Biofilm formation on biomaterials implant surfaces and subsequent infectious complications are a frequent reason for failure of many biomedical devices, such as total hip arthroplasties, vascular catheters and urinary catheters. The development of a biofilm is initiated by the formation of a conditioning film of adsorbed macromolecules, such as proteins, followed by adhesion of microorganisms, where after they grow and anchor through secretion of extracellular polymeric substances. Adhesion of microorganisms is influenced by the physico-chemical properties of the biomaterial surface. Positively charged materials stimulate bacterial adhesion, but prevent growth of adhering bacteria. The use of low surface free energy materials did not always reduce in vitro adhesion of bacteria, but has been found beneficial in in vivo applications where fluctuating shear forces prevail, like on intra-oral devices and urine catheters. Polymer brushes have shown a very high reduction in in vitro adhesion of a great variety of microorganisms. However, for clinical application, the long term stability of polymer brushes is still a limiting factor. Further effort is therefore required to enhance the stability of polymer brushes on biomaterial implant surfaces to facilitate clinical use of these promising coatings.