Ester,

If I understand your question right, you are asking how to take care of biofilm on an open wound without using anti-microbial dressings. That would be a tall order but not unsurmountable. Debridement is one of the best ways to remove biofilm with ultrasonic debridement probably being the best but sharp debridement then mechanical debridement. You can also take a wound culture and use systemic antibiotics. However, you would also want to provide a wound environment that makes it difficult for the bacteria to survive. This is where the topical anti-microbials come into play. Dressing with silver can work. You can also use methylene blue or gentian violet (Hydrofera Blue, RTD foam, DermaBlue foam). But the best dressing to prevent the recurrence of biofilm is cadexomer iodine (Iodosorb/Iodoflex). Hopefully this helps.

Thank you so much Mike. Of course I know antimicrobials are key for biofilm management but I was trying to get an answer about other measures, just like you said, mechanichal and sharp debridment, that I use. I do not use ultrasonisc debridment because it is not available in my hospital. I am wondering about other topical measures like DACC! What is your opinion about it?

Ester,
Many of the topical anti microbial agents whether it be infused with silver, iodine, DACC,PHMB, et cetera et cetera... Are always a good place to start when you have biofilm ...the question is what do you start with?
FIRST,knowing the data about the specific dressing that you're using can be helpful...
For example you wanted to know about DACC..
Https://www.magonlinelibrary.com/doi/full/10.12968/jowc.2016.25.2.76
This is one of many articles but a very good example. It's also helpful to look at the quality of the research and who may be supporting/sponsoring it
.... But just because a company may sponsor a article it doesn't necessarily mean it's bad it means that a critical eye must always be upon all articles whether it is sponsored or not...
The 2nd step in the process is to figure out what you have available to you... You might want a certain dressing because of its data but you can't get
The 3rd step is much more elusive. I find in my practice that certain anti microbial agents work really well in some environments or institutional settings but if you go two miles down the road, it is not as effective ...so the local environment probably impacts patient response. It's very similar to using your local antibiotic sensitivity chart....
Hopefully, you'll find this helpful!
Cathy

Ester,

Now I believe I understand the question better. Yes, I have use DACC before (Cuimed Sorbact) and it has worked quite well and it was fairly inexpensive. In fact, we used to use Cutimed Sorbact and Iodosorb together quite often. You could also consider PHMB infused foams as Cathy mentioned above. In the US, the main way we use PHMB is a cellular tissue product (Puraply AM). I believe there are a few PHMB infused foams available in Europe that we don't have as much access to in the US such as Activheal foam. Hopefully this answers your question better.
https://activheal.com/wound-care-dressing-range/phmb-foam-dressing/