Reducing Pain and Dressing Change Frequency on Thermal Partial-Thickness Burns (PTB) in a Crititcal Access Hospital (CAH) Setting Utilizing Sodium Carboxymethylcellulose (NaCMC) with Ionic Silver* in the Protocol of Care

Clinical Problem: CAHs provide essential healthcare services to areas of sparse population.  Although burn center referral guidelines assist in triaging patients to regional burn centers, the majority of PTBs are managed locally.  Silver sulfadiazine with gauze (SSD) has prevailed in a majority of protocols.  The Cochrane Collaboration revealed benefits of advanced dressing categories versus SSD in terms of pain, comfort, satisfaction, cost, healing, and additional interventions.  An alternative to SSD is a NaCMC with ionic silver dressing.

 

Past Management:

All cases were initially treated with SSD.  Petrolatum base antibiotic was used patient C on the post-burn day (PBD) # 3.  SSD was to be removed before the next applications and patients reported this process to be very painful.  

 

Current Clinical Approach:

In each case the protocol of care using a NaCMC ionic silver dressing was initiated on consultation.  The burn was cleansed,  the dressing applied and it was left in place until it detached or was removed by the clinician. 

 

Patient Outcomes:

Patient A: 39-year-old male seen PBD 2 with bilateral burns to forearms and hands after exposure to ignited flammable substance. On PBD 9 showed 75 % healing. 

Patient B: 2-year-old male with burn to right leg from hot coffee seen PBD 5. Follow up on PBD 12 revealed 80 % epithelium.

Patient C: 43-year-old female with PTB on left thigh from fireworks seen PBD 4. The wound revealed 95 % healing on PBD 6.

Conclusions:  Each patient experienced reduced pain, fewer dressing changes, and outpatient visits while expedited healing.  No infections occurred.  A rural CAH with limited resources increases the need for adherence to evidence-based protocols.  Physician training and protocol implementation will assist in standardizing to an evidence-based protocol of care using NaCMC with ionic silver dressing.

 

*AQUACEL® Ag dressing 

AQUACEL is a registered trademark of ConvaTec Inc.

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