Clinical indicators of wound infection and biofilm: reaching international consensus
Abstract
Objective:
To achieve international consensus relating to clinical indicators for a chronic wound, wound infection and biofilm presence to inform the development of international clinical guidance for assessing and managing wound infection.
Method:
An online Delphi consensus process of international key opinion leaders in infection was undertaken. A literature search underpinned the development of issue statements related to terminology, emerging topics and debate in the field of wound infection. Experts participated in three rounds of consensus voting, sharing their opinions and indicating their level of agreement with the issue statements. Votes were calculated using web-based software that implements a nominal group voting methodology previously published by Research and Development/University of California at Los Angeles.
Results:
A total of 14 experts took part in the development process. Consensus was reached on clinical indicators of wound chronicity, wound infection and biofilm presence. Agreement was also reached that the term ‘critical colonisation’ should no longer be used to refer to a stage in the wound infection continuum.
Conclusion:
Outcomes from the consensus process were used to inform the development of international, evidence-informed guidance on the assessment and treatment of wound infection to promote improved outcomes for people with wounds.
Declaration of interest:
There were no external sources of funding for this study. The authors have no conflicts of interest to declare.
In 2008, the International Wound Infection Institute (IWII) produced the first international guidance document on the identification and management of wound infection.1 Endorsed by the World Union of Wound Healing Societies (WUWHS), the document was developed by volunteer, multidisciplinary health professionals with expertise and interest in wound infection.1 The production of this consensus document acknowledged the evolution of wound management (particularly for chronic wounds) from a focus on assessing wounds and following standard protocols to greater understanding of underlying biological processes that cause wound infection and its progression.
Since publication of IWII's 2008 consensus document,1 awareness and understanding of wound infection has developed at an exponential rate. The most significant advance in this field is the recognition and increasing understanding of wound biofilm. In the same year that IWII published its first consensus document, several studies were published that documented the presence of biofilm in human wounds,2–4 as was an early commentary on biofilmbased wound management.5
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