This content is modified from a poster presented at Wounds UK November 2022.

Guest et al (2020) in their study of 2017/18 data identified that 30% of wounds (1.1 million) were non-healing. A critical element to this has been biofilms: Understanding them and their role in preventing wounds from healing has revolutionised the way clinicians now view non-healing wounds. Prontosan Solution and Gel X both contain betaine, a surfactant that can help break the bonds securing biofilm and non-viable tissue to the wound bed and can help with preventing biofilm (IWII, 2022). The Prontosan Debridement Pad is a microfibre tear drop shaped thin pad, it is effective in the presence of emollients, and reported by patients in the author’s Trust to be less painful than the previous product used while also offering a cost saving. 

An 85-year-old patient had lower limb ulceration for 6 years, treated with antibiotics, antimicrobials, superabsorbents and paste bandages. They were unable to tolerate compression, due to a pain score of 5/10.

Biofilm Pathway Treatment

Prontosan soak for 15 minutes due to fixed slough, mechanical debridement with a Prontosan Debridement Pad, topical application of Prontosan Gel X and a DACC swab*, with a superabsorber as the secondary dressing and retention bandage to secure.

The treatment is undertaken three times a week.

The patient had 2 courses of flucloxacillin 500mg QDS in the 6 weeks pre-pathway and 0 courses on the pathway. The pathway started 10.08.2022, debridement finished 28.09.2022.

Conclusion

Prior to introduction of the biofilm pathway, this patient was receiving a silver dressing** at a cost of £19.12 per dressing change. A 3 step Prontosan wound bed preparation system cost just £15.93 per dressing change including the addition of 2 x debridement pads; this suggests prevention of infection with wound bed preparation may present cost savings of 16% compared to standard infection treatments.

The pathway was observed for 10 weeks, 6 weeks included frequent use of a debridement pad and DACC swab. Had the previous care plan continued the cost over 10 weeks would have been £1,149.60, pathway costs over 10 weeks were £1017.89 representing a saving of £131.71 or 11%. As Prontosan Solution £0.28, Prontosan Gel X £2.07. (Costings: October 2022 Drug Tariff.)

Tackling suspected biofilm presence in non-healing wounds with surfactants is supported in the literature (Tyldesley et al, 2019, Murphy et al, 2019, WUWHS, 2019, IWII 2022). A key element is its lack of toxicity to fibroblasts/keratinocytes and ability to cleanse a wide surface area of debris and dirt as well as breaking down the biofilm itself and prevent reformation through deep penetration of slough, necrosis, and the extracellular matrix (Bradbury & Fletcher, 2011 and IWII, 2022).

From a clinical perspective, a key factor is breaking the cycle of allowing the biofilm to reform by maintaining a prevention strategy, this has been achieved with this patient through the judicious use of the Prontosan range.

*4 x 6cm DACC swab

**15 X 15cm silver surfactant chelating hydrofibre dressing

References:

_{Bradbury S, Fletcher J. Prontosan® Made Easy. Wounds International 2011; 2(2). Available from http:// www.woundsinternational.com} 

_{Guest, J. F., Fuller, G. W., & Vowden, P. (2020). Cohort study evaluating the burden of wounds to the UK’s National Health Service in 2017/2018: update from 2012/2013. BMJ Open, 10(12), e045253. doi:10.1136/bmjopen-2020-045253} 

_{International Wound Infection Institute (IWII). 2022. Wound Infection in Clinical Practice. Wounds International.}

_{Murphy, C., Atkin, L., Swanson, T., Tachi, M., Tan, Y. K., de Ceniga, M. V., Wilson, P. (2020). Defying hard-to-heal wounds with an early antibiofilm intervention strategy: wound hygiene. J Wound Care, 29(Sup3b), S1-s26. doi:10.12968/jowc.2020.29.Sup3b.S1}

_{NHS Vacancy Statistics England April 2015 – March 2022 Experimental Statistics. https://digital.nhs.uk/data-and-information/publications/statistical/nhs-vacancies} 

_{Tyldesley H, Salisbury A-M, Chen R et al (2019). Surfactants and their role in biofilm management in chronic wounds. Wounds International, 10 (1). www.woundsinternational.com} 

_{World Union of Wound Healing Societies (WUWHS) Consensus Document. Wound exudate: effective assessment and management Wounds International, 2019}