The formation of bacterial biofilm on implanted devices or damaged tissues leads to biomaterial-associated infections often resulting in life-threatening diseases and implant failure. It is a challenging process to eradicate biofilms as they are resistant to antimicrobial treatments. Conventional techniques, such as high heat and chemicals exposure, may not be suitable for biofilm removal in nosocomial settings. These techniques create surface degradation on the treated materials and lead to environmental pollution due to the use of toxic chemicals. A novel technique known as non-thermal plasma has a great potential to decontaminate or sterilize those nosocomial biofilms. This article aims to provide readers with an extensive review of non-thermal plasma and biofilms to facilitate further investigations. A brief introduction summarizes the problem caused by biofilms in hospital settings with current techniques used for biofilm inactivation followed by the literature review strategy. The remainder of the review discusses plasma and its generation, the role played by plasma reactive species, various factors affecting the antimicrobial efficacy of non-thermal plasma and summarizes many studies published in the field.

Biofilm formation on implanted medical devices is the reason for most of the nosocomial infections in clinical settings. Biofilms are more resistant to antimicrobials than their planktonic cells mainly because of the presence of the matrix of extracellular polymeric substances (EPSs), which acts as a physical barrier that limits the transport of antimicrobials inside the biofilm. A combinatorial antimicrobial approach of a non-thermal plasma and chlorhexidine (CHX) digluconate can be used to sterilize those surfaces contaminated with biofilm. However, the reason behind achieving this combinatorial decontamination is not known. Thus, in this study, we developed a mathematical model to explain the reason behind sterilization with the combinatorial treatment approach. It was found that the application of plasma prior to treatment with CHX is disrupting the biofilm and making it very porous. This is allowing CHX to penetrate deeper inside the porous biofilm, which is then effective at sterilizing the biofilm.

Bacterial biofilm formation on medical implants is a major cause of illness in patients and is, therefore, increasing healthcare costs due to extended hospital stays and the failure/disposal of contaminated implants. Only limited progress has been made to prevent or eradicate this growing problem. Effective approaches include inhibiting the initiation of biofilm growth by killing planktonic bacteria and breaking down existing biofilms. We propose to employ atmospheric pressure nonthermal regular dielectric-barrier discharge (DBD) and jet plasma to kill bacteria that have been grown planktonically or in biofilms. In this paper, Pseudomonas aeruginosa was grown either planktonically or on titanium coupons in a bioreactor under dynamic conditions to form mature biofilms. The planktonic bacteria and biofilms were exposed to regular DBD and jet plasma and bacterial survival was evaluated after treatment for various times and at different distances. Within 5 min of plasma treatment, we observed complete decontamination of planktonically grown bacteria, and within 15 min, we observed more than a 3 log reduction (99.9%) of bacteria grown as biofilms. The efficacy of plasma treatment was also visualized using scanning electron microscopy, where disruption of biofilm was found with an increasing treatment time. This paper also determined that jet plasma is more effective in treating biofilms than regular DBD plasma.

Periprosthetic joint infection (PJI) after total joint arthroplasty is a major concern requiring multiple surgeries and antibiotic interventions. Staphylococcus aureus , Pseudomonas aeruginosa , and Escherichia coli are the predominant causes of these infections. Due to biofilm formation, antibiotic treatment for patients with PJI can prolong resistance, further complicating the use of current treatments. Previous research has shown that cathodic voltage-controlled electrical stimulation (CVCES) is an effective technique to prevent/treat implant-associated biofilm infections on titanium (Ti) surfaces. This study thus evaluated the efficacy of CVCES via the use of 10% betadine alone and in combination with CVCES to eradicate lab-grown biofilms on cemented and cementless cobalt–chromium (CoCr) and Ti surfaces. CVCES treatment alone for 24 hours demonstrated no detectable CFU for E. coli and P. aeruginosa biofilms on cementless CoCr implants. In the presence of cement, E. coli biofilms had 10 ⁶ CFUs/implant remaining after CVCES treatment alone; however, P. aeruginosa biofilms on cemented implants were reduced to below detectable limits. The use of 10% betadine treatment for 3 minutes followed by 24-hour CVCES treatment brought CFU levels to below detectable limits in E. coli and P. aeruginosa . The same was true for S. aureus biofilms on cementless patellofemoral implants as well as femoral and tibial implants. These treatment methods were not sufficient for eradication of S. aureus biofilms on cemented implants. These results suggest that CVCES alone and CVCES with 10% betadine are effective approaches to treating biofilms formed by certain bacterial species potentially leading to the treatment of PJI. IMPORTANCE: Periprosthetic joint infections (PJIs) are problematic due to requiring multiple surgeries and antibiotic therapies that are responsible for increased patient morbidity and healthcare costs. These infections become resistant to antibiotic treatment due to the formation of biofilms on the orthopedic surfaces. Cathodic voltage-controlled electrical stimulation (CVCES) has previously been shown to be an effective technique to prevent and treat biofilm infections on different surfaces. This study shows that CVCES can increase the efficacy of 10% betadine irrigation used in debridement, antibiotics, and implant retention by 99.9% and clear infection to below detection limits. PJI treatments are at times limited, and CVCES could be a promising technology to improve patient outcomes.