The infection risk of plastic wrap as an acute burns dressing

Background

Domestic plastic wrap has been recommended as an appropriate acute burn wound dressing in the Emergency Management of Severe Burns course. There remain limited studies reporting the risk of infection associated with this dressing.

Aim

To determine the potential infection risk of domestic plastic wrap used to treat acute burns wounds by assessment for the presence of clinically significant micro-organisms.

Methods

Ten plastic wrap samples were collected from a roll that had been opened for several months on the burns ward at our institution. Plastic wrap was imprinted directly onto horse-blood agar plates. The plates were incubated for 72 h in aerobic conditions with 5% CO₂.

Results

We found no significant growth on any agar plate after incubation. A sufficient amount of plastic wrap was sampled to be confident that areas up to 12 cm × 12 cm from the centre of the plastic sheet were aerobically sterile.

Conclusions

Our data suggest that the potential for plastic wrap to act as a fomite when used as an acute burn wound dressing is extremely low.     

Methylated spirit burns following traditional hair dressing practice

Methylated spirit burns have been reported following domestic uses such as igniting fondues. It has also been used as an accelerant for self-immolation. We report the first documented case of severe methylated spirit burns sustained during traditional hair dressing. Increased awareness on the dangers of methylated spirit as well as making it less readily available for domestic use is warranted.     

Duoderm, an alternative dressing for smaller burns

In this study Duoderm has been used for the treatment of superficial and deep partial thickness burns in 61 patients. In 15 patients a second similar burn was treated with human allografts or silver sulphadiazine cream. Five very small full skin thickness burned areas were also treated with Duoderm. Treatment with Duoderm had to be stopped before total epithelial cover had occurred in 3 patients. Duoderm is a very good alternative for the treatment of smaller superficial and deep partial thickness burns, since it provides very good results, both cosmetically and functionally, combined with fast re-epithelialization and comfort for the patients.     

The enhanced Total Body Wrap—The new frontier in dressing care for burns

The management of extensive burns with their associated high fluid exudate following burn excision and skin grafting has always posed a challenge in burn wound care. The ideal dressing should protect the wound from physical damage and micro-organisms; be comfortable and durable; allow high humidity at the wound; and be able to allow maximal activity for wound healing without retarding or inhibiting any stage of the process.     

Evaluation of a new antiseptic dressing in minor burns

A prospective trial was conducted to compare a new povidone iodine impregnated dressing (Inadine) with a standard petroleum jelly gauze dressing for small superficial burns treated on an outpatient basis. The results show no difference between comfort and ease of removal of dressings, in the number of positive bacteriological cultures or the number of days to healing. Inadine is more than twice as expensive as petroleum jelly gauze.     

The use of lyophilised skin as an initial dressing in partial thickness burns

Summary Sixty patients with partial thickness burns have been treated using freeze dried cadaver allograft. It has proved a convenient biological dressing and has useful properties of pain relief, reduction in fluid loss and post burn skin hypertrophy and irritation; there is reduction in healing time compared with exposed areas. The limitation in its use lies in the availability of cadaver skin.In our opinion the presence of lyophilised allograft ensures that optimum conditions for healing prevail through mechanical protection of the burn wound. On the whole, infection is reduced by sealing the wound and prevention of evaporative loss greatly reduces the amount of resuscitative fluid required in the post burn period. The early mobility found by using lyophilised allograft on hand skin covering joint sites is largely due to relief of pain and reduction in bulky dressings. At the same time early dispersal of oedema occurs.We would like to thank the Consultants at Queen Victoria Hospital under whose care these patients came, and the Department of Medical Photography for their co-operation in this trial.     

Hydrocolloid dressing in pediatric burns may decrease operative intervention rates

Introduction

Partial-thickness scalds are the most common pediatric burn injury, and primary management consists of wound dressings to optimize the environment for reepithelialization. Operative intervention is reserved for burns that fail to heal using conservative methods. Worldwide, paraffin-based gauze (Jelonet) is the most common burn dressing; but literature suggests that it adheres to wounds and requires more frequent dressing change that may traumatize newly epithelialized surfaces. Hydrocolloid dressings (DuoDERM) provide an occlusive moist environment to optimize healing and are associated with less frequent dressing changes.

Aim

The aim of the study was to retrospectively analyze pediatric burns in a single tertiary referral center over a 10-year period comparing the impact of Jelonet and DuoDERM dressings relative to operative intervention rates.

Methods

All pediatric burns admitted between 1997 and 2007 were identified using the Hospital Inpatient Enquiry system. Demographics were collected from hospital records and theater logbooks. Acute, partial-thickness burns in patients younger than 15 years were analyzed according to dressing type applied (Jelonet or DuoDERM).

Results

Two hundred forty-eight pediatric burns were analyzed between 1997 and 2007. One hundred thirty-nine patients were treated with Jelonet dressings, and 109 were treated with DuoDERM. Debridement and grafting were required in 60 (43%) of the Jelonet patients compared with 10 (9%) of the DuoDERM patients (P < .05). The DuoDERM-managed patients maintained a significantly lower graft rate on subanalysis of scalds excluding early grafting within 5 days (P < .001).

Conclusion

Observational evidence suggests that DuoDERM leads to less operative intervention and should be preferentially used in pediatric burns.     

移动电话技术在管理化疗相关副作用中的应用

背景通过与服务器相连接的新型移动电话技术，患者可与专业医护人员交流症状，此种技术适合用于记录化疗的毒副作用和提供处理化疗毒性的意见。我们报告一项关于通过手提电话监测家庭患者症状的效果的可行性研究。方法6名结肠癌患者接受辅助化疗，每天2次在移动电话的用户友好界面输入症状资料。这种“实时”自我评估包括有无恶心、呕吐、黏膜炎、腹泻和手足综合征以及体温测量，评估资料通过一个安全连接到被送往远程计算机。在出现中度或重度症状时（分别产生黄色和红色警报），计算机立即通过传呼机提醒护士。护士随后联系患者，将增加的自动通知发送到患者手机，并使用临床算法评估患者。结果患者在第一次两周期的化疗中使用了手机。服务器软件成功分析了数据，而且警报在适当时候关于患者症状能予以参与研究的护士警示。共有91条警报--54条红色警报和37条黄色警报，54％（29／54）的红色警报出现的数据延迟和传输问题被迅速纠正。余下的红色警报被参与研究的护士适当处理。患者和医务人员都对这种症状管理的方法信心十足。结论本研究表明，该技术在监测患者症状方面运作良好。在得知自己的症状正被密切监测且本人能有效地参与自我护理管理后，患者感到很安全。     

Amniotic membrane as a biological dressing in the management of burns

This report details observations in 90 patients with dermal depth burns treated using amniotic membrane. The patients were divided into three subgroups: superficial dermal, intermediate dermal and deep dermal burns diagnosed clinically. All patients were dressed with amniotic membrane which was changed daily. The amniotic membrane relieved the discomfort of dressing changes, postoperative pain and oozing and allowed rapid epithelialization and early healing in superficial and intermediate depth dermal burns. In deep dermal burns the membrane was dissolved because of slough in the burn wound. After removal of the slough the amniotic membrane helped in rapid regeneration of epithelium and early healing.