By Dr. Martin Vasilev, Tissue Viability Lead ยท Category: Wound Care Science ยท Published 8 April 2026
Most hard-to-heal wounds are not stalled because the wrong dressing was chosen. They are stalled because something is living in them. Biofilm is present in the majority of chronic wounds, and until it is disrupted, even the most sophisticated dressing is working against a rigged system.
Why biofilm changes the plan
Biofilm is a community of micro-organisms encased in a self-produced protective matrix that adheres to the wound bed. That matrix is the problem. It shields the organisms from host immune defences, from systemic antibiotics and from many topical antimicrobials. It re-forms quickly โ often within 24 to 72 hours of disruption โ which is why a single heroic intervention rarely works.
Biofilm is also largely invisible. Clinicians cannot reliably see it, so it has to be assumed rather than diagnosed. The practical consequence is simple: if a wound has failed to progress despite appropriate care, treat it as though biofilm is present.
Clues that biofilm is holding a wound back
- The wound has not reduced in area by roughly 40 to 50 per cent after four weeks of standard care.
- There is friable, shiny or gelatinous tissue that returns quickly after cleansing.
- Exudate levels are persistently high without another obvious cause.
- Granulation tissue looks unhealthy, pale or overly bright and bleeds easily.
- The wound responds briefly to antimicrobials and then plateaus again.
The four-step wound hygiene framework
Wound hygiene reframes wound bed preparation as routine maintenance rather than an occasional rescue. Like brushing teeth, it works because it is repeated at every dressing change, not because any single episode is perfect.
- Cleanse. Cleanse the wound bed and the surrounding periwound skin, at least 10 to 20 centimetres beyond the wound margin. Use a surfactant or antimicrobial cleansing solution with mechanical action โ a gauze, pad or monofilament cloth โ rather than passive irrigation. Passive rinsing does not lift a biofilm matrix.
- Debride. Remove devitalised tissue, slough and residual biofilm using the most effective method available to you and tolerable for the patient: sharp, mechanical, ultrasonic, larval or autolytic. Debride to the point of discomfort tolerance, not to an arbitrary endpoint, and repeat at every review.
- Refashion the wound edges. Rolled, callused, dehydrated or overhanging edges harbour biofilm and physically prevent epithelial migration. Removing hyperkeratosis and freshening the margin is the step most often skipped and most often decisive.
- Dress the wound. Apply a dressing that will continue the work between visits โ managing exudate, maintaining an optimal moist environment and, where indicated, delivering sustained antimicrobial action to suppress biofilm reformation.
Where dressing choice does the heavy lifting
Steps one to three happen while you are with the patient. Step four has to work for the next three to seven days without you. This is where dressing technology matters.
- Hydrofiberยฎ Technology gels on contact with exudate, locking fluid and the bacteria within it into the dressing structure rather than allowing lateral spread to the periwound skin. Clinicians have relied on it for more than 25 years.
- AQUACELยฎ Ag+ Extraโข combines that gelling action with MORE THAN SILVERโข technology, which is designed to disrupt the biofilm matrix and expose the organisms within it to the antimicrobial.
- ConvaFoamโข supports exudate management and protection where a foam profile suits the wound and the patient's lifestyle.
- DuoDERMยฎ hydrocolloids support autolytic debridement in lightly exuding or sloughy wounds.
Making it stick in a real service
Frameworks fail when they add time nobody has. Teams that embed wound hygiene successfully tend to do four things.
- Standardise the cleansing solution and the debridement tools so no one has to hunt for kit.
- Write the four steps into the dressing change record so the edges step cannot be quietly dropped.
- Photograph and measure at week two and week four, and treat a stalled trajectory as a trigger for escalation rather than a reason to continue.
- Train the whole team, including community colleagues, so the protocol survives handover.
The bottom line
Biofilm is the default assumption in a hard-to-heal wound, not the exception. Cleanse, debride, refashion the edges and dress โ every time, not occasionally. It is unglamorous, repeatable and, for a great many patients, the difference between a wound that closes and one that does not.
Convatec Academy offers accredited modules, webinars and product selection tools on wound hygiene and biofilm management for clinical teams.