Wound dressings and other topical treatment modalities in bioburden control

Reduction of wound bioburden has traditionally been achieved by the use of topical antimicrobial agents, such as bactericidal antiseptics or antibiotics. This has worked well for many years, however, concerns about toxicity and resistance 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, while the control of exudate restricts the availability of free water, impeding the growth of water-loving bacteria. 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. This is a chapter taken from the book Microbiology of Wounds, published by CRC Press in 2010.