Burns : journal of the International Society for Burn Injuries
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Randomized Controlled Trial Multicenter Study
A novel rapid and selective enzymatic debridement agent for burn wound management: A multi-center RCT.
Excisional debridement followed by autografting is the standard of care (SOC) for deep burns, but is associated with serious potential complications. Conservative, non-surgical and current enzymatic debridement methods are inefficiently slow. We determined whether a non-surgical option of rapid enzymatic debridement with the debriding enzyme NexoBrid™ (NXB) would reduce need for surgery while achieving similar esthetic and functional outcomes as SOC. ⋯ Enzymatic débridement with NXB resulted in reduced need for and extent of surgery compared with SOC while achieving comparable long-term results in patients with deep burns.
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Randomized Controlled Trial
Aquacel(®) Ag dressing versus Acticoat™ dressing in partial thickness burns: A prospective, randomized, controlled study in 100 patients. Part 1: Burn wound healing.
Studies comparing contemporary silver dressings in burns are scarce. ⋯ Both silver dressings resulted in comparable healing times and bacterial control but the Aquacel(®) Ag dressing significantly increased comfort for patients as well as nurses and was significantly more cost-effective than the Acticoat™ dressing for the given indication.
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To provide a systematic review of the literature regarding development of an evidence-based Precepting Program for nurses transitioning to burn specialty practice. ⋯ A significant clinical gap existed between the scientific evidence and actual precepting practice of experienced nurses at the Burn Center. Based on this extensive review of the literature, it was determined that a sufficient evidence base existed for development of an evidence-based Precepting Program.
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Comparative Study
Comparison of pathogens and antibiotic resistance of burn patients in the burn ICU or in the common burn ward.
This study aims to compare pathogens and their antibiotic resistances of burn patients from burn intensive care unit (ICU) or common burn ward. Of 2395 clinical samples from 63 patients in burn ICU, pathogens were detected in 1621 samples, in which 1203 strains (74.2%) were Gram negative bacteria, 248 strains (15.3%) were Gram positive bacteria, 170 strains (10.5%) were fungi. Top-4 microorganisms isolated from patients in burn ICU were Bauman's Acinetobacter (557, 34.4%), Pseudomonas aeruginosa (287.17.7%), Staphylococcus aureus (199, 12.3%) and Klebsiella pneumoniae (171, 10.5%). Of 512 clinical samples from 235 patients in common burn units, pathogens were detected in 373 samples, in which 189 (50.6%) strains were Gram negative bacteria, 150 strains (40.2%) were Gram positive bacteria, 34 strains (9.2%) were fungi. Top-4 microorganisms isolated from patients in common burn units were S. aureus (103, 27.6%), P. aeruginosa (46, 12.3%), K. pneumoniae (38, 10.2%) and Escherichia coli (32, 8.6%). Antibiotic resistance rates of pathogens isolated from clinical samples of burn patients from ICU was significantly higher than those from common units. ⋯ Pathogens and their antibiotic resistances are significantly different between burn ICU and common burn units. This finding has great implication for infection control in burn patients.
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The aim of the study was to conduct a systematic review to identify and appraise the evidence on possible association of the site of venous catheter insertion in burn patients and an increased occurrence of catheter-related infection. Searches were performed in MEDLINE, LILACS, CINAHL, EMBASE, Web of Science and The Cochrane Library. Nine studies were selected for the review; four of them mentioned, directly or indirectly, an association between catheter-related infection and the insertion of the catheter either in the burn wound or in surrounding area, and five studies investigated the occurrence of infection related to both the catheter and the anatomical sites of catheter insertion. ⋯ No significant differences in infection occurrence rates were observed between central catheters and peripherally inserted central catheter (level of evidence IV). Further investigations for techniques and types of coverage of venous catheter insertion dressings are important for preventing infection in burn patients. Also, new technologies for venous access must be evaluated.