Abstract
Introduction
Topical antibacterial agents are an essential component of burn wound management. The aim is to prevent wound infection effectively and promote healing. A poorly treated wound can result in scarring or even sepsis and multi-organ dysfunction in severe cases. Topical Silver Sulfadiazine cream (SSD 1%) has been the gold standard for burn care since 1960s. Due to the immediate burst release of the drug into the exposed areas, application is relatively frequent, usually twice daily. However, it remains unknown whether twice-daily SSD dressings are superior to once-daily.
Methods
Our institution maintained a twice-daily dressing change standard of care until 01/01/2019. Patients admitted after that date had their dressing changed once daily. Our goal is to review outcomes for 75 patients before the change-of-practice and 75 patients after the change. Our main outcomes recorded are wound infection, average pain scores, average daily narcotic requirements and length-of-stay.
Results
Preliminary results of 20 pre-change-of-practice and 20 post-change-of-practice patients showed no difference in the outcomes between the two groups. The infection rates were the same for both groups (15%), average pain scores (Graph 1) for the post-change group were slightly higher (pre=5.5, post=5.8; p=0.7), average length-of-stay (Graph 2) was longer in the pre-change group (pre=9.2, post=5.7; p=0.04), and no other surgical complications were reported for patients in either group.
Conclusions
Preliminary results show that a once-daily dressing change of SSD, has no negative impact on burn wound outcomes. In addition, it is associated with a decreased length-of-stay. A decreased length-of-stay means reduced medical expenses for the patient and the hospital. Changing the standard-of-care to once-daily could prove beneficial. Further patient review will shed more light on the significance of these results, however so far there is no inferiority in wound healing.
Applicability of Research to Practice
The frequency of dressing changes directly affects staff workload who are required to spend a lot of time carefully changing dressings. In addition, patient discomfort associated with frequent dressing changes including interference with sleep hygiene and increased pain medications could also be avoided. Finally, fewer dressing changes are associated with less medical supplies and hospital utilization without putting the patient at any further risk of infection.
Comparison of the healing effects of silver sulfadiazine cream 1% and the essential oil of Hypericum perforatum on scald burn wound in a rat model
