This stage depends on a microbial-to-microbial cell communication system, called quorum sensing, in which small signaling molecules are released and gradually increase in concentration. The signaling molecules regulate gene expression and help form the biofilm.

This stage depends on a microbial-to-microbial cell communication system, called quorum sensing, in which small signaling molecules are released and gradually increase in concentration.

The second stage is the permanent adhesion or maturation stage in which the organisms permanently attach, proliferate, and maturate in the wound surface.