated this position document in collaboration with the World Union of Wound Healing Societies (WUWHS). In this paper leading clinicians look at the role biofilm plays in delayed wound healing, the management of biofilm in practice as well as the understanding of these bacterial communities.
pdf (1.1 MB)

*Seipp HM et al. Efficacy of various wound rinsing solutions against biofilms. ZfW 2005; 4(5):160-163 / Perez R et al. Effect of different wound rinsing solutions on MRSA biofilm in a porcine model. WoundM 2010; 4(2):44-48

1) Attinger, Christopher and Randy Wolcott. “Clinically Addressing Biofilm In Chronic Wounds”. Advances in Wound Care 1.3 (2012): 127-132. Web.

2) Bjarnsholt, T et al. “Biofilm Management”. 2016. Lecture.

3) International Wound Infection Institute (IWII): Wound infection in clinical practice. Wounds International;2016.

4) Bradbury, S and J Fletcher. “Prontosan Made Easy”. Wounds International 2.2 (2016): 1-6. Web. 23 Sept. 2016.

5) Kaehn, K Polihexanide: A Safe and Highly Effective Biocide, Skin Pharmacol Physiol 2010;23(suppl1);7-16