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Dressings used in burn units in Italy—A survey
Burns 3 3 S ( 2 0 0 7 ) S1–S172
S39
Conclusion: These results suggest that the use of EED compared well with the PAC and provided non-invasive and reliable tool for monitoring the CI in patients with extensive burns. doi:10.1016/j.burns.2006.10.092 Comparing the costs of skin graft and an absorbing nanocrystalline silver dressing in the treatment of a vasculitic ulcer—A cost model Sara R. a,b , Lorenzini M. a,b , Miguel L.S. a,b a
Smith & Nephew, Italy Umberto I Hospital, Italy E-mail address: [email protected] (R. Sara).
b
Introduction: Under current budgetary pressures health professionals must provide patients with care that is both effective and affordable. A common mistake is to consider the price of a product as an indicator of treatment costs; evidence suggests that the impact of products on nursing time and length of treatment is much more important. Aim: To develop a simple model to assess the overall cost of treatment including the wound care product. Methodology: The following parameters were considered: • • • •
material costs, labour costs, frequency of dressing changes, time to heal. By using the formula:
The patient, a 75 year-old woman, suffering from rheumatoid arthritis and on steroids for the past 15 years, had incurred an accidental trauma to her right leg. Results: The patient underwent two skin grafts for which she was hospitalised for 25 days. The skin grafts took only partially. The overall cost of hospital treatment was 5126. Upon hospital discharge, the patient still had an open wound of approximately 8 cm × 5 cm, managed with an absorbing nanocrystalline silver dressing covered by a secondary dressing and retention bandages, on an outpatient basis. Dressing changes took place every 3–4 days. The wound completely closed after 55 days. Table 1 summarises the overall cost to heal the wound with the nanocrystalline silver dressing. Conclusion: The overall cost of healing this ulcer with the absorbent nanocrystalline silver dressing in the community was 4559 less than the total costs incurred during the hospitalisation, while expenditure on silver dressings represented less than 8% of the overall treatment costs. doi:10.1016/j.burns.2006.10.093 Dressings used in burn units in Italy—A survey Rowan S. a,b,c , Molon A. a,b,c , Caminati G. a,b,c a
Smith & Nephew, Italy Burn Unit, Torino Hospital, Italy c Burn Unit, Cesena Hospital, Italy E-mail address: [email protected] (S. Rowan). b
Aim: To investigate the products most used in burn units in Italy during 2003. Methodology: Questionnaires were sent to 18 burn units in Italy. Eleven (61%) burn units replied and participated in the survey. The questionnaires were divided according to type of wounds: donor site, burns and grafted wounds. Each type of wound was subdivided into infected and non-infected. Products or antiseptics were listed in a column and the investigator had to fill in the percentage of product or antiseptic used in their units. Results: The most used topical dressings for donor site wound (DSW) were: gauze and antiseptics 30%, paraffin gauze 10%, a combination of few dressings 10%. There was a slight variation when the DSW was infected: a combination of dressings (often paraffin gauze and a soak of antibiotics) 23%, topical antibiotics 10%.
S40
Burns 3 3 S ( 2 0 0 7 ) S1–S172
Around 50–30% marked “other dressings” as the treatment. Among the dressings mentioned in the column “other Dressing” were: foam dressings, hydrocolloids, hydrogels, enzymes, HyalomatrixTM and JaloskinTM . The most used skin substitutes for minor burns and major burns were skin grafts: 75% and 52.2%, respectively. In major burns where skin grafts were not sufficient, a variety of other substitutes were used: 8% Allograft, 9% combined grafts and a variety of other products. Products used as the contact layer in the treatment of skin substitutes/grafts were foam dressings (53%), paraffin gauze (10%), topical antibiotics (9%); the rest were “other products”. Discussion: The data obtained in this investigation was approximate. It was not possible to review all the charts to quantify precisely the number of products used in a year. The results obtained are in line with the received notion that conventional dressings and antiseptics are extensively used in the treatment of burn wounds. doi:10.1016/j.burns.2006.10.094 Using CT to find oral infection on intensive care and burn patients B.W. Burgess, D.W. Voigt, C.N. Paul Saint Elizabeth Regional Burn And Wound Center, USA E-mail address: [email protected] (B.W. Burgess). Introduction: We have found using CT to find oral infection in the critically ill and burn patients an essential tool. Chronic periapical abscesses are generally asymptomatic and difficult to find without X-rays. Since traditional dental X-rays are impossible to take on burn/critical care patients, the CT scan becomes an essential tool in finding these hidden dental infections. Methods: A review of medical records was conducted on all patients having a CT scan in association with a dental exam over a 2 year period. Demographic data was collected on this group of patients, including age, length of stay, reason for dental consult, dental findings and CT findings. Results: Seven patients were identified. Of this group, the average age was 47.3 years and average length of stay was 18 days. Conclusion: Patients with sepsis (2, 4, 5, and 6) all had hidden dental infections not found on the dental exam but located by CT. Patient 1 and 3 had a CT used to rule out any dental infections as primary source. Patient 7 had a CT done to confirm a dental abscess. CT identified 7 infected teeth that were not identified on exam. The use of a CT scanner has been an essential tool to find, confirm or rule out oral infections in the critically ill and burn patients. doi:10.1016/j.burns.2006.10.095 The eyelt wire—A novel method of endotracheal tube retention Gilbert P., Dheansa B., Booth S.P. Mcindoe Burn Centre, Queen Victoria Hospital, UK E-mail address: [email protected] (P. Gilbert). Securing an endotracheal tube in a patient with facial burns presents numerous problems. Facial swelling may cause ties to become tight and induce pressure necrosis on the angle of the lips and underneath the tapes. Wound management of the face is troublesome and oral hygiene is limited by the interference of the tube ties in using suction, tooth brushing and other cleaning methods. We present a novel method of securing the endotracheal tube safely by use of dental wire around the teeth or in the case of the edentulous patients through the alveolus. The authors do not claim to be the originators of this method however it has not been described in the literature and as far as we can ascertain is not used widely by other burn and intensive care units. The eyelet wire technique is easily learnt and well tolerated by patients. Nursing, surgical and anaesthetic staff have found that the wire makes oral care and facial wound management considerably easier. Risk of accidental extubation is reduced as the tube is attached securely to the teeth. We believe that this technique is safe and useful to all who manage ventilated facial burns. doi:10.1016/j.burns.2006.10.096
S39
Conclusion: These results suggest that the use of EED compared well with the PAC and provided non-invasive and reliable tool for monitoring the CI in patients with extensive burns. doi:10.1016/j.burns.2006.10.092 Comparing the costs of skin graft and an absorbing nanocrystalline silver dressing in the treatment of a vasculitic ulcer—A cost model Sara R. a,b , Lorenzini M. a,b , Miguel L.S. a,b a
Smith & Nephew, Italy Umberto I Hospital, Italy E-mail address: [email protected] (R. Sara).
b
Introduction: Under current budgetary pressures health professionals must provide patients with care that is both effective and affordable. A common mistake is to consider the price of a product as an indicator of treatment costs; evidence suggests that the impact of products on nursing time and length of treatment is much more important. Aim: To develop a simple model to assess the overall cost of treatment including the wound care product. Methodology: The following parameters were considered: • • • •
material costs, labour costs, frequency of dressing changes, time to heal. By using the formula:
The patient, a 75 year-old woman, suffering from rheumatoid arthritis and on steroids for the past 15 years, had incurred an accidental trauma to her right leg. Results: The patient underwent two skin grafts for which she was hospitalised for 25 days. The skin grafts took only partially. The overall cost of hospital treatment was 5126. Upon hospital discharge, the patient still had an open wound of approximately 8 cm × 5 cm, managed with an absorbing nanocrystalline silver dressing covered by a secondary dressing and retention bandages, on an outpatient basis. Dressing changes took place every 3–4 days. The wound completely closed after 55 days. Table 1 summarises the overall cost to heal the wound with the nanocrystalline silver dressing. Conclusion: The overall cost of healing this ulcer with the absorbent nanocrystalline silver dressing in the community was 4559 less than the total costs incurred during the hospitalisation, while expenditure on silver dressings represented less than 8% of the overall treatment costs. doi:10.1016/j.burns.2006.10.093 Dressings used in burn units in Italy—A survey Rowan S. a,b,c , Molon A. a,b,c , Caminati G. a,b,c a
Smith & Nephew, Italy Burn Unit, Torino Hospital, Italy c Burn Unit, Cesena Hospital, Italy E-mail address: [email protected] (S. Rowan). b
Aim: To investigate the products most used in burn units in Italy during 2003. Methodology: Questionnaires were sent to 18 burn units in Italy. Eleven (61%) burn units replied and participated in the survey. The questionnaires were divided according to type of wounds: donor site, burns and grafted wounds. Each type of wound was subdivided into infected and non-infected. Products or antiseptics were listed in a column and the investigator had to fill in the percentage of product or antiseptic used in their units. Results: The most used topical dressings for donor site wound (DSW) were: gauze and antiseptics 30%, paraffin gauze 10%, a combination of few dressings 10%. There was a slight variation when the DSW was infected: a combination of dressings (often paraffin gauze and a soak of antibiotics) 23%, topical antibiotics 10%.
S40
Burns 3 3 S ( 2 0 0 7 ) S1–S172
Around 50–30% marked “other dressings” as the treatment. Among the dressings mentioned in the column “other Dressing” were: foam dressings, hydrocolloids, hydrogels, enzymes, HyalomatrixTM and JaloskinTM . The most used skin substitutes for minor burns and major burns were skin grafts: 75% and 52.2%, respectively. In major burns where skin grafts were not sufficient, a variety of other substitutes were used: 8% Allograft, 9% combined grafts and a variety of other products. Products used as the contact layer in the treatment of skin substitutes/grafts were foam dressings (53%), paraffin gauze (10%), topical antibiotics (9%); the rest were “other products”. Discussion: The data obtained in this investigation was approximate. It was not possible to review all the charts to quantify precisely the number of products used in a year. The results obtained are in line with the received notion that conventional dressings and antiseptics are extensively used in the treatment of burn wounds. doi:10.1016/j.burns.2006.10.094 Using CT to find oral infection on intensive care and burn patients B.W. Burgess, D.W. Voigt, C.N. Paul Saint Elizabeth Regional Burn And Wound Center, USA E-mail address: [email protected] (B.W. Burgess). Introduction: We have found using CT to find oral infection in the critically ill and burn patients an essential tool. Chronic periapical abscesses are generally asymptomatic and difficult to find without X-rays. Since traditional dental X-rays are impossible to take on burn/critical care patients, the CT scan becomes an essential tool in finding these hidden dental infections. Methods: A review of medical records was conducted on all patients having a CT scan in association with a dental exam over a 2 year period. Demographic data was collected on this group of patients, including age, length of stay, reason for dental consult, dental findings and CT findings. Results: Seven patients were identified. Of this group, the average age was 47.3 years and average length of stay was 18 days. Conclusion: Patients with sepsis (2, 4, 5, and 6) all had hidden dental infections not found on the dental exam but located by CT. Patient 1 and 3 had a CT used to rule out any dental infections as primary source. Patient 7 had a CT done to confirm a dental abscess. CT identified 7 infected teeth that were not identified on exam. The use of a CT scanner has been an essential tool to find, confirm or rule out oral infections in the critically ill and burn patients. doi:10.1016/j.burns.2006.10.095 The eyelt wire—A novel method of endotracheal tube retention Gilbert P., Dheansa B., Booth S.P. Mcindoe Burn Centre, Queen Victoria Hospital, UK E-mail address: [email protected] (P. Gilbert). Securing an endotracheal tube in a patient with facial burns presents numerous problems. Facial swelling may cause ties to become tight and induce pressure necrosis on the angle of the lips and underneath the tapes. Wound management of the face is troublesome and oral hygiene is limited by the interference of the tube ties in using suction, tooth brushing and other cleaning methods. We present a novel method of securing the endotracheal tube safely by use of dental wire around the teeth or in the case of the edentulous patients through the alveolus. The authors do not claim to be the originators of this method however it has not been described in the literature and as far as we can ascertain is not used widely by other burn and intensive care units. The eyelet wire technique is easily learnt and well tolerated by patients. Nursing, surgical and anaesthetic staff have found that the wire makes oral care and facial wound management considerably easier. Risk of accidental extubation is reduced as the tube is attached securely to the teeth. We believe that this technique is safe and useful to all who manage ventilated facial burns. doi:10.1016/j.burns.2006.10.096