1 A biofilm (literally = living thin layer) consists of a community of micro-organisms of various species, which are bound in a three-dimensional matrix of Extracellular Polymeric Substances (EPS). The EPS consist largely of sugar compounds. Biofilms form on a wide variety of surfaces and materials, e.g. on living tissue such as wounds, invasive indwelling instruments and in artificial or natural aquatic systems. As biofilms are bound firmly to these surfaces, they cannot be removed by simple rinsing. Characteristics features of biofilm are their increased resistance to many antimicrobials substances, to drying out and to the defense mechanism of the host organism. Acute or chronic wounds are susceptible to infection because micro-organisms in the form of a biofim can invade the wound milieu. As soon as a wound is contaminated with micro-organisms, and especially if these have formed a biofilm, wound healing is impaired.. In a recent study by James et al (2007) it found that in 60% of chronic wounds a biofilm is present. Once a biofilm is disturbed & removed a wound can heal quicker What is a biofilm?

2 The formation of a biofilm takes place in several phases

3 (I) Biofilm building - bacteria adhere and replicate to a surface Surface flow direction

4 (II) Building up a biofilm Surface flow direction

5 (III) Bacterial Growth inside the biofilm Surface flow direction

6 (IV) Bacteria build up a biofilm to protect themselves from enemies Surface flow direction

7 (V) Release of bacteria, leading to renewed colonisation elsewhere and again bacteria replication Surface flow direction

The problems a biofilm creates 8 Once a biofilm is disturbed & removed a wound can heal quicker

Prontosan – the answer to biofilm removal 9 The usually applied solutions for the irrigation of wounds (saline, water etc) glide over the biofilm without removing it PRONTOSAN is able to remove the biofilm by destroying it’s structure Prontosan contains betaine which is a surfactant and this physically removes biofilm this making wound healing possible.

10 Clinical Evidence StudySummary Seipp H M, Hofmann A, Hack A, Skowronsky A, Hauri A, (2005 – 2007) Efficacy of various wound irrigants against biofilm This study tested Prontosan, Saline and Ringers in there efficacy against biofilm of Pseudomonas Aeruginosa. Baseline biofilms were unaffected by Ringers and Saline but Prontosan reduces biofilm with no adverse affects enabling healing to take place. Kaehn K,Eberlein T, (2009) In-vitro test for comparing the efficacy of wound rinsing solutions The aim of this study was to test the efficacy of Saline, Ringers, Prontosan and Ocenisept to solubilize and remove wound coatings using a wound coating model. Prontosan was the only solution were the test coatings disintegrated and the denatured proteins solubilized. The test coatings became fixed and insoluble when immersed in Octenisept. James A, (2007) Biofilms in chronic wounds Light and scanning electron microscopy techniques were used to analyze 50 chronic wounds and 30 were characterized as containing biofilms (60%). Molecular analysis was performed on the remaining 27 chronic wounds, this revealed diverse polymicrobial communities and the presence of bacteria. Phillips PL, Wolcott RD, Fletcher J, Schultz GS, (2010) Biofilms made easy This article describes what biofilms are and the important roles they play in disrupting wound healing. In addition, it discusses potential interventions (Prontosan) aimed at removing / reducing biofilms and preventing their reformation in wounds. TO READ FULL STUDIES – PLEASE GO TO THE CLINICAL EVIDENCE SECTION