Surfactants and their role in wound cleansing and biofilm management
Abstract
Surfactants are widely used as detergents, emulsifiers, wetting agents, foaming agents and dispersants in the cosmetics, hygiene, food and oil industries. Their use in a clinical setting is also common, particularly within the field of wound care. Many wound cleansers contain surfactants and subsequently there is available data that shows the growing potential of these wound cleansers in the enhancement of wound closure. The presence of microorganisms in wounds has been recognised as a significant factor that delay healing. In complex or chronic wounds that are complicated by biofilms, persistent inflammation or the production of non-viable tissue and slough, the use of surfactants has been shown to aid in the removal of these barriers to wound healing. The use of concentrated surfactant(poloxamer) based wound dressings represent an important component of wound management. Consequently, this article will discuss the effect of clinically used surfactants, with specific focus on a concentrated poloxamer for use against wound biofilm.
Many wounds become stalled or do not progress through the normal stages of wound healing. The longer a chronic wound remains open, the greater the likelihood of biofilm formation.1,2 While antibiofilm strategies are complex and multifaceted, their key components comprise wound cleansing, regular debridement and the use of antimicrobial dressings to prevent its reformation. The most common options for debridement are surgical and sharp and dressings that promote autolysis. The latter can be used in conjunction with surgical and sharp debridement, or as an alternative when they are not available or desired. Recently, surfactants have been promoted as another option as they can cleanse, remove slough and most types of necrotic tissue and are active against biofilm.
Surfactants are used extensively in all walks of life and are often applied to the skin, clothes and other materials to remove dirt, reinforcing their role as cleaning agents. Soap is one of the earliest examples of a surfactant: its ability to increase the miscibility (how completely two or more liquids dissolve in each other) of dirt and oils enhances their removal from the skin surface. As well as removing dirt, surfactants have also been reported to enhance the removal, via sequestration (the uptake, trapping and locking in) of microorganisms. This indicates that they can play a major role in biofilm management and infection control. Surfactants can be chemically synthesised (synthetic) or occur naturally. Surfactants such as poloxamer 188 are used widely in medicine.
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