Reducing Biofilm Infections in Burn Patients’ Wounds and Biofilms on Surfaces in Hospitals, Medical Facilities and Medical Equipment to Improve Burn Care: A Systematic Review

Abstract

Biofilms in burns are major problems: bacterial communities rapidly develop antibiotic resistance, and 60% of burn mortality is attributed to biofilms. Key pathogens are Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus, and multidrug-resistant Acinetobacter baumanii. Purpose: identify current and novel interventions to reduce biofilms on patients’ burns and hospital surfaces and equipment. Medline and Embase were searched without date or language limits, and 31 possible interventions were prioritised: phages, nano-silver, AgSD-NLs@Cur, Acticoat and Mepilex silver, acetic acid, graphene-metal combinations, CuCo2SO4 nanoparticles, Chlorhexidene acetate nanoemulsion, a hydrogel with moxifloxacin, carbomer, Chitosan and Boswellia, LED light therapy with nano-emodin or antimicrobial blue light + Carvacrol to release reactive oxygen species, mannosidase + trypsin, NCK-10 (a napthalene compound with a decyl chain), antimicrobial peptide PV3 (includes two snake venoms), and polypeptides P03 and PL2. Most interventions aimed to penetrate cell membranes and reported significant reductions in biofilms in cfu/mL or biofilm mass or antibiotic minimal inhibitory concentrations or bacterial expression of virulence or quorum sensing genes. Scanning electron microscopy identified important changes in bacterial surfaces. Patients with biofilms need isolating and treating before full admission to hospital. Cleaning and disinfecting needs to include identifying biofilms on keyboards, tablets, cell phones, medical equipment (especially endoscopes), sinks, drains, and kitchens.

Bactogram: Spatial Analysis of Bacterial Colonization in Epidermal Wounds

“…However, a potential explanation for this is the challenge of determining whether sparse bacterial colonies on the Bactogram are associated with the wound or the dressing. This ambiguity may be more prevalent in wounds with few bacteria, such as some of the wounds in this study, and less evident in clinical scenarios with higher bacterial colonization, like chronic wounds 9 , burn wounds 36 , or atopic dermatitis 37 . In this study, it appears that at least approximately 3 × 10 3 CFU/cm 2 bacteria collected by the swab and approximately 5 × 10 3 CFU/cm 2 collected in the dressing fluid are required before colonies become visible on the Bactogram.…”

Antimicrobial activity of stingless bee honey (Tribe: Meliponini) on clinical and foodborne pathogens: A systematic review and meta‐analysis

“…One main concern worldwide is the biofilm formation by several pathogens on wounds, burns, or even intravascular devices due to the robust protection provided by biofilm structure against empirical standard treatments and host immune responses being a persistent source of microbial dissemination (Cangui‐Panchi et al., 2022, 2023; Percival et al., 2015; Rajpaul, 2015; Thomas & Thomas, 2021). To date, few studies have been conducted on the possible antibiofilm effects of stingless bee honey (see Figure 4).…”

Factors associated with cleaning quality of reusable medical devices at a single center in China

“…If improper pre-treatment is implemented, a biofilm can form on the surface of the device within 2 h after the contaminants dry out [ 20 ]. When the biofilm is formed, it can be removed with a certain concentration of peracetic acid, alkali and enzyme cleaning agent and glutaraldehyde cleaning agent [ 21 ]. The results of our study have shown that non-standard/lack of pre-treatment was the significant factor affecting the cleaning quality of reusable medical devices.…”