70 Chlorhexidine Gluconate for Burn Wound Cleansing: Reduction in Multi-drug Resistant Organism Acquisition

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S45-S46
Author(s):  
Kelsey L Miller-Willis ◽  
Mini Thomas ◽  
Victor C Joe
Keyword(s):  
Wound Care ◽  
Baseline Period ◽  
Chlorhexidine Gluconate ◽  
Wound Management ◽  
Resistant Organism ◽  
Drug Resistant ◽  
Intact Skin ◽  
Burn Wound ◽  
Burn Wounds ◽  
Burn Unit

Abstract Introduction Daily wound care is an important part of burn wound management to help prevent infection. Literature suggests that daily Chlorhexidine Gluconate (CHG) bathing can reduce the risk of acquiring Multi-Drug Resistant Organisms (MDRO). The purpose of this study was to identify change in overall MDRO acquisition in the Burn Unit with the addition of a 1% CHG solution for wound care to the CHG bathing protocol for burn patients. Methods Prior to March 2018, routine bathing and wound care involved use of CHG-incompatible antibacterial soap and water followed by 2% chlorhexidine gluconate cloths to intact skin. In March 2018, the bathing protocol changed, in consultation with the hospital’s infection prevention program, to involve a 1% CHG solution for burn wounds followed by 2% CHG cloths to intact skin in order to prevent the loss of protective residual CHG due to rinsing with CHG-incompatible soap and water. A solution of 1% CHG was chosen by staff as an acceptable concentration for wound bathing. Adherence was measured through review of daily documentation of bathing in the electronic medical record. Incidences of burn unit-attributable hospital-onset MDRO cultures were reviewed for the following periods: Baseline (Aug 2016-Aug 2017), Phase-In (Sept 2017 – Aug 2018) and Post-Implementation (Sept 2018 – Aug 2019). Results Adherence was >85% throughout the intervention period. No adverse events were noted. Incidences of hospital-onset burn unit MDROs during the following time periods were: 22 cases (Baseline), 15 cases (Phase-In), and 10 cases (Post-Implementation). The most common organisms in the baseline period were Extended-Spectrum b-Lactamase (ESBL) Escherichia coli, MRSA, and Multi Drug Resistant Pseudomonas; and post-implementation, the most common organisms were: MRSA and MDR-Pseudomonas. Conclusions A change to a 1% CHG solution for rinsing burn wounds in the setting of 2% CHG cloths to intact skin was well tolerated and associated with a decline in MDRO acquisition attributable to the burn ICU in the one-year post implementation. Applicability of Research to Practice The use of a 1% CHG solution for burn wounds may help prevent MDRO acquisition in the highly susceptible and unique burn population.

Management of the Burn Wound

2019 ◽  
Author(s):  
Nicole S. Gibran ◽  
Jose P. Sterling ◽  
David M. Heimbach
Keyword(s):  
Wound Care ◽  
Donor Site ◽  
Skin Grafting ◽  
Wound Management ◽  
Skin Substitutes ◽  
Burn Wound ◽  
Burn Wounds ◽  
Initial Care ◽  
Wound Excision ◽  
Burn Depth

Current approaches to burn management are based on an understanding of the biology and physiology of human skin and the pathophysiology of the burn wound. The clinical evaluation and initial care of a burn wound is described and includes an assessment of burn depth, determining the need for escharatomy and daily burn wound care. Burns can be topical or surgical. Topical burn wounds require choice in the use of antibiotics. Considerations and techniques for surgical burn wound management are described and include early excision and grafting, wound excision, skin grafting, graft and donor-site dressings, postoperative wound care, biologic dressings and skin substitutes, allograft and xenograft skin, cultured epidermal autografts, and skin substitutes. Figures show the two distinct layers of the skin, various types of burns, and both fascial and tangential excision of burn wounds.  This review contains 12 figures, 11 tables, and 61 references. Keywords: Burn wound, graft, partial-thickness, full-thickness, dermis, epidermis,  sloughing, dressing

Management of the Burn Wound

2019 ◽  
Author(s):  
Nicole S. Gibran ◽  
Jose P. Sterling ◽  
David M. Heimbach
Keyword(s):  
Wound Care ◽  
Donor Site ◽  
Skin Grafting ◽  
Wound Management ◽  
Skin Substitutes ◽  
Burn Wound ◽  
Burn Wounds ◽  
Initial Care ◽  
Wound Excision ◽  
Burn Depth

Current approaches to burn management are based on an understanding of the biology and physiology of human skin and the pathophysiology of the burn wound. The clinical evaluation and initial care of a burn wound is described and includes an assessment of burn depth, determining the need for escharatomy and daily burn wound care. Burns can be topical or surgical. Topical burn wounds require choice in the use of antibiotics. Considerations and techniques for surgical burn wound management are described and include early excision and grafting, wound excision, skin grafting, graft and donor-site dressings, postoperative wound care, biologic dressings and skin substitutes, allograft and xenograft skin, cultured epidermal autografts, and skin substitutes. Figures show the two distinct layers of the skin, various types of burns, and both fascial and tangential excision of burn wounds.  This review contains 12 figures, 11 tables, and 61 references. Keywords: Burn wound, graft, partial-thickness, full-thickness, dermis, epidermis,  sloughing, dressing

scholarly journals The Guru-UKM Method: Synergistic Effect of Hydrogel, Hydrofibre and Dermal Conservation in Burn Wound Management

2020 ◽  
Vol 17 (3) ◽  
Author(s):  
Farrah-Hani Imran ◽  
Chik Ian ◽  
Enda Gerard Kelly ◽  
Razman Jarmin
Keyword(s):  
Wound Healing ◽  
Synergistic Effect ◽  
Wound Care ◽  
Normal Function ◽  
Wound Management ◽  
Burn Wound ◽  
Burn Unit ◽  
Moist Environment ◽  
Partial Thickness Burns ◽  
Time Of Admission

Initial wound care idioms were designed around a moist dressing in presumed better wound healing. As wound care advances, innovations of dressings were formed. In the Guru-UKM Method (GUM), we combined two well-established dressings producing a synergistic effect in burn wound management. Patients with deep partial thickness burns were selected for the GUM. From the time of admission, they receive 2 cycles of paraffin tulle dressings once every two days to allow demarcation, then are reassessed for suitability of the GUM technique. We discuss 7 different burn cases that presented to our Burn Unit from January 2014 – June 2015.All dressings should create a suitable moist environment for healing, yet should be a painless dressing to help the patient return to normal function as soon as possible. In burn wounds, a suitable dressing ideally also biochemically debrides fibrin and softens hardened eschar and slough, without necessitating the patient to undergo general anaesthesia and surgical debridement. The Guru-UKM Method is a combination dressing technique that facilitates optimal burn wound management.

577 The Collaboration of Burn Outreach and Wound Care Nurses

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S140-S140
Author(s):  
Ekta Vohra
Keyword(s):  
Wound Care ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospital Setting ◽  
Basic Knowledge ◽  
Definitive Treatment ◽  
Knowledge Gap ◽  
Burn Wound ◽  
Improvement Project ◽  
Burn Wounds

Abstract Introduction Certified wound care nurses perform a vital role in skin health and management in the hospital setting. During the certification process, minimal time is spent on burn wound education, despite the fact that wound care nurses are consulted for various wound etiologies; one of those being burns. This construct created a need for collaboration between the burn team and wound care nurses. Although all burns are essentially wounds, the reality is that all wounds are not burns. The management of the burn wound is often different from the management of pressure injuries or surgical wounds. In speaking with the wound care nurses at this large urban academic medical center, a knowledge gap was identified in burn wound care education as well as appropriate and timely consultation of the burn team. Methods This knowledge improvement project focused on educating the wound care nurses in assessment and treatment of burns, and the process for burn service consultation. Burn education was provided through in-person didactic presentations. The lecture included burn wound photos with opportunities to classify the potential depth of burn wounds as well as typical complications. Additionally, it discussed when a burn consult is needed. A basic knowledge retrospective pre-posttest method was utilized. Results An educational plan was tailored to meet the learning needs of the wound care nurses to address the knowledge gap. Post test data results were tracked. Post scores were increased, indicating a successful educational intervention. Also, while providing the education, the burn outreach coordinator identified an opportunity to expand the burn center’s presence among colleagues through collaboration with the wound care nurses. The wound nurses made excellent ambassadors for the mission of the burn service. Conclusions Provision of burn education across disciplines may improve recognition of burn wounds and facilitate definitive treatment.

Phenotypic and Molecular Characteristics of Pseudomonas Aeruginosa Isolated from Burn Unit

2021 ◽  
Vol 30 (1) ◽  
pp. 19-28
Author(s):  
Yasser M. Ismail ◽  
Sahar M. Fayed ◽  
Fatma M. Elesawy ◽  
Nora Z Abd El-Halim ◽  
Ola S. El-Shimi
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Virulence Factors ◽  
Antimicrobial Susceptibility ◽  
Virulence Gene ◽  
Molecular Characteristics ◽  
Drug Resistant ◽  
Burn Wound ◽  
Burn Wounds ◽  
Related Data ◽  
Genes Encoding

Background: The biggest concern for a burn team is a nosocomial infection in burn patients, which is a significant health issue. Pseudomonas aeruginosa is an extremely troublesome drug-resistant bacterium in the world today. We are now faced with rising P. aeruginosa pan-drug-resistant clones in hospital settings. Objectives: To evaluate the distribution of different virulence factors generated by P. aeruginosa isolated from burn wound infections, together with its antimicrobial susceptibility. Methodology: The isolates reported as P. aeruginosa were further tested for the presence of various phenotypic and genotypic virulence factors including (Biofilm formation, lipase, protease, gelatinase, DNase, bile esculin hydrolysis & hemolysin). Also, genes encoding (nan 1 and Exo A) were investigated by PCR using specific primers. All the isolates were tested for their antimicrobial susceptibility patterns. Results: The study reported that toxins and enzymes were expressed by the tested strains in varying proportions; (92.0%) were producing β-hemolysin, lipase (86%), and protease (86%). The formation of biofilm was observed in 84%. Exo A (70%) was the main virulence gene found in the tested strains. Nan 1 gene was identified in 30% of the samples. 82% of MDRPA isolates were found. There is indeed a relationship between biofilm production and drug resistance, as well as the presence of virulence genes (nan 1 and Exo A) were associated with certain patients and burn wounds characteristics as burn size, burn wound depth, length of hospital stays, and socioeconomic status. Conclusions: Correlation of Pseudomonas aeruginosa virulence profiles with burn wounds and patient-related data can be useful in establishing of an appropriate preventive protocol for hospitalized patients with P. aeruginosa burn serious infections. The targeting of these bacterial virulence arsenals is also a promising approach to developing alternative drugs, which act by attenuating the aggressiveness of the pathogen and reducing its potential to cause vigorous infection.

scholarly journals Clinical outcome of Maggot Debridement Therapy followed by Negative Pressure Wound Therapy for chronic hand wound with Multi-Drug Resistant Organism infection: Two cases and review of the literature

2021 ◽  
Vol 29 (3) ◽  
pp. 230949902110673
Author(s):  
Zi Hao Phang ◽  
Saw Sian Khoo ◽  
Jayaletchumi Gunasagaran ◽  
Tunku Sara Tunku Ahmad
Keyword(s):  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Wound Management ◽  
Resistant Organism ◽  
Drug Resistant ◽  
Wound Therapy ◽  
Maggot Debridement Therapy ◽  
Attractive Option ◽  
Inappropriate Antibiotics ◽  
Science And Research

The advancement in science and research has led to development of medical maggots which feed exclusively on dead tissue. Medical maggots have three important functions namely debridement, disinfection, and stimulation of wound healing. The modern use of medical maggots now goes by the term “Maggot Debridement Therapy” (MDT) for use in wound management. MDT is still used infrequently due to the effectiveness of surgical debridement and antibiotics for treatment of wound infection. Lately, there was emergence of Multi-Drug Resistant Organism (MDRO) likely due to inappropriate antibiotics usage. Maggot secretions have been shown to be effective in inhibiting some MDRO, for example, Methicillin-resistant Staphylococcus aureus, thus making MDT an attractive option for wounds with MDRO. We report two patients with multiple medical comorbidities, diagnosed with serious MDRO Diabetic Hand Infections treated with three cycles of MDT followed by Negative Pressure Wound Therapy.

Burn depth assessment

2019 ◽  
pp. 77-88
Author(s):  
Peter George Dziewulski ◽  
Quentin Frew
Keyword(s):  
Hypertrophic Scar ◽  
Surgical Planning ◽  
Surgical Intervention ◽  
Wound Care ◽  
Scar Formation ◽  
Wound Management ◽  
Burn Wound ◽  
Increased Risk ◽  
Burn Depth ◽  
Burn Depth Assessment

Burn depth assessment is key assessing healing potential and risk of scarring. It informs wound management and surgical planning. The dynamic and evolving nature of a burn wound can make this difficult. Burns which are likely to take longer than 3 weeks to heal have a significantly increased risk of hypertrophic scar formation leading to functional and aesthetic morbidity. Assessing healing potential allows the treating clinician to optimize wound care and the need for surgical intervention.

scholarly journals MRSA COLONITATION DETECTION IN OBJECT NEAR PATIENTS IN BURN UNIT RSUD DR. SOETOMO - INDONESIA

2021 ◽  
Vol 5 (1) ◽  
pp. 22
Author(s):  
Manik Retno Wahyunitisari ◽  
Melisa Indah Mustikasari ◽  
Lynda Hariani
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Sampling Period ◽  
Medical Faculty ◽  
Microbiology Laboratory ◽  
Nosocomial Pathogen ◽  
Intact Skin ◽  
Burn Wound ◽  
Burn Unit ◽  
Mrsa Infection

Background: Burn unit is a unit where patients with a burn wound in which the patient’s skin is not intact are taken care of. Methicillin-resistant Staphylococcus aureus (MRSA) as the prototype of a nosocomial pathogen is usually transmitted through contact from the surfaces of the object to the non-intact skin. Therefore, the possibility of MRSA infection increase in the burn unit. Purpose: The purpose of this research is to find out whether there is any colonization of MRSA on the objects around burn unit patients that can contribute to the spreading of MRSA in the RSUD Dr.Soetomo Indonesia. Method: The sampling period was started from October 2019 until March 2020. Samples were taken randomly from 28 patients in the Burn unit RSUD Dr.Soetomo -ndonesia and then tested for identification in the microbiology laboratory of the medical faculty, Universitas Airlangga. Result: Nineteen bacterial growths were obtained from twenty-eight samples taken, nine of them were confirmed as Stahylococcus aureus and one from nine of them was confirmed as MRSA. Conclusion: MRSA contamination was found on an object around the patient burn unit Dr. Soetomo-Indonesia which comes from the stethoscope membrane.

scholarly journals Pediatric Thermal Burns and Treatment: A Review of Progress and Future Prospects

2017 ◽  
Author(s):  
Elton Mathias ◽  
Madhu Srinivas Murthy
Keyword(s):  
Wound Repair ◽  
Wound Care ◽  
Point Of View ◽  
Burn Injuries ◽  
Skin Substitute ◽  
Future Prospects ◽  
Skin Substitutes ◽  
Burn Wound ◽  
Burn Wounds ◽  
Basic Care

Burns is a pervasive and oppressive basic care issue. In children, burn injuries are a major reason for bleakness and mortality. The quirks in the physiology of liquid and electrolyte taking care of, the vital necessity and the distinctions in the different body extends in children direct that the pediatric wounds administration ought to be brought with an alternate point of view than for adults. Notwithstanding, for the intensivist, challenges regularly exist that muddle quiet help and adjustment. Moreover, burn injuries are mind-boggling and can show exceptional challenges that require deep-rooted recovery. Investigation in burn wound care has yielded progressions that will keep on improving practical recuperation. What's more, pain management all through this period is essential. Managing these wounds requires escalated therapeutic treatment for multi-organ dysfunction, and forceful surgical treatment to forestall sepsis and other inconveniences. The biological therapeutic bilayered skin substitutes with a long shelf life that recapitulates the normal barrier function of the intact human skin and stimulate wound repair and skin regeneration. A definitive objective is to accomplish a perfect skin substitute that gives a successful and without scar wound recuperating. This review article features the headway in pediatric burn wounds with an emphasis on the pathophysiology and treatment of burn wounds.

657 Preliminary Study on the Effect of Various Antimicrobial Formulations Containing Silver Oxynitrate on Reducing Pseudomonas Aeruginosa Using an in-vivo Porcine Burn Wound Model

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S174-S174
Author(s):  
Stephen C Davis ◽  
Joel Gil ◽  
Michael Solis ◽  
Alex Higa
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Untreated Control ◽  
Chronic Wounds ◽  
Wound Care ◽  
Wound Dressings ◽  
Bacterial Reduction ◽  
Burn Wound ◽  
Burn Wounds ◽  
Preliminary Study

Abstract Introduction Silver has long been known for its antimicrobial effects and has been commonly applied topically to burn wounds for years. More recently, wound dressings compounded with silver ions, have been developed to prevent and treat wound infection in both burn and chronic wounds. Methods This preliminary study evaluates the effect of a proprietary silver oxynitrate creams on Pseudomonas aeruginosa (PA) biofilms using a well-established burn wound porcine model model. Swine were used due to their skins similarities to humans and response to wound treatments. Briefly, second degree burn wounds were created and inoculated with PA. Wounds were then covered for 24 hours with a polyurethane dressing to allow for biofilm formation. The polyurethane dressing was removed and wounds were randomly assigned to one of the following treatment groups: 1) silver oxynitrate cream 0%, 2) silver oxynitrate cream 4%, 3) silver oxynitrate cream 7%, 4) silver oxynitrate cream * 10%, 5) silver oxynitrate powder, 6) silver sulfadiazine cream (SSD)~, or 7) untreated control. All treatments groups were covered with a polyurethane dressing to prevent any cross contamination. On days 3 and 7 after wounding wounds were cultured using an established scrub technique. Results Silver oxynitrate powder was the most effective treatment group at reducing PA counts. Silver oxynitrate 10% formulation had a high percentage of bacterial reduction. On day 7, compared to untreated control the silver oxynitrate 4, 7 and 10% treatments showed a 3.45, 4.05, and 4.30 log CFU/ml reduction, respectively. Conclusions These studies suggest that the silver oxynitrate formulations can reduce the bacterial bioburden in vivo against wounds that have PA biofilms. Additional animals are needed to substantiate these findings. Applicability of Research to Practice Gram-negative bacteria such as PA pose a challenge for wound care practitioners and new effective therapies are needed.

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