Enzymatic debridement in the treatment of partial and full thickness burns: clinical experience in 40 patients

Hilal  Bahia1, Jeanna  Bernard1, Dr Jenna Langschymidt1, Daniel Widdowson1

Abstract:

Introduction: Nexobrid is a bromelain based enzymatic agent of plant origin licensed for use in the treatment of deep partial and full thickness burns. Nexobrid is capable of selectively removing burn eschar within 4 hours without the need for a general anaesthetic thereby providing a minimally invasive alternative to burn debridement. Our aim was to review the clinical effects/benefits of using this modality of treatment in our burn unit.
Method: We carried out a retrospective analysis of the case notes of 40 patients undergoing Nexobrid treatment. We recorded information including: demographics, total body surface area affected, type of burn, burn depth, time to Nexobrid application, pain scores before, during and after treatment, anaesthesia given, need for surgical debridement following Nexobrid treatment, length of hospital stay, cost of treatment, time to healing and wound microbiology.
Results: None of our patients experienced a significant complication to treatment. Nexobrid debridement was effective in 37/40 cases. Additional benefits of Nexobrid included a reduction in over debridement in anatomically challenging areas, minimal blood loss and potentially reduced hospital admissions.
Conclusion: We have found Nexobrid to be safe and effective in adequately debriding deep partial and full thickness burns. In our selected patients Nexobrid was found to reduce the need for surgical debridement under a general anaesthetic and its associated morbidities. Many have avoided skin grafting due to preservation of the dermis. The selected use of this product may significantly alter the acute management of partial and full thickness burn injuries.

Biography:

 

Do emergency services and general practitioners follow current first-aid guidelines in the early management of paediatric burns?

Mr Cody Frear1Dr Bronwyn Griffin1, Professor Roy Kimble1

1Centre For Children’s Burns And Trauma Research; The University Of Queensland

Abstract

Background: In the treatment of burns, the provision of cool running water (CRW) first-aid is known to significantly improve clinical outcomes. Due to poor knowledge of and adherence to appropriate first-aid guidelines among the Australian public, it frequently falls to ambulances, general practitioners (GPs), and Emergency Departments (EDs) to provide patients with adequate CRW.
Objective: This study aims to determine the effectiveness of healthcare providers involved in the early burns management in ensuring the delivery of adequate CRW to children with acute burns.
Methods: A retrospective analysis was performed using a registry containing first-aid details for every patient presenting to the burns centre of a quaternary children’s hospital.
Results: Of the 3,205 children referred to the burns centre, 71.2% received adequate first-aid, 30.4% at the scene of injury. Both paramedics and GPs administered appropriate CRW in less than 25% of cases among patients with previously inadequate first-aid. ED clinicians were generally more effective at rectifying prior lapses in first-aid protocol, although the quality of first-aid varied significantly between EDs. Notably, patients were significantly more likely to receive adequate CRW at the quaternary hospital’s ED than at a referral centre ED (80.9% vs. 54.2%; p<0.05).
Conclusion: Among the healthcare providers studied, only the quaternary hospital’s ED administered adequate CRW to a large majority of its patients, with paramedics and GPs falling well short of current first-aid guidelines. This discrepancy highlights the potential value of disseminating the hospital’s burns-related training programs and educational resources to other providers of acute burns care.


Biography

Cody C. Frear is an MD/PhD candidate at The University of Queensland. He joined the Centre for Children’s Burns & Trauma Research in 2016.

Donor site dressings: how much do they affect pain?

Megan Grigg1, Cienwen Town2, Jason Brown3

1 Royal Brisbane and Women’s Hospital; Herston QLD, 4029, megangrigg31@gmail.com 2 Research Nurse, Department of Perioperative Medicine, Royal Brisbane and Women’s Hospital, Herston, QLD 4029 3 Director of Burns, Royal Brisbane and Women’s Hospital, Herston, QLD 4029

Abstract

Pain causes significant distress in burn patients and is both neuropathic and nociceptive in character. Background pain is usually managed with regular, long-acting medications whilst dressing changes require breakthrough analgesia. Dressing changes remain a substantial source of acute pain but are a necessary evil. This audit focuses on Suprathel® used specifically in donor sites and the effect it has on both analgesia and opiate requirements. Data was collected retrospectively over a three-month period at the Royal Brisbane and Women’s Hospital Professor Stuart Pegg Adult Burns Centre. All patients who received Suprathel® (under the discretion of the consultant surgeon) and had small burns <5% TBSA were included in the audit. This data was then compared to previously collected data involving patients who had standard dressing care – Algisite. Pain scores and opiate requirements were then compared between the two. This audit demonstrates the importance of choosing appropriate dressings and the benefits of pain reducing dressings. Suprathel® is emerging as an alternative to standard dressings as both a way of reducing dressing changes and improving analgesia.


Dr Megan Grigg is a resident medical officer at the Royal Brisbane and Women’s Hospital with a keen interest in research and analgesia.

Factors associated with home fire escape plans in New South Wales: Multinomial analysis of high risk individuals and nsw population

1Agho Kingsley Kathy Tannous  

1Western Sydney University,School of Science and Health 2Western University of Sydney

Abstract:

Introduction: The design and practice of home escape plans have been considered as important safety strategies for families to employ, to reduce and/or prevent injury or death. The aim of this study was to assess the prevalence and factors associated with home escape plans in the state of New South Wales, Australia.

Method: This study utilised two surveys: fire safety attitudes and behaviour survey administered to high risk individuals (n=296) and 2013 NSW health survey, comprising 13,027 adults aged 16 years were examined using multinomial logistic regression analyses to identify factors associated with having no home fire escape plan, and having no written home escape plan.

Results: The prevalence of written home escape plan was (7.9%, 95% confidence interval (CI): 7.3, 8.6 for NSW population, 4.3%, 95%CI: 2.5, 7.5 for the high risk individuals), no written home escape plan (26.2%, 95%CI: 25.1, 27.2 for NSW population, 44.6%, 95%CI: 38.8, 50.5 for the high risk individuals) and no home escape plan (65.9%, 95%CI: 64.8, 67.1 for NSW population, 51.1%, 95%CI: 45.2, 56.9 for the high risk individuals). After adjusting for other covariates, the following factors were significantly associated with no written home escape plan and not having a home escape plan: respondents who spoke only English at home, respondents who took over a year to practice home escape plan, married respondents, females and those respondents who tested their smoke alarm less frequently.
Conclusion: Future fire interventions should target people who speak only English at home and people who test their smoke alarms less frequently.

Keywords: Home fire; escape plan; fire safety; high risk individual; New South Wales


Biography:

 

60 years Burns Service at the Women’s and Children’s Hospital, South Australia

HP Chong1, E Gibson1, L Quinn1R Cooksey1,D Molony1,A Jeeves1, M Lodge1,B Carney1

1Women’s And Children’s Hospital, North Adelaide, Australia

Abstract:

Introduction: Burns are a preventable cause of pediatric injury with over 100 000 annual hospitalizations. The authors hypothesize that analysis of injury patterns can generate age-specific and injury-specific prevention strategies to reduce these injuries.

Methods: A retrospective study of data from the unit’s local registry was collected over a 50 year period. Cross-tabulations were employed to examine associations. An analysis of variance model was used to examine differences in injury pattern.

Results: Treating burns in children less than 1 year accounted for the majority of inpatient and outpatient service. The most common mechanism of injury was scalds from a hot beverage or hot noodles, followed by contact burn to iron, and friction burns from treadmill.

CONCLUSIONS:
We would like to place emphasis on public education targeting parents with infants to exercise extra precaution in circumstances that can result in these accidental burn injuries.


Biography:

HP Chong is the Burns Fellow at WCH and previous unaccredited registrar at Flinders Medical Centre

Survivability in Major Paediatric Burn Injuries: A Single Centre Experience

HP Chong1, E Gibson1, L Quinn1R Cooksey1,D Molony1,A Jeeves1, M Lodge1,B Carney1

1Women’s And Children’s Hospital, North Adelaide, Australia

Abstract:

Survival rates in burn injuries are inversely proportional to burn size. With advancement in technology, multidisciplinary approach comprising of knowledgeable and dedicated specialist with particular interest in treating this unique surgical population, and multiple medical innovations, mortality rates have decreased significantly. However, no large analysis on outcomes in pediatric burn patients with current treatment regimen exists. This study was designed to identify the burn size presently associated with significant increases in morbidity and mortality in pediatric burn patients. We perform a single center retroprospective observational cohort study utilizing the clinical data of severely burned pediatric patients admitted between 1975 and 2017. This study included severely burned pediatric patients with burns over at least 30% of their total body surface area (TBSA). We analyse the epidemiology, trends in presentations and treatment approaches that have lead to the implementation of our approach to this date.


Biography:

HP Chong is the Burns Fellow at WCH and previous unaccredited Plastics and Reconstructive Surgery Registrar at Flinders Medical Centre.

Assessment and Management of Hot Springs Burns in New Zealand

Dr Ming-Chi  Wang1, Dr Theresa  Magoye1, Ms Deirdre Seoighe1

1Waikato Hospital, Hamilton , New Zealand

Abstract:

Aim: New Zealand is a geothermically active country with numerous easily-accessible hot springs. Yet there is paucity of data and of previous research to guide the assessment and management of burns injury sustained in hot springs. We aimed to review the current literature; and report the presentation of hot spring burns in a major regional burns referral centre.

Method: A retrospective review of medical records gathered from Waikato Hospital, a regional burns centre in New Zealand was performed to examine the pattern of injuries sustained, rate of use of antimicrobial agents and wound infection rates in hot-spring related burns. A literature search was also performed to look for evidence to support early prescription of antibiotics and correlate the rate of infection in hot spring burns.

Results: Medline and Google Scholar search combining the following terms: “burns” and “hot springs” did not return any result pertaining to the current practice in managing hot-spring burns. On review of our database we found inconsistent use of antibiotics and less than thorough microbial investigations performed in the early stages of burns management.

Conclusions: We present a retrospective study of the assessment and management of hot springs burns in a major regional burns centre in New Zealand. To our knowledge, no previous study has singled out this mechanism of burns to examine its characteristics, and there is no evidence to support the empirical use of antibiotics in its initial management.


Biography:

Surgical registrar at Waikato Hospital

Time for a change in paradigm in clinical wound care: a review of literature and role of acetic acid dressing

Mr  Eric Tan1,2, Dr Wei Lun Wong1,2, Mr Terrence Creagh1,2

1Christchurch Hospital, Christchurch , New Zealand, 2University of Otago, Christchurch, New Zealand

Abstract:

Introduction:The balance between anti-bacterial activity and tissue toxicity with the final impact on wound healing for every antimicrobial agent ever proposed has been raised in literature but difficult to quantify in clinical practice.
Acetic acid (AA) is not commonly used in New Zealand for burn care.
We would like to investigate the medical literature on the role of AA in burn and outline our proposal to address any paucity of information.

Method: A Pubmed search using keywords ‘antimicrobial acetic acid’ and ‘wound’ was performed. 307 articles were produced but after initial review only 17 were suitable for analysis.
Only one randomised study has been conducted comparing AA against saline dressing in 32 patients with better outcome in AA group (P<0.001).

Results: 12 in vitro study were performed with 4 directly on burn wounds. AA is effective at 0.1666% concentration (2015) and determined to be non-cytotoxic at 1% (2017). A single in vitro study (2010) found suprathel-acetic acid matrix having better anti-MRSA and Pseudomonas aeruginosa activity in comparison to silver and suprathel-silver combination.
A 2018 wound consensus described AA as a future promising agent.

Conclusion:Our proposal for a randomised controlled trial comparing AA against silver dressing and saline dressing as control in a single burn unit in New Zealand will be of utmost clinical relevance.


Biography:

Mr Eric Tan is a current fellow in the department of plastic surgery in Christchurch hospital. He has a special interest in evidence based burn practice and has produced educational curriculum for emergency department and junior doctors in UK on burns. He has also chaired sessions on burns in European Burns Association meetings with a special interest in chemical burns.

Setting up evidence-based cost-effective and clinically efficacious wound care service in a tertiary hospital in New Zealand: lessons learned

Mr Eric Tan1,2, Dr Wei Lun  Wong1,2, Mr Terrence Creagh1,2

1Department of Plastic Surgery, Christchurch Hospital, Christchurch , New Zealand, 2University of Otago, Christchurch, New Zealand

Abstract:

Introduction:Commonly used antimicrobial dressing (AD) are not robustly tested and have been adopted into clinical practice from a combination of marketing efforts from distributors, individual clinician’s preference and traditional departmental practice.
We would like to evaluate the level of EB practice at our workplace and its’ consequential health economics.

Methods: A standardised survey was sent to different medical and nursing staff involved in wound care in Christchurch Hospital.
A Pubmed/Medline systematic review was conducted using keywords “antimicrobials”, “silver dressing”, “acetic acid” and “wound”.

Results: 100/101 staff who completed the survey use silver based dressing for most wounds in general without correlation to previous and/or concurrent international consensus (Chi squared test p<0.00001). 95 out of 101 are unfamiliar with alternative AD like acetic acid (Chi squared test p<0.00001).
46 papers were included in systematic review. There are no randomised clinical trial comparing silver based dressing with other antimicrobial dressing in clinical practice. 2 Cochrane review groups found no evidence that silver based dressing improves healing rate.
In vitro studies suggest cytotoxic properties identified in silver based dressing and 1% acetic acid being to be non-cytotoxic but retain antimicrobial properties at 0.16% concentration.
A cost analysis based on 10 patients with 10% burn admission and 200 minor burn service in 6 months found that a predominantly acetic acid based dressing service reduces the estimated expenditure of NZD48,000 to NZD42.

Conclusion: A carefully design standardised treatment pathway will reduce cost but also ensure patients continue to receive the best concurrently recommended treatment.


Biography:

Mr Eric Tan is a current fellow in the department of plastic surgery in Christchurch hospital. He has a special interest in evidence based burn practice and has produced educational curriculum for emergency department and junior doctors in UK on burns. He has also chaired sessions on burns in European Burns Association meetings with a special interest in chemical burns.

The Shared Value of Consumer Engagement

Mr Dale Forbes1, Mrs Anne Darton2

1Agency of Clinical Innovation Statewide Burn Injury Service Consumer Representative, , , 2Agency of Clinical Innovation Statewide Burn Injury Service, 

Abstract:

The National Safety and Quality Health Service Standards provide a national mandate for Health Services to engage meaningfully with consumers. However, there is no consistent approach to achieving this in the provision of a clinical burns service across Australia.

This presentation highlights the vital role of consumer representatives in a burns service. The shared value can be realised when clinicians and consumers partner to co design innovative health care improvements.

Consumer engagement provides an empathetic and respectful framework that brings together professional knowledge and best practice evidence and lived experience to design, implement and evaluate improvements, activities, products and services.

The NSW Statewide Burn Injury Service has embedded consumer participation in its burn service using a number of strategies. These are based on the principles of equal partnership, openness, respect, empathy and designing together. Key initiatives include the SHARE Peer Support Program, Patient Reported Experience Measures Project and the Beyond Burns Online Hub Project.

Lastly, this presentation discusses the emerging evidence around improved outcomes and how burn survivors only stand to benefit as clinical burns services work more collaboratively as a network partnering with consumers.


Biography:

Dale Forbes is an Aboriginal man from Rural NSW. Dale has a lived experience as a Burn Survivor in addition to growing up in Out of Home Care. Dale has been heavily involved in volunteering and charitable work in burns sector for many years. Dale is currently finishing a Bachelor of Social Work while working as an Aboriginal Senior Project Officer with the NSW Department of Family and Community Services. Dale has been a driving force behind the Beyond Burns project from the initial conception through to the design and development and has a deep commitment to collaborative consumer centred approaches

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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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