Biofilm detection by wound blotting can predict slough development in pressure ulcers: A prospective observational study

Abstract

Bacteria have been found to form multicellular aggregates which have collectively been termed “biofilms”. It is hypothesized that biofilm formation is a means to protect bacterial cells including protection form the immune response of humans. This protective mechanism is believed to explain persistent chronic wound infections. At times, the biofilms are abundant enough to see, and remove by simple wiping. However, recent evidence has shown that the removal of these visible portions are not sufficient, and that biofilms can continue to form even with daily wiping. In this work, we sought to test an approach to detect the biofilms which are present after clinically wiping and preparing pressure ulcers during dressing changes. Our method is based on a variation of impression cytology in which a nitrocellulose membrane was used to collect surface biofilm components, which were then differentially stained. In this prospective study, members of an interdisciplinary pressure ulcer team at a university hospital sought to test our method's ability to predict the generation of wound slough in the week that followed each blotting. A total of 70 blots collected from 23 pressure ulcers produced 27 wounds negative for staining and 43 positive. 55.6% of the negative blots were found to have either increased or unchanged wound slough generation, while 81.4% with positive staining had either increase or unchanged wound slough generation. These results lead to an odds ratio of positive blotting cases of 25.9 (95% confidence intervals: 1.91–350.67, P=0.014) for slough formation; suggesting that the changes in wound slough formation can be predicted clinically using a non-invasive wound blotting method. This article is protected by copyright. All rights reserved.

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