Advancing Wound Care: Lessons from the Wound Hygiene Podcast Series

From Crisis to Care: The Four Steps Transforming Wound Healing

There is a significant healthcare crisis around chronic wound care. Healing wounds is challenging, costs are rising, and we face complex cases and the growing threat of antimicrobial resistance. To tackle the issues, wound care has to shift from passive care to proactive management.¹

Convatec’s Wound Hygiene Bite-Size Podcast series explored their four-step protocol of care, designed to simplify and standardise best practice that has been shown to offer a statistically significant reduction in wound size and wound volume by frontline clinicians.³ With the wound hygiene protocol, any clinician can consistently tackle wounds across all steps: cleanse, debride, refashion, and dress.¹

Hosted by Shelley Hawkins, Strategic Customer Engagement Manager at Convatec, and featuring experts in microbiology, clinical strategy, and wound care innovation, this six-episode series covered all the pressing issues, from biofilm to debridement.¹

We’ve summarised our highlights from the whole series right here.

Why do we need the Wound Hygiene Protocol? 

It’s clear that global wound care is in crisis. As Rachel Torkington-Stokes, Director of Clinical Solutions, explained in episode one, an ageing population, rising co-morbidities, and resistance to antimicrobials have created a complex clinical and economic problem.¹

This is why Convatec convened international experts to identify a new approach, the Wound Hygiene Protocol: a four-step model of cleanse, debride, refashion, and dress. This protocol empowers all clinicians (regardless of skill mix or setting) to take proactive steps that drive better outcomes.¹

Biofilm: A true challenge for healthcare professionals¹ 

In episode 2, we focused on biofilm. Dr. Kate Meredith, Principal Scientist and Microbiologist, explained biofilms are sophisticated bacterial communities encased in a protective matrix.

Present in around 80% of hard-to-heal wounds, biofilm represents a major barrier to healing.⁴
What makes biofilms particularly problematic is their resilience. Protected by their extracellular slime, bacteria can resist both antibiotics and antiseptics. They also communicate and adapt through quorum sensing, sharing genetic material that increases resistance, while sleeper cells restart the infection.

Unlike acute infections, biofilms create chronic, low-level infections that undermine tissue repair and frustrate traditional care strategies. Kate likened them to the plaque on our teeth — regular, twice-daily intervention is essential. In wound care, we must adopt a similar proactive, structured approach to eliminate the biofilm entirely.

What is the Wound Hygiene Protocol: Step-by-Step 

Cleaning: Look beyond water and saline

In episode three, we jumped straight into therapeutic cleansing with Dale Copson, Clinical Strategy Manager and Tissue Viability Nurse (TVN). 

He started by emphasising that cleansing can no longer be a passive rinse with saline, but an active treatment.¹ Expensive dressings can’t stick to debris, so therapeutic cleansing has to be done. We must shift from the mindset of ‘getting ready to dress’ to actively focusing on getting rid of dead cells, exudate, and planktonic bacteria.¹

As Dale stressed, this is about moving past water of saline and using what will cut through the biofilm. While the common sense advice stands — change wipes frequently and don’t double dip — Dale stressed that it’s the surfactants in cleaning that hold the power to help destabilize the structure of biofilm and prevent bacteria from sticking to the wound bed.¹ He even used an analogy of cleaning a greasy frying pan with detergent to loosen stubborn residues.

The second key principle? The cleaning must be purposeful, extending around the surface skin by 20 cm. This zone needs protecting too. The mantra is clear: “Clean it like you mean it.” 
Thorough, intentional cleansing lays the foundation for healing.¹

Debridement: Any clinician can remove unviable tissue 

In episode 4, we discussed removing unwanted tissue from the wound area, a task that any clinician can contribute to. Effective debridement, as explained by Angela Walker, Clinical Strategy Manager and podiatrist, doesn't have to be done with a scalpel.¹
With purpose, debridement that clears away non-viable tissue and disrupts biofilm formation can be performed using a cleaning pad (mechanical debridement), or alternative methods such as larval therapy or ultrasonic options.¹

Angela explained that what to look for is pinpoint bleeding. Tiny pink pricks are a good sign that the dead layer of surface biofilm has been removed and the body can now start the proper healing process.¹

Of course, it’s important to only debride after a patient assessment. Clinically, you would also avoid doing so if a lack of blood flow was an issue or if there was an underlying issue with blood flow. Critically, debridement is not a one-off process. For hard-to-heal wounds, this should become part of the care routine, done progressively and with the intention of continually disrupting the biofilm.¹

Refashioning: From cliffs to beaches 

Proactive wound care doesn’t stop at the centre of the wound either: The whole wound bed must be considered.¹

In episode 5, Jo Wilkins, Clinical Strategy Manager and TVN, described that while the wound edges are places for epithelialisation and contraction-driven closure, they are also hotspots for biofilm, which can suppress new cell growth.¹

That’s why refashioning, through cleaning and debriding the edges — whether with gauze and solution for minor build-up, or mechanical/sharp tools for heavier callus — is so important.¹

There shouldn’t be a stark contrast between healthy and dead skin. Jo made an analogy that contrasted “cliffs” (raised, thickened edges requiring more work) with “beaches” (smooth, low-lying edges closer to closure). The goal is to achieve alignment between the edge and the bed, enabling healthy tissue to migrate and close the wound.¹

Dressing: Not any will do!

In episode 6 of the series, Adam Campbell-Train, Brand Manager, addressed common myths about antimicrobial dressings, particularly silver dressings.¹

You may not be aware that the well-known “two-week rule” for silver dressings is not entirely accurate. While you may have been told to stop use after two weeks, the guidance should be about reassessing effectiveness. If improvement is ongoing, but signs of biofilm are present, silver dressings should be continued. As things improve, you may be able to step down to an antimicrobial dressing, such as Aquacel® Extra™.¹

Adam also clarified that silver dressings are not limited to visibly infected wounds. Redness, heat, pus, and fever are always identified as signs of infection, but biofilm has other, more covert signs. Therefore, it is wise to use specialized dressings before signs of obvious infection appear.¹

Adam stressed that not any dressing will do if we want to be actively fighting against biofilm, and Convatec’s Aquacel® Ag+ Extra™ was highlighted as an evidence-backed choice, combining ionic silver with surfactants and metal chelators. This unique formulation disrupts biofilm more effectively than silver alone, allowing lower concentrations to achieve powerful results while supporting antimicrobial stewardship. ⁵

A wound protocol for all, backed by evidence

The Wound Hygiene protocol makes good sense, but there’s also compelling evidence that it works.²

The Wound Hygiene Challenge examined 693 wounds in total across five European countries, including diabetic foot ulcers and challenging surgical wounds.³

Rather than lab experiments, the protocol was followed by frontline clinicians, podiatrists, and specialized nurses, wound care day in and day out. Real-world evidence showed that the 4-step protocol resulted in a statistically significant reduction in wound size and an overall 80% decrease in wound volume.³ 

Most strikingly, 99% of clinicians said they would continue to use the protocol.⁶

Combined with global adoption in 38 countries and recognition in the Journal of Wound Care, the protocol has become an internationally validated approach.³

The takeaway? By following four repeatable steps — cleanse, debride, refashion, and dress — clinicians of all backgrounds can tackle the biofilm barrier and create momentum toward healing.¹