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Volume XXXI

Number 3

September 2018
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Summaries

163 AGING AND BURN: A FIVE-YEAR RETROSPECTIVE STUDY IN A MAJOR BURN CENTRE IN PORTUGAL
(Caetano P., Brandão C., Campos I., Tão J., Laíns J., Cabral L. - Portugal)
Aging is an important factor contributing decisively to the clinical outcome of burn patients. The aim of this study was to assess the characteristics of patients admitted to a Burn Unit and determine the impact of aging on mortality. A retrospective analysis of patients successively admitted to a major burn centre in Portugal from 1/1/2012 to 31/12/2016 was conducted. They were divided into 2 groups: "elderly" (?65 years) and "non-elderly" (<65 years). A total of 736 patients were included, 324 of them classified as elderly with a mean age of 78.12±7.14 years. Most of the patients in the elderly group were female (59.6%), in contrast to the non-elderly group (35%; p<0.001). The elderly patients had a higher mean length of hospital stay (20.14±18.46 days; p=0.011). Most of the burns were caused by fire (58.3%) and scalding (36.1%) and mainly after home accidents. Elderly patients showed a higher mean of burn severity index (7.26; p<0.001) and 6.8% needed an amputation. Mortality rate was significantly higher in the elderly group (11.7%; p=0.001). Age (p<0.001; OR=1.169), a higher total burn surface area (p<0.001; OR=1.081), full-thickness burns (p=0.005; OR=11.985) and the need for mechanical ventilation (p<0.001; OR=16.856) were associated with a higher mortality risk and reached statistical significance after multivariate analysis. The functional and vital prognosis of patients admitted to a burn centre is affected by multiple factors. This study showed that age, higher TBSA, full-thickness burns and need for mechanical ventilation seem to increase the risk of mortality.
168 FACTORS THAT INFLUENCE THE DEC ISION FOR HYPE RBARIC OXYGEN THERAPY (HBOT) IN CASES OF CARBON MONOXIDE POISONING: A RETROSPECTIVE STUDY
(Altintop I., Akcin M.E., Tatli M., Ilbasmis M.S. - Turkey)
Carbon monoxide poisoning (COP) is one of the most common types of potentially fatal poisoning throughout the world. Hyperbaric oxygen therapy (HBOT) is an effective and quick response modality that clears symptoms and prevents sequelae. HBOT should be administered within 4-6 hours after poisoning. The aim of this study was to contribute COP treatment protocols by retrospectively examining the results of COP cases who were administered HBOT according to clinical and laboratory findings at the Emergency Department.
174 ELECTRICAL BURN INJURY: A COMPARISON OF OUTCOMES OF HIGH VOLTAGE VERSUS LOW VOLTAGE INJURY IN AN INDIAN SCENARIO
(Srivastava S., Kumari H., Singh A., Rai R.K. - India)
Electrical burn injury (EBI) is a mutilating form of injury. The objective of this study was to evaluate the various aspects of EBI and analyse the differences between high voltage injury (HVI) and low voltage injury (LVI). A retrospective study was conducted by reviewing the medical records of all burn admissions from June 2016 to May 2017. A total of 1572 patients were admitted, of which 385 (24.49%) had suffered an electrical injury. 104 (27.01%) patients sustained LVI and 281 (72.98%) HVI. One hundred patients from both groups were randomly selected using the chit method, in order to analyse their differences. In our study, the mean age was 35.23±19.96 in the HVI group and 24.15±14.39 years in the LVI group. Most of the injuries were work related. Events during the early phase of admission included a rise in serum creatine phosphokinases, myoglobinuria, renal failure, abnormal cardiac events and other concomitant injuries in the HVI group (p<0.001). Unfavourable outcomes in the form of amputations, prolonged hospital stay and high mortality rate were observed in the HVI group (8.5%) (p<0.027). However, LVI cannot be overlooked as number of reconstructive surgeries and mean number of operations showed no significant difference between both groups. HVI has a disastrous impact on burn survivors but LVI cannot be underestimated. We advocate a low threshold for managing associated injuries, education on safety principles, for men at work especially, and infrastructure improvement by the state to bring changes to the present scenario.
178 ÉPILEPSIE ET BRÛLURE : É PIDÉMIOLOG IE ET INTERACTIONS
(Brosset S.,Vantomme M., Viard R., Aimard R., Mertens A., Comparin J.P., Voulliaume D. - France)
Nous avons mené une étude descriptive rétrospective afin d'apprécier les interactions entre crise d'épilepsie et brûlure. L'ensemble des patients pris en charge dans le centre de traitement des brûlés de l'hôpital Saint Luc-Saint Joseph de Lyon, de l'année 2000 à l'année 2015, chez qui un diagnostic d'épilepsie avait été retenu ont été inclus. Quatre-vingt-quatre dossiers associant brûlure et épilepsie ont été revus. Vingt-huit patients présentaient une brûlure secondaire à une crise d'épilepsie. L'âge moyen était de 43 ans, et la surface brûlée de 9%. Les brûlures étaient principalement causées par contact avec une surface chaude (32%) ou par ébouillantement (50% dont 32% avec de l'eau de cuisson et 17,8% par exposition accidentelle à l'eau chaude sanitaire -douches). Les brûlures par flammes étaient rares (4 cas/28 : 14,3%). Les brûlures étaient profondes et ont toutes nécessité un traitement chirurgical par excision - greffe dermo-épidermique. On ne recense aucun cas de brûlure par eau chaude sanitaire après 2010. Trois des patients (11%) ont présenté une nouvelle crise d'épilepsie au cours de leur hospitalisation. Aucun des patients connus comme épileptiques et ayant subi une brûlure en dehors d'une crise d'épilepsie n'a présenté de crise lors de son hospitalisation. Les mesures de prévention primaire des accidents domestiques, particulièrement la réglementation de la température de l'eau chaude sanitaire apparaissent comme efficaces. Une éducation des patients épileptiques sur l'importance de l'observance thérapeutique et l'éviction des activités à risques lors des périodes de modification thérapeutique doit permettre de réduire davantage l'incidence des brûlures liées aux crises convulsives.
181 DIABETES AN D FOOT BURNS
(Momeni M., Jafarian A-A., Maroufi S-S., Ranjpour F., Karimi H. - Iran)
The incidence of diabetes and diabetic foot burns is increasing worldwide. In the present study, we surveyed frequency, morbidity and mortality of diabetic foot burn patients in our centre. The study was a cross-sectional survey with one-year follow up of our adult diabetic patients with lower extremity burns. Data on demographics, cause of burn, time from injury to hospital, TBSA, presence of neuropathy and diabetic foot, treatment plan for controlling blood sugar, smoking, infection, morbidity, co-morbid diseases, amputation and mortality were gathered from patient files. Statistical analysis was done with SPSS 21 software. A p value less than 0.05 was considered significant. Of the 34,300 burn patients seen in a year, 2096 were admitted according to ABA criteria. 47 patients had diabetic foot burn. Half of them had diabetic neuropathy. 48.9% had type I diabetes and 51.1% had type II. 70.2% were male, 29.8% were female. Mean +/- SD age was 58 +/- 14 years; 14 patients were smokers and 40 had co-morbid diseases. Hypertension frequency was 44%, ischemic heart disease 25%, CVA 8.5% and renal failure 6.4%. Half of the patients had uncontrolled blood sugar. Mean +/- SD delay in admission was 2.5±1.5 (days). Mean +/- SD TBSA was 2.4 +/- 1.4%. Mean +/- SD length of stay was 11.4±6.1 (days). 8.5% underwent amputation and there were no deaths. Diabetic foot burn patients delay seeking medical attention, have a longer length of stay, more complications and more amputations than other burn patients (compared with our previous study on burn patients). Prevention and training programs are highly needed to prevent foot burns.
185 PROGNOSIS VALUE OF SERUM CYTOKINE LEVELS AMONG BURN-INDUCED ARDS PATIENTS
(Nguyen L.N., Tran D.H., Dong K.H. - Vietnam)
The aim of this study was to investigate changes in and relationships between selected serum pro-inflammatory cytokine levels (IL-1?, IL-6, IL-8 and TNF?) and outcome of postburn ARDS patients. A descriptive study was conducted on 18 burn patients complicated with ARDS, treated at the intensive care unit, National Institute of Burns. Relationships between ARDS severity, mortality rate and serum cytokine levels were analyzed and compared over time. Results showed that on admission, all selected plasma cytokine concentrations were extremely high. On day 1 of ARDS, IL-6 level increased from 485.7pg/ml to 714.3pg/ml, while other cytokine levels decreased slightly (p > .05). On day 3 of ARDS, all serum cytokine levels had marginally reduced, apart from IL-1?, which continued to rise from 568.7 ± 173.6pg/ml to 606 ± 198pg/ml (p > .05). No significant relationship was seen between pro-inflammatory cytokine levels and ARDS severity, or mortality rate. Further studies need to be conducted to determine the prognostic role of plasma cytokines among postburn ARDS patients.
189 INFECTION CONTROL IN GERMAN-SPEAKING BURN CENTRES: RESULTS OF AN ONLINE SURVEY
(Baier C., Ipaktchi R., Ebadi E., Rennekampff H-O., Just H-M., Vogt P.M., Bange F-C., Suchodolski K. - Germany)
To systematically evaluate which infection control measures are in place in burn units, we conducted an online survey among 43 German-speaking burn units. The 29 units that responded and agreed to publication represented more than 125 patient beds. All units were located in advanced care hospitals. A total of 14 units provided single rooms only, and 22 units had a nurse-to-patient ratio of at least 1:2. Infection control practices included pre-emptive barrier precautions (29 units), the use of sterile filters for tap water supply (29 units), and an antibiotic stewardship program (24 units). Microbial screening of the patients on admission (23 units), regular prevalence screening (26 units) and surveillance of nosocomial infections (21 units) were also widely used. The high reply rate to the survey indicates the special relevance of infection control for burn units. Our survey shows that great efforts and several measures are being undertaken to address infection control challenges in burn patient care, but it also underlines the need for increased interdisciplinary infection control and antibiotic stewardship activities.
194 EVALUATION OF ANTIBIOTIC USE AND BACTERIAL PROFILE IN BURN UNIT PATIENTS AT THE DR. SOETOMO GENERAL HOSPITAL
(Aisyah S., Yulia R., Saputro I.D., Herawati F. - Indonesia)
The high inaccuracy of antibiotic prescribing in Dr. Soetomo General Hospital Surabaya, Indonesia, is one of the factors triggering the increasing prevalence of antibiotic-resistant pathogenic bacteria. The World Health Organization (WHO) showed that bacterial resistance to antibiotics was a threat to people's health around the world. Burn injuries are susceptible to infection and need appropriate antibiotics. The purpose of this study was to obtain a germ map for our burn patients and to evaluate the antibiotic therapy that had been used to treat them. This was a descriptive observational study, conducted in the Burn Unit at the Dr. Soetomo General Hospital. The study used data from burn patients who were treated there from February to May 2018. The patients' medical records, records of drug usage (antibiotics) and culture results data (bacterial sensitivity test for antibiotics) were examined. Total antibiotic usage was calculated using the Defined Daily Dose (DDD) method per 100 days. The quality of antibiotic usage was assessed using the Gyssens method. Bacterial profile was obtained from culture swab. According to our findings, the most widely used antibiotic is ceftazidim with DDD / 100 days of 22.25. Based on the qualitative analysis using the Gyssens method, 33.3% were in category VI-0. The most common bacteria obtained from the swabs were Bacillus cereus and Acinetobacter baumanni, found in 12% of the patients. Antibiotics are still not used wisely in the Burn Unit at the Dr. Soetomo General Hospital.
198 ANTISEPTICS FOR BURNS: A REVIEW OF THE EVIDENCE
(Slaviero L., Avruscio G., Vindigni V., Tocco-Tussardi I.- Italy)
The burn patient is easily subject to colonization by microorganisms and infection, due to reduced defence capabilities and immune dysfunction. Moreover, burn units and intensive care units are characterized by a selection of resistant bacterial strains. If the burn patient is not adequately cared for in terms of infection prevention and control, sepsis is inevitable. Nowadays, several different antiseptics and antiseptic dressings are used in the topical treatment of burns, each with positive and negative effects. Topical antiseptics allow control of bacterial load, but they can also cause cytotoxicity and reduce healing rate. Choosing the most effective antiseptic is crucial to preventing infection from compromising wound healing. The present study aims to review the available literature in order to highlight evidence on the use of topical antiseptics in burns.
204 COMPARING THE EFFECT OF COLACTIVE PLUS AG DRESSING VE RSUS NIT RO FUR AZONE AND VASELINE GAUZE DRESSING IN THE TREATMENT OF SECOND-DEGREE BURNS
(Salehi H., Momeni M., Ebrahimi M., Fatemi M.J ., Rahbar H., Ranjpoor F., Salehi A ., Moosavizadeh F. - Iran)
Wound care quality and speed of burn healing are important factors that affect the treatment, prognosis and complications of burns. Burn care is challenging, and the ideal method controversial. The aim of this study was to compare the effects of a new dressing (ColActive dressing) in the treatment of superficial second-degree burns versus traditional dressing including Vaseline and Nitrofurazone. This was a randomized clinical trial study involving 25 cases. A superficial second-degree burn area was divided into two parts in each patient; randomly, traditional dressing was used on one area, and ColActive plus Ag dressing on the other. Every 3 days, after removing the dressings and washing the wounds, wound surface area was evaluated by medical photographic records and J image software. Wound surface area in the two groups was compared before dressing and on the 3rd, 6th, 9th and 12th day afterwards. The difference was not significant before dressing, but significant on the 3rd, 6th, 9th and 12th post-operative day. The difference was significant in both groups, but it was more prominent in the ColActive group (p<0.001) than in the traditional group (p<0.05). Considering the results of this study and good results in previous case reports, ColActive may be more effective than traditional dressing. We suggest a more comprehensive study for a longer period with a larger number of cases to compare other important variables such as scar quality, cost, and pain in the two dressings.
209 ANTIBIOTHÉRAPIE PÉRI-OPÉRATOIRE ET GREFFE DE PEAU: ÉTAT DES LIEUX SUR LES PRESCRIPTIONS DANS LES CENTRES FRANÇA I S DETRAITEMENT DE LA BRÛLURE, VER S U NE HARMONISATION DES PRATIQUES?
(Tiry E., Leduc A., Dumont R., Ridel P., Perrot P., Duteille F. - France)
La plupart des hôpitaux disposent d'un protocole sur l'antibioprophylaxie en chirurgie. Concernant la prise en charge des brûlés, malgré les recommandations de 2009 émises par la SFB en faveur d'une antibioprophylaxie, il persiste des variations importantes de pratiques individuelles intra-établissement et inter-établissement lors d'une autogreffe cutanée ou la pose d'un substitut dermique dans les CTB français. Nous avons interrogé les chirurgiens exerçant dans douze CTB français par e-mail. Le chirurgien avait à cocher s'il prescrit une antibioprophylaxie, selon quelles modalités, sur la greffe de peau mince ou totale et le substitut dermique, dans deux indications que sont la brûlure aiguë et la séquelle de brûlure. Huit centres sur les douze nous ont retourné le tableau complété. Pour la brûlure aiguë, trois centres (37,5%) prescrivent systématiquement une antibioprophylaxie lors d'une greffe de peau mince ou totale, deux (25%) ne la prescrivent que si l'aspect clinique per opératoire est suspect d'infection et trois (37,5%) n'en prescrivent jamais. Lors de la pose d'un substitut dermique, cinq centres (62,5%) prescrivent une antibioprophylaxie systématiquement, un (12,5%) ne la prescrit que si l'aspect clinique est suspect et deux (25%) n'en prescrivent jamais. Pour la chirurgie des séquelles, cinq centres (62,5%) prescrivent systématiquement une antibioprophylaxie, qu'ils réalisent une greffe de peau mince ou totale ou un substitut dermique. Trois centres (37,5%) n'en prescrivent jamais. La survenue d'une infection après greffe de peau ou pose d'un substitut dermique est une complication fréquente. Notre état des lieux des pratiques à prescrire ou non une antibioprophylaxie démontre des variations très importantes. Évaluer de façon multicentrique le protocole d'antibioprophylaxie établi par la SFB en 2008 et publié en 2009 et son intérêt dans la diminution des infections après autogreffes cutanées et substituts dermiques dans la prise en charge du brûlé en aigu ou en séquelles pourrait permettre d'harmoniser les pratiques dans les CTB.
213 NOUV EAU PROCÉDÉ: LES GREFFES SÉQUE NTIELLES DE CELLULES CUTANÉES GUÉRISSENT-ELLES LES BRÛLURES DE TROISIÈME DEGRÉ? ÉTUDE COMPARATIVE À PROPOS DE 517 PATIENTS
(Sabeh G., Sabé M., Ishak S., Sweid R. - Liban)
Le but de cette étude est d'évaluer une alternative aux greffes tissulaires et substituts cutanés. Cinq cent dix sept brûlés ont été traités entre février 2012 et juin 2016 dont 381 ont bénéficié d'une thérapie cellulaire. Ce procédé consiste à prélever 1 à 4 cm2 de peau saine, à la séparer en épiderme, derme, et hypoderme et à préparer trois suspensions riches en cellules. Une partie de ces suspensions est diluée dans du plasma riche en plaquettes initialement, dans du cryoprécipité de plasma ensuite. Des ensemencements séquentiels sont effectués tous les 2 jours, suivis dès le lendemain d'irrigations biquotidiennes par des antioxydants, des protecteurs et des stimulants de la cicatrisation. Les brûlures du 2ème degré profond ont cicatrisé dans les 5 à 10 jours, celles du 3ème degré peu étendues en une vingtaine de jours, celles sur une plus grande surface en une cinquantaine de jours. Cette technique reproductible pourrait trouver sa place dans l'arsenal thérapeutique contre les brûlures.
223 PROCEDURAL SEDATION AND ANALGESIA DURING ENZYMATIC DEBRIDEMENT OF BURN PATIENTS
(Galeiras R., Mourelo M., Pértega S., López M.E., Esmorís I., - Spain)
Procedural sedation and analgesia (PSA) is a widely used strategy in various fields to carry out numerous diagnostic and therapeutic procedures. However, there is limited information on its efficacy and safety during enzymatic debridement of burn patients with Nexobrid®. The aim of our study was to describe the U-type PSA procedure in a series of patients requiring enzymatic debridement. We carried out a retrospective, descriptive study involving 28 patients requiring enzymatic debridement of a limb, trunk or multiple locations, who had been admitted to the Burn Unit of the University Hospital Complex of A Coruña (Spain). Of these, 17 patients (not requiring invasive mechanical ventilation [IMV]) received intravenous PSA and two received local/regional anesthesia. Among those patients who received PSA, the most frequently used sedative during the application and removal of Nexobrid® was ketamine following premedication with midazolam (median Ramsay sedation score = 3; range = 2-4). The most common type of analgesics prescribed for the debridement procedure was opioids. Three patients required rescue analgesia because of the intensity of their pain (Visual Analogue Scale [VAS] ? 4). The patients did not experience any of the complications analyzed. In our case series, U-type PSA proved to be a satisfactory and safe support strategy for enzymatic debridement of burn patients not requiring IMV due to another cause.
228 BILATERAL THIRD-DEGREE BURN OF THE LEGS: LOWER LIMB SALVAGE WITH DERMAL REGENERATIVE MATRIX
(Ribeiro L.M., Serras R., Guimarães D., Vilela M., Mouzinho M.M. - Portugal)
Third-degree burns of the lower extremities are among the most difficult burn injuries to treat as they frequently expose bone, tendons or articular surfaces. Coverage with a flap is the ideal treatment, but local tissue is often unavailable, and free flaps require sophisticated equipment and perfect microsurgical technique. We demonstrate a treatment option to obtain a stable cutaneous coverage for this kind of injury, consisting in an association of skin grafts, amniotic membrane and bilaminar dermal matrix templates. This combined treatment proved to be an excellent option to cover a wide area of tibial exposure with low donor site morbidity and good functional and aesthetic results. This shows that artificial dermis is a good alternative for treating bone exposure, especially in patients for whom a classic flap reconstruction is not suitable.
233 THE ROLE OF MICROSURGICAL FLAPS IN PRIMARY BURN RECONSTRUCTION
(Pessoa Vaz M., Brandão C., Meireles R., Brito I.M., Ferreira B., Pinheiro S., Zenha H., Ramos S., Diogo C., Teles L., Cabral L., Lima J. - Portugal)
Despite the wide and growing use of microsurgery, its application in primary burn reconstruction is not very frequent as it faces a number of additional challenges in this setting. A retrospective analysis of the clinical records of all patients submitted to microvascular free tissue transfer for primary burn reconstruction over an 8-year period (from January 2009 to December 2016) was performed. An evaluation of the indications, timing, principles of flap selection, complications and outcomes of free tissue transfer in primary burn reconstruction was made. Fourteen patients required 18 microsurgical flaps for acute soft tissue reconstruction (1.1% of all patients admitted). 64.3% of the patients were male. The mean age was 59.64 years, and mean TBSA was 10.5%. The majority of the injuries were caused by flames (71.4%), followed by electrical contact (21.4%). The primary indication for microsurgical reconstruction was tissue deficit with exposure of tendons, nerves, vessels, bone and/or joints after debridement. The procedure was more often performed in the early period after injury (between the 5th and 22nd day). The most frequently used flaps were the Latissimus dorsi and the anterolateral thigh flap. Major complications included 2 total flap failures (11.1%) and a partial flap failure that required reconstruction with another free flap. Microsurgical free flaps have a valuable role in primary burn reconstruction. Despite the reported higher complication rate in this specific clinical scenario, their use may reduce the total number of surgeries needed to achieve wound closure.
238 GAIN FONCTIONNEL, ANTALGIQUE ET ESTHÉTIQUE DE LA LIPOSTRUCTURE DANS LES SÉQUELLES DE BRÛLURES
(Barani C., Viard R., Aimard R., Lalloue C., Vincent P.L., Comparin J.P., Voulliaume D. - France)
La place de la lipostructure dans le traitement des séquelles de brûlure est aujourd'hui de plus en plus établie. Les capacités de régénération des cellules souches mésenchymateuses apparaissent prometteuses sur cette peau séquellaire peu vascularisée, rétractile et souvent douloureuse. Le but de notre étude est d'établir les propriétés antalgiques et les améliorations fonctionnelles comme esthétiques de la lipostructure dans le traitement des séquelles de brûlure. Quarante trois patients ayant bénéficié de lipostructure selon la méthode de Coleman pour séquelles de brûlure entre 2005 et 2017 ont été sélectionnés. Les résultats ont été relevés avec un recul minimum de un an post-opératoire, sur des critères de gain esthétique, antalgique et de mobilité. Nos patients se répartissaient en 32 femmes et 11 hommes d'âge moyen de 31,7 ans (15 à 64 ans). Le recul moyen lors de l'étude est de 49,8 mois (2 à 205 mois). Les patients ont bénéficié en moyenne de 1,3 (1 à 3) séances de lipostructure pour une quantité moyenne de 153 cc (10 à 1 040) par séance. Les sites séquellaires étaient représentés par la face chez 13 patients, le membre supérieur chez 13 patients, le membre inférieur chez 16 patients et le tronc chez 4 patients. Douze patients avaient des lésions sur des localisations multiples. Vingt patients ont bénéficié de cette chirurgie à but uniquement esthétique ou fonctionnel, 23 dans le cadre de séquelles douloureuses. On observe une EVA significativement inférieure après la chirurgie et un gain fonctionnel corrélé à la restauration des amplitudes devenues non douloureuses. Les patients relèvent également un gain esthétique dans plus de trois quart des cas. Dans deux cas, l'effet antalgique s'est amenuisé après un an et a nécessité une deuxième lipostructure. L'utilisation de la lipostructure dans les séquelles de brûlure a déjà prouvé son efficacité sur l'aspect fonctionnel, esthétique mais aussi antalgique. Cependant, l'évaluation des résultats reste dépendant d'échelles encore imparfaites. La lipostructure n'est pas le seul geste réalisé dans les séquelles de brûlures. Des chirurgies de types plasties ou greffes de peau sont également utilisés, mais elles sont plus invasives et n'ont pas d'effet antalgique direct. Le recours à la lipostructure n'est possible que sur des cicatrices matures, souples et non adhérentes afin de ne pas traumatiser les cellules graisseuses. La peau cicatricielle post-brûlure est marquée par des phénomènes de rétractions et d'adhérences aux plans profonds nécessitant un lourd travail de rééducation au préalable. Enfin, l'effet n'est pas toujours pérenne et la durée d'efficacité reste à ce jour inconnu. La lipostructure prend toute sa place dans le traitement des séquelles de brûlures hyperalgiques et inesthétiques, source de handicap fonctionnel et social pour le patient.
243 INTRODUCTION TO A CASE OF ORF DISEASE IN A BURN WOUND AT MOTAHARI HOSPITAL
(Alinejad F., Momeni M., Keyvani H., Faramarzi S., Mahboubi O., Rahbar H. - Iran)
Orf disease is caused by a double-stranded DNA virus of the Parapox family. Human infection is mostly due to occupational hazard and handling infected animals. Our patient was an 18-year-old woman who suffered burns in 2015. Total Burn Surface Area (TBSA) was 22% and cause of burn was flame. One week after hospital admission, she underwent skin grafts of her upper extremities. However, vegetative granulomatous ulcerations developed on the wound, resulting in the grafts failing to take. After careful investigation into the patient's history, we discovered that the water used to douse the flames was from a drinking trough for sheep. Suspecting Orf disease, we disinfected the wounds and dressing tools with Dakin's solution. We waited about 12 days to perform a new skin graft, and most of the grafted skin took. PCR test for Parapox virus was positive. Orf disease should be considered a distinct possibility in burn patients with a history of probable contamination. Manipulation of the disease in the early stages of burn wound could potentially spread it and change the degree of the wound, therefore being aware of this possibility can save the patient unnecessary pain and time. To prevent a nosocomial outbreak of Orf, wound care and wound disinfection should be scrupulously carried out. Isolation and disinfection of the entire dressing tool should be considered. Educating wound care providers in burn hospitals and scrupulous wound disinfection would protect the patient from cross contamination and allow skin grafts to take with ease, without the formation of ulcerations associated with Orf.
246 NURSE KNOWLEDGE OF EMERGENCY MANAGEMENT FOR BURN AND MASS BURN INJURIES
(Lam N.N., Huong H.T.X., Tuan C.A. - Vietnam)
A survey was conducted on 353 registered nurses working in Emergency and Trauma departments of district and provincial hospitals in Vietnam. Contents of the survey included first aid and initial care for burn and mass burn injuries. Only 15.3% of participants correctly answered over 50% of the items. The average percentage of correct answers was 39.7%. For cases of mass burn injuries, 53.6% of nurses recognized oral fluid resuscitation to be an appropriate method. Pre-transportation intubation for suspected inhalation injury was indicated by 44.6% of participants. Meanwhile, only 5.4% of nurses gave the correct answer regarding burn triage. A significantly higher knowledge level was recorded among nurses who had attended training courses in the past (54.8 ± 10.5% vs. 38 ± 9.7% respectively; p < .001). Meanwhile, work experience and place did not influence knowledge level. To improve the burn emergency management of nurses, further and continuing education is highly recommended.
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