Wound Dressings and Other Topical Treatment Modalities in Bioburden Control

This is a chapter taken from the book Microbiology of Wounds, published by CRC Press in 2010. It has traditionally been the case that reduction of wound bioburden has been achieved by the use of a topical antimicrobial agent, such as bactericidal antiseptics or antibiotics. This has worked well for many years, however, there are concerns about toxicity and resistance, which have prompted research into other mechanisms. There are various means of removing bacteria from the wound, without recourse to chemical agents; for example, larvae (maggots) ingest bacteria, together with the devitalised tissue of the wound. The control of exudate restricts the availability of free water, impeding the growth of those water-loving bacteria such as the staphylococci and pseudomonads. The discovery that some materials selectively adsorb, or sequester, bacteria has led to the development of bacteriostatic dressing materials, which do not rely on antiseptics for their action. These are designed to physically remove microorganisms, such as bacteria, from the wound, thus reducing bioburden. However, this still demands validation as a clinically relevant mechanism. Until that time, it remains a fascinating theoretical concept.