Honey as an alternative dressing to reduce infections in Wounds – A literature review

Mr Peter Stone1, Miss Hana Menezes1, Dr Natasha  Jennings1

1Alfred Hospital, Melbourne, Australia

Abstract:

Aims/Objectives:
1] What is the evidence for knowledge translation on the modality of honey dressings used to decrease infections by antibiotic-resistant bacteria?
2] Do honey dressings provide a moist healing environment; reduce slough formation, and odor in wounds?
3) Do honey dressings improve healing time while delivering greater patient comfort and contentment while reducing healing time?
Background:
Patient presentations for skin and wound management significantly contribute to emergency department (ED) workload. Appropriate decision making for dressing modalities is often ad hoc and infrequently evidenced based. There is a suggestion of a lack of clarity around best practice standards for wounds in the ED. Honey has been considered as one alternative to standard dressings as it may reduce resistance to antibiotics and have less side effects.
Method:
A literature review will be undertaken to investigate if honey dressings are an alternative to current standard practice in relation to wounds dressings in the ED. Key outcomes will be: Use of honey on ED wounds, healing time and other benefits. A PICO framework audit question will be used.
P: infected wounds in people presenting to emergency department aged 16-98
I: Honey type of dressing for the treatment of infected wounds
C: silver sulfadiazine dressings or Vaseline impregnated gauze dressing
O: cost effective dressings, that offer patient comfort, and durability/longevity, and acceptability, and an effective treatment against bacterial infection.
Conclusion:
an analysis of the literature will provide an opportunity to synthesize the current literature and make recommendations for further research being an interventional study.


Biography:

Peter Stone is a Nurse Practitioner at the state emergency and trauma center, Victoria, with an interest in wound care, burns, and Dermatology.
started trauma nursing 2003 in the UK
started at the Trauma center Alfred Center Victoria 2008, completing a Masters and becoming an endorsed critical care nurse practitioner in 2017

The use of a unique silicone-lined thermoplastic to fabricate a portfolio of head and face orthoses to manage burn scar hypertrophy.

Mr Jonathan Niszczak1

1Bio Med Sciences, inc., Allentown, United States

Abstract:

Introduction: Recent advancements in medicine have vastly improved the survival chances of burn patients.  The focus of the burn recovery has now shifted from survival to early rehabilitation. We have designed 6 head and face splints that, if initiated early, could prevent deformity.

Methods: A Low Temperature Silicone-lined thermoplastic is utilized for the fabrication of the splints.  The chin splint cups the chin and reverses lower lip eversion.  The mouth splint is designed to stretch both commissures vertically. One nose splint is designed to expand the nostril diameter and the other is designed to depress scar hypertrophy around the nasal bridge-ala-epicanthal region.  One of the ear splints is designed to increase the ear canal diameter and the other prevents the ear helix from contracting toward the head.

Results: We have found that utilizing these splints at the first evidence of scar hypertrophy or tightness, results can be very positive.  Nostril and ear canal diameters can increase by 5mm in about 10 days.  Vertical and horizontal mouth opening can increase between 1cm-1.5cm in approximately 1 month.  Lower lip eversion and scar hypertrophy around the ala/nasal bridge/epicanthal region can be inhibited when the chin and nose splint are worn underneath a garment mask.

Discussion: The splinting material is coated with silicone which provides for a comfortable contact to the skin.    The combination of silicone and thermoplastics in splinting theoretically enhances the principles of gentle, prolonged sustain stretch and promotes scar hydration/pliability that could lead into elongated tissues and flat scars.


Biography:

Jon has an advanced Master’s Certification in Hand and Upper Quadrant rehabilitation as well as a Master’s of Science in Occupational Therapy. Jonathan has been working in burn
rehabilitation for over 17 years. He is a Clinical Care Specialist for Bio Med Sciences, Inc. in Allentown, PA. Additionally, he works in the Burn Center at Temple University Hospital and
serves as a Medical Diplomat with Physicians for Peace on burn care missions throughout Central and South America and the Middle East. He is an active member of the American Burn
Association; European Burn Association; International Society for Burn Injures and the Australian New Zealand Burn Association. He has published and presented in domestic and
international peer reviewed journals primarily on burn rehabilitation and scar management of the upper extremities and face.

 

High Serum Levels of Silver in a Paediatric Burns Patient Managed with Silver Dressings Does Not Equate to a Clinical Disaster

Dr Ingrid Salna1, Dr Edward Gibson2, Dr Lachlan Farmer2, Dr  Bernard Carney2

1Royal Adelaide Hospital, Glandore, Australia, 2Women’s & Children’s Hospital, North Adelaide, Australian

Abstract:

Silver ion has been employed as an antimicrobial for several millennia and, in burn wound care, for over 200 years. Since the 1960s, silver dressings have become the mainstay in burns dressings in an adult population and proven safe in long-term use. Argyria is a feared condition caused by excessive exposure to silver compounds. Silver dressings are thus used cautiously in the paediatric population, who have nearly three times the body surface area to body mass ratio of adults. However, adverse effects are almost always related to inappropriate use, such as oral ingestion of colloidal silver solutions. This is a case report of serial silver dressings in a young boy that led to high levels of serum silver and a review of the literature. He had no significant clinical findings or adverse outcomes and once the dressing regime was changed, his serum levels normalised relatively quickly. On review of the literature, overall silver dressings: were cost effective, reduce burn wound incidence, decrease pain levels during dressing changes, decrease the frequency of dressing changes, decrease the matrix metalloproteinase activity, reduces the wound exudate and bioburden levels, and promotes wound healing in chronic wounds. There is no in vivo evidence to suggest that nanocrystalline silver is toxic to skin cells such as keratinocytes and fibroblasts. The purpose of this is to highlight the safety of silver dressings and reiterate their role in burns care in paeditric patients.


Biography:

Dr Ingrid Salna is a current Unaccredited Plastic & Reconstructive Surgery Registrar at the Royal Adelaide Hospital. She has successfully completed an undergraduate degree including a Health Science Honours and subsequently a Doctor of Medicine at Flinders University in 2013. She has since been working in the Central Adelaide Local Health Network as a surgical medical officer and registrar in both general and plastic surgery, and has ongoing interests in multiple fields of Plastic & Reconstructive Surgery research.

Therapy-Related Outcome Measures in Burn Care: A Literature Review

Ms Pei Fen Seah1

1Department of Physiotherapy, Singapore General Hospital, , Singapore

Abstract:

The aim of medical care, including burn care, is to enable people to return to functional lives after illness or injury. With burns becoming increasingly survivable, enabling return to functionality has become a high priority. Measuring outcomes is essential for optimising and evaluating the quality of care. Outcome measures allow us to set and maintain standards of care within a service, monitor and compare services nationally and internationally, and interpret research and audit findings. Reflecting its importance, there has been an increasing amount of literature on outcomes for burns care in recent years and much of it is relevant to therapy. A documentation audit conducted on 20 randomly chosen burn injury cases admitted to Singapore General Hospital revealed the lack of consensus on and utilisation of therapy-related outcome measurement tools. To address this gap and select the most relevant therapy-related outcome measures, we conducted a literature review of outcome measures in the areas of joint mobility, strength, functional ability, scar and quality of life. With the employment of the most relevant outcome measures, clinicians and researchers will be able to better evaluate the effectiveness of therapeutic interventions and provide suggestions for further advancements in burn care.


Biography:

Pei Fen is a Senior Physiotherapist with the Department of Physiotherapy, Singapore General Hospital. She graduated with a Diploma in Physiotherapy from Nanyang Polytechnic, Singapore, in 2008 and is currently pursuing Masters in Burn Care with Queen Mary University, London. Pei Fen has eight years of working experience in managing patients with Burns injuries and Plastic reconstruction surgeries, both in the acute and outpatient settings. In 2012, Pei Fen was awarded the Health Manpower Development Plan (HMDP) fellowship in rehabilitation for burns and reconstructive surgery, which she completed at Shriners Hospital-Galveston and UTMB Blocker Burn Unit, USA.

Factor XII Deficiency in a Patient with Severe Burns: A Case Study

Dr Isobel Yeap1, Dr  Aruna Wijewardana1, Dr John Vandervord1

1Royal North Shore Hospital, St Leonards, Australia

Abstract:

Factor XII deficiency has an estimated incidence of 1-3%. For many years, it was believed to be unique amongst the factor deficiencies in the sense that it was thought to have no clinical significance. It is typically diagnosed incidentally on pathology tests: ex vivo it causes a prolongation of partial thromboplastin time (PTT), but in vivo it has been shown to have no effect on haemostasis. Large-scale human studies have proven contradictory. Some studies have suggested an inverse association between factor XII levels and risk of myocardial infarction, while other have suggested that factor XIIa may contribute to thrombus formation.

We present an interesting case of a patient with Factor XII deficiency who presented with a 13% burn to her forearm, face and abdomen due to smoking in bed. She was taken to the operating theatre eight times for repeated debridement and application of split thickness skin grafts. Due to significant post-operative bleeding, her haemoglobin dropped to 57. She required regular blood transfusions, in total receiving 22 units of packed red blood cells.

Recent studies involving murine models have shown that mice with Factor XII deficiency have impaired formation of thrombi in arterial injury models. Burns surgery involves extensive and repeated debridement of dermal skin, which is rich in capillaries, venules and arterioles. We propose that our patient may have been unable to achieve adequate haemostasis of the small vessels sheared during debridement, such that her Factor XII deficiency may have been responsible for her delayed but significant post-operative oozing.


Biography:

Isobel is a resident medical officer who has worked with the Severe Burns Unit and Plastic Surgery Department at Royal North Shore Hospital. Prior to studying medicine, she completed her Bachelor (Honours) in Economics.

A historical outlook of burns and burns surgery over time

Dr Jason Diab1

1Women And Children’s Hospital, Adelaide, Australia

Abstract:

The rich history of burns and burns surgery is a tapestry of social and historical print on how humans have approached the notion of fire. With its variations of concoctions and remedies across regions and different treatments from Chinese and Roman times, the conceptual understanding is somewhat similar. This poster succinctly explores how burn surgery began from its earlier roots in the mid 16th century expanding upon the Hippocratic repertoire for burns. Then, ultimately leading to the works of the gentle surgeon Ambroise Pare for his innovative approach to wounded war veterans. The 18th century is heralded as an evolution of medicine in general, and surgery in particular. with John Hunter and John Earle. It follows the effect of wars into the 20th century and the scientific movements into resuscitation, bioengineered dressings and support regimens for rehabilitation.


Biography:

Jason is a paediatric plastic craniofacial registrar with an interest in reconstructive surgery and burns.

An emerging public health concern: e-cigarettes and burns

Dr Jason Diab1, Ms Vanessa Diab2

1Women And Children’s Hospital, Adelaide, Australia, 2University of Sydney, Sydney, Australia

Abstract:

Background:E-cigarette use is becoming an increasingly popular alternative to traditional cigarette smoking. Since their invention in 2003, the growing trend amongst the youth has been well documented; also, the increase in spontaneous combustion of e-cigarettes from lithium powered devices resulting in variable patterns of burns is increasing.
Method:A comprehensive review of the medical literature across search engines highlighted many case reports. Furthermore, documented media reports of these cases and health journals requesting regulation was researched.
Discussion:Global series case reports highlight the mixed partial and full thickness burns from spontaenous combustion. Albeit a revolutionary product in harm reduction, the increase in burn reports suggests reflection on regulation, manufacturing standards and safety evaluation. The data encourages an increased awareness among healthcare providers, consumers and the general public of the potential risks associated with e-cigarette use. A need for better understanding of the hazards associated with e-cigarette use is recommended to better inform the population, particularly with respect to the youth.


Biography:

Jason is a paediatric plastic craniofacial registrar with an interest in reconstructive surgery and burns.

Appropriate First Aid in Chemical Burn Injury

Dr Daniel Calandro1, Dr Suzanne Rea1, Prof. Fiona Wood1

1State Burns Service, Western Australia, Murdoch, Australia

Abstract:

Burn injuries are common and debilitating, but can be appropriately managed, with timely and adequate first-aid dramatically improving burn outcomes. This study assessed first-aid performance in chemical burns, which has an increased risk in Western Australia (WA) due to its large industrial sector.

51 Adult patients presenting to the State Burns Service of WA with exclusively chemical burns between April and December 2016, were assessed for appropriate burns first-aid care with respect to stop, cool, and cover methods and timing.

Key Demographics: 78% of burns occurred in men. 61% affected trades-persons and related workers. 51% of burns occurred at work vs. 31% at home. 51% of burns were to the upper limb and hand; TBSA for all burns was 1.2%. PPE worn in 26% of burns, with 71% of that worn in the workplace.

Key First-Aid: Stop first-aid data was available in 80% of patients, with 34% receiving appropriate methods. Cooling first-aid data was the best documented area, available in 98% of patients, with 33% receiving adequate cool running water for >20 minutes <3hrs from injury. Appropriate dressings were used in 22% of burns. Patients who received adequate cooling first-aid required less inpatient care, shorter hospital stays, and fewer surgeries.

Conclusions: This was the first study evaluating exclusively chemical burn first-aid in WA, identifying patterns of chemical burn injury, with trades-persons at highest risk, and found that practices under-performed when compared to local and national mixed-type burn studies; supporting the need for strategies to improve first-aid performance and outcomes.


Biography:

Daniel grew up in country Victoria. His academic journey began with a triple major bachelor of science from the University of Melbourne in anatomy, physiology, and neuroscience; before a doctor of Medicine, and Master of Philosophy in Medicine, from the University of Sydney and University of Notre Dame. He works as a medical officer and medical research scientist; and currently aspires to complete surgical training in Australia

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About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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