Contributing Clinical Educator

Andrew Marxen, BAN, RN, CWCN, CWHS, MBA

Infection is one of the most complex and persistent challenges in wound care, especially when it comes to chronic infections. Whether managing a pressure injury, diabetic ulcer, or surgical wound, clinicians face the difficult task of not only identifying infection but also controlling its root causes without contributing to antibiotic resistance. At Wound Care Professionals, we believe in a modern, proactive approach that integrates expert wound assessment, targeted treatment, and long-term prevention—because infection control in wound care is about more than temporarily putting out the fire.

Let’s explore how biofilm, multidrug-resistant organisms, and antibiotic misuse shape the landscape of wound care, and what we as professionals can do to counter them with smarter strategies.

Understanding the Enemy: Biofilm and Chronic Infection

Biofilms are microscopic communities of bacteria that embed themselves in the wound environment, cloaked in a protective matrix that makes them extremely resistant to both antibiotics and the body’s immune system. According to the National Institutes of Health, biofilms are responsible for over 80% of chronic infections.

When biofilm is present, you may not see the classic signs of infection, but healing is delayed, inflammation persists, and traditional treatments yield minimal results. That’s why effective wound assessment must go beyond visible symptoms and include clinical suspicion for biofilm, especially in wounds that stall for more than 4 weeks.

Key signs of potential biofilm presence include:

• Recurrent slough despite proper debridement

• Subtle signs of inflammation without progress

• Frequent need to restart antibiotics

Removing biofilm requires targeted strategies, such as sharp or mechanical debridement, appropriate antimicrobial dressings, and wound hygiene protocols that consistently clean the wound bed and disrupt the biofilm structure.

Action Tip: Schedule regular debridement appointments for chronic wounds and incorporate wound hygiene techniques to prevent biofilm buildup between visits.

The Role of Antibiotic Stewardship in Wound Care

Let’s be honest: antibiotics are often overused in wound management. Although they can be life-saving, unnecessary prescriptions can increase resistance, disrupt healing, and harm future treatment options, not just for the patient, but across the healthcare system.

Antibiotic stewardship promotes the responsible use of antimicrobials by ensuring:

• Antibiotics are prescribed only when there’s clear evidence of systemic infection.

• The narrowest-spectrum agent is chosen.

• Treatment is guided by culture results whenever possible.

• Duration is minimal but effective (typically 7–14 days max for soft tissue infection).

This isn’t just a theoretical talking point; it’s a practical necessity. A 2023 review in Wound Practice and Research reported that implementing antimicrobial stewardship in wound care led to measurable improvements, including the de-escalation of antimicrobial use, dosage changes in 25% of cases, and duration adjustments in 46.3% of cases. Overall, the review demonstrated that AMS programs deliver tangible clinical benefits for patients.2 At Wound Care Professionals, we champion education and protocols that help clinicians distinguish between colonization, local infection, and systemic infection.

Action Tip: Incorporate clinical infection criteria (such as NERDS and STONEES frameworks) into your wound assessment process to guide better decisions on antibiotic use.

Elevating Wound Assessment to Prevent Infection

It all begins with good wound assessment. Experienced clinicians know that infection doesn’t always present with pus or odor—and that early detection and prevention require a systematic evaluation of the wound itself, patient factors (e.g., diabetes, immobility), and the wound environment.

Our recommended five-step process for proactive infection control includes:

1. Comprehensive visual and tactile assessment

2. Evaluation of exudate volume and type

3. Assessment of periwound tissue and signs of infection

4. Identification of risk factors for chronic infection (e.g., ischemia, neuropathy)

5. Documentation and standardized wound scoring tools

When wound assessment is done well, it drives smarter decisions—from selecting the right dressings to understanding when systemic antibiotics are (or are not) appropriate.

Action Tip: Explore our CE course on Advanced Wound Assessment Skills to sharpen your eye and practice evidence-based infection prevention.

Putting It All Together: A New Infection Control Mindset

Infection control in wound care demands both precision and prevention. From aggressively managing biofilm in chronic wounds to minimizing unnecessary antibiotics through stewardship, modern wound management is evolving—and so must we.

At Wound Care Professionals, we offer tools, education, and community support that empower clinicians to improve wound outcomes responsibly. Need help building an infection management protocol for your team or practice? We’re here to support your growth from hands-on strategies to big-picture thinking.

Partner with Experts in Infection Control

Want to take your infection control strategy to the next level? Contact Wound Care Professionals today to learn more about how we can help you with Infection Control in Wound Care: From Biofilm to Antibiotic Stewardship. Whether you’re looking for continuing education, product recommendations, or clinical consulting, we’re here to empower your next step.

Ready to dive deeper? Contact us today to connect with our experts, strengthen your knowledge, and implement smarter, evidence-based strategies that improve outcomes for both patients and providers.

Sources

1. NIH. “The Role of Biofilms in Chronic Infections.” https://www.ncbi.nlm.nih.gov/books/NBK190429/

2. Wound Practice and Research. “Antimicrobial stewardship in wound care: Measurement, implementation and outcomes,” 2023. journals.cambridgemedia.com