Chronic wounds are not kitchen counters; they are delicate ecosystems.

Biofilm is trending again, but let’s have an honest talk about it. The truth is, in chronic wounds we rarely achieve true eradication of biofilm; we manage and control it.

Lately, I have seen so many posts acting like biofilm is some new final boss in wound care, but that silver-bullet thinking is usually just hype. We need to stay grounded in the science of how humans actually work.

We have to remember that humans are not sterile machines; we are living, breathing ecosystems. We don’t just have a microbiome (bacteria); we also have a mycobiome (fungi) and a virome (viruses). These communities live on and in us all the time. Biofilm isn’t always an outside invader; it’s often a survival strategy, a protective “house” microbes build that can increase tolerance to immune pressure and many of the interventions we use.

Because of this, chasing “sterilization” is the wrong goal. You can’t turn a wound into a desert. The real target is to restore a more functional balance: move away from dysbiosis (where harmful microbes dominate) and toward conditions where the body can heal.

In the clinical practice, this means a rigorous and consistent Wound Hygiene approach to disrupt and control. We physically disrupt biofilm architecture through appropriate debridement and deep cleansing, and then use tissue-safe, evidence-informed adjuncts to help limit regrowth and reduce bioburden.

Important: When there are clear clinical signs of infection, systemic antibiotics and source control remain essential, biofilm-aware care complements, but never replaces, acute infection management and antibiotic stewardship.

However, treating the wound surface is only half the battle. If we don’t fix the host, the person the wound is attached to, local treatment is clinically insufficient. We must manage perfusion/blood flow, glycemic control, offloading/pressure redistribution, edema, and nutrition. If the body isn’t supported, biofilm can re-establish quickly. We should avoid overclaiming what products can do and focus on biofilm-aware care that treats the whole patient.

Bottom Line: We need to move past the idea that managing a wound is like cleaning a kitchen counter, and start embracing the reality that we are managing a delicate ecosystem.



Note: This reflects my personal clinical perspective. I’ve focused on biofilm in chronic wounds for the last 10 years, from my initial MSc dissertation to daily practice.