Biofilm plays an important role to hinder the appropriate wound healing process of pressure ulcers, thus biofilm-based wound care has been attracting clinician’s attention. To offer biofilm-based wound care, methods for visualization and elimination of biofilm are needed in clinically applicable form. For visualizing the biofilm distribution, conventional microscopic approach using biopsy samples is not appropriate because it is invasive, cost- and time-consuming, and at risk for overlooking the biofilm. Furthermore, conservative sharp wound debridement using scissors and scalpels is sometimes inappropriate due to its invasiveness. To tackle these problems, we offer biofilm-based wound care system (BWCS), a combination of wound blotting as a point-of-care testing for biofilm distribution and performance of ultrasonic debridement, for promoting wound healing.
The biofilm detection system employs the sterilized wound blotting technique which captures small molecules including polysaccharide on the wound surface. Blotted membranes are then stained by alcian blue to visualize the biofilm component on the membrane. The staining process takes only 2 minutes and is easily performed at the patient’s bedside (Nakagami et al., Wound Repair Regen, 2017). For concurrent validity we confirmed the image analysis of signal intensity can be used for biofilm quantification (Astrada et al, J Wound Care, 2021). For predictive validity, we prospectively observed the pressure ulcers to confirm whether the presence of biofilm on the wound surface precedes the delayed wound healing (Nakagami et al., Wound Repair Regen, 2017). This technology has been approved by Japanese government and is now commercially available in Japan as a point-of-care biofilm detection tool.
We conducted an observational study to investigate the effectiveness of biofilm-based wound care system (BWCS) which comprises biofilm detection and less-invasive ultrasonic debridement on wound healing in home care setting. The proportions of wound healing between wounds treated with BWCS and those with standard care in the home-visiting clinic were compared by Kaplan–Meier curve, and the Cox proportional hazard modeling was used to assess the effect of BWCS on wound healing. The proportion of wound healing within 90 days was significantly higher in wounds treated with BWCS than in those treated with standard care (p = 0.001). The adjusted hazard ratio of BWCS for wound healing was 4.5 (95% confidence interval, 1.3–15.0; p = 0.015) (Mori et al., Wound Repair Regen, 2019). BWCS using wound blotting is a promising approach to enhance wound healing in hard-to-heal wounds. Here we offer our novel technique to visualize the biofilm and efficiently eliminate wound biofilm which will help clinicians to solve the biofilm-related wound deterioration or infection.

Nakagami G, Schultz G, Gibson JD, Phillips P, Kitamura A, Minematsu T, Miyagaki T, Hayashi A, Sasaki S, Sugama J, Sanada H. Biofilm detection by wound blotting can predict slough development in pressure ulcers: A prospective observational study. Wound Repair and Regeneration. 2016;25(1):131-8.
Nakagami G, Gregory S, Kitamura A, Minematsu T, Akamata K, Suga H, Kurita M, Hayashi C, Sanada H. Rapid detection of biofilm by wound blotting following sharp debridement of chronic pressure ulcers predicts wound healing: A preliminary study. International Wound Journal. 2019. doi: https://doi.org/10.1111/iwj.13256
Mori Y, Nakagami G, Kitamura A, Minematsu T, Kinoshita M, Suga H, Kurita HM, Kawasaki A, Sanada H. Effectiveness of biofilm-based wound care system on wound healing in chronic wounds. Wound Repair and Regeneration. 2019;27(5):540-7.
Astrada A, Nakagami G, Minematsu T, Goto T, Kitamura A, Mugita Y, Sanada H. Concurrent validity of biofilm detection by wound blotting on hard-to-heal wounds. Journal of Wound Care. 2021;30(Sup4):S4-S13.

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