Clinical experience of acticoat™ treatment in extensive burn wounds.

Acticoat™ (Smith & Nephew, Hull, UK) is a relatively new form of silver antimicrobial barrier dressing produces a moist healing environment along with the sustained release of ionic silver for improved microbial control. The benefits of acticoat™ in the management of extensive burn wounds have been well established. Acticoat™ has been reported to reduce wound infection and promote healing. No evidence has emerged of resistance or cytotoxicity to acticoat™. Given these potential advantages, we have used acticoat™ in a variety of treatment of extensive burn wounds at burn unit, Siriraj Hospital during September 2002-May 2005. We reviewed with attention to wound etiology, % of organism colonization, efficacy and cost effectiveness. Due to its long lasting properties led to less frequent dressing changes and reduce trauma and pain to burn patients. It is particularly benefit to patients who suffered from partial thickness burn wound especially in children and high% of total body surface area (TBSA) patients (>15%). Acticoat™ treatment in extensive burn wounds also confirmed its efficacy, low labor cost set up and cost effectiveness compared to conventional dressing with silver sulfadiazine.

Comparison of efficacy of 1% silver sulfadiazine and Acticoat for treatment of partial-thickness burn wounds.

BACKGROUND: Acticoat (Smith & Nephew, Hull, UK) is a silver-coated dressing reported to reduce infection and exhibit antimicrobial activity in wounds. OBJECTIVE: The purpose of the present study was to compare the efficacy ofacticoat and 1% silver sulfadiazine (1% AgSD) for treatment of partial thickness burn wounds. MATERIAL AND METHOD: The authors reviewed 50 patients who had partial thickness burn wounds less than 25% admitted to Siriraj Burn Unit from May 2002 to September 2005. All patients were divided into 2 groups: the acticoat treated group (25 patients) and the 1% silver sulfadiazine treated group (25 patients). The 2 groups were compared for the etiology of burn wound, demographic data including age, sex, % Total Body Surface Area burn (TBSA%), cultured organisms, wound infection and outcome of Length Of hospital Stay (LOS) and level of pain. RESULTS: The authors found no significant differences in age, TBSA (%) between both groups. 7 patients (28%) developed wound infection. There were no differences in wound infection and LOS between both groups (p > 0.05). All of the patients who developed wound infection responded well to targeted topical and systemic antibiotic treatment. The 1% AgSD treated group (6 of 25, 24%) obtained more split thickness skin graft to close the granulation defects compared to patients who were treated with acticoat (4 of 25, 16%) but no statistical significance, p = 0.32). Average pain scores in the acticoat treated groups were significantly lower than the 1% AgSD treated group (4 +/- 0.6 versus 5 +/- 0.7, respectively). CONCLUSION: The present study confirms the efficacy of acticoat treatment in partial thickness burn wound. The authors conclude that acticoat has an advantage of limiting the frequency of replacement of the dressing and provides a less painful alternative to wound care with 1% AgSD with comparable incidence of burn wound infection. This is due to its long wear time and the ease of application and removal.

The factors influenced on the length of hospital stay in burn patients.

The aim of this study was to analyse association between the factors ; (the extent of burn, patient’s age, type of micro-organism, severity of infection and patient’s past medical illness) and the length of hospital stay among 147 survived burn patients who were admitted to the Burn Unit, Siriraj Hospital during January 1, 1994 to August 31, 1997. By using analysis of variance (ANOVA) for bivariate analysis. It was found that statistical significant determinants for variance in the length of hospital stay were extent of burn (F=43.130, df=1,145, p-value<0.0001), type of micro-organism (F=40.792, df=1,145, p-value<0.0001). severity of infection (F=24,409, df=1,145, p-value<0.0001), and type of burn (F=12.815, df=1,145, p-value<0.0001). When we entered these 4 influential independent variables in a final multiple classification analysis, the total explained variance in the length of hospital stay was 44.4% whereas the explained variance were 12.25%, 10.24%, 3.61% and 3.61% for extent of burn, type of micro-organism, severity of infection and type of burn, respectively.