Biofilms

Amy Dukoff, D.M.D.
Biofilms

Amy Dukoff

IOFILMS have become a growing concern for health professionals. A biofilm forms when microorganisms embed themselves into a sticky substance that can adhere to both living and nonliving surfaces. This sticky substance is an exopolymer matrix produced from the microorganisms. The film can be found on medical devices and can be carried in water. Biofilms can lead to infection because the microorganisms that it houses are resistant to many antimicrobial agents.
     Some biofilm-related diseases are well known. Biofilms have been implicated in urinary tract infections, catheter infections, middle-ear infections, formation of dental plaque, and gingivitis. Some biofilm diseases have been linked to chronic wounds, tonsilitis, peritonitis, endocarditis, and otitis media. Since biofilms can be transported on the medical devices needed to treat a patient for other conditions, they may therefore create a secondary problem. Furthermore, many bacteria, including those in bioflims, are becoming more resistant to antibiotics and present an increasing danger to the highly susceptible immunocompromised patient. It is important for the healthcare practitioner to understand the presence of biofilms and to practice techniques to prevent their transmission.
     A growing concern in our delivery systems is our delivery of water. Biofilms are seen in water, and water often transports biofilms. Even purified-water systems are susceptible to biofilms, for there is a large surface area of piping and tanks to which bacteria can attach. The presence of biofilms in water is of concern in dental practices. Implants are an additional concern, because they are also at risk for transporting biofilms. As the use of implants increases, their relationship with biofilms will be an increasing concern. Good infection-control procedures in your practice can help eliminate—or at least reduce—some of the risks.
     There are many useful techniques and chemicals that you can use to combat biofilms. Heating water above 80 degrees Celcius can destroy biofilms within it. Also, adding chlorine to water can aid in controlling bacterial growth. Chlorine is usually added to drinking water systems. Intercept, a new detergent, is useful in removing biofilms and killing the microorganisms within them. This detergent has a neutral pH and, according to a study done by Dr. Thomas Gentle and Dr. Ronald Kippenham, had no reported incidents of skin irritation. In their research, Gentle and Kippenham used surgical clamps, checking them for the presence of biofilms after washing them in Intercept. Biofilms are of grave importance in the medical world, and of increasing concern in the practice of dentistry.
     As dentists, we have been incorporating many medical techniques into our practices to prevent the transmission of diseases, but we musn’t allow ourselves to become complacent. For example, since many of us now use the “Purel” types of chemicals to sanitize our hands instead of the classical hand washing, which may only remove debris, we may think that we are doing enough and therefore be slow in incorporating other measures to help combat biofilms. Biofilms must be of growing concern to all practitioners. We have to increase our knowledge of them and our knowledge of ways to control them.

January - March 2008

Good infection-control procedures can reduce the risks.

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