sodium-hypochlorite and Burns

Wound infection following burn injury can be clinically challenging to manage. Its presence in a thermally compromised patient can detrimentally affect the ability of the wound to heal leading not only to wound progression but ultimately contribute to a large part of the economic health burden expenditure in the National Health Service. Despite meticulous wound care and infection control measures the colonisation of burn wounds by bacterial pathogens has and continues to be the case. There has been a growing interest in the use of antimicrobial applications when managing localised burn wound infections due to a constantly increasing number of antibiotic-resistant organisms.. To survey which antimicrobial dressings are currently being used across UK burns services when managing localised pseudomonas wound infections.. We conducted a nationwide telephone survey of UK burns services during October 2019 to determine which topical antimicrobial agent was used to treat local pseudomonas burn wound infections.. Six burns services (31.6%) used acetic acid-soaked dressings, one of which alternates acetic acid with sodium hypochlorite solution. Silver-based dressings were also used by six burns services (31.6%) - again, one department alternates silver-based dressings with sodium hypochlorite solution. Betadine-soaked, gauze-based dressings were used across five burns services (26.3%) and the remaining two burns services (10.5%) used sodium hypochlorite solution and non-medicated dressings respectively.. We identified a significant difference in the UK burns services' approach to pseudomonas burn wound infections. Our literature review demonstrates that a daily dressing regime of 2.5-3% acetic acid is a well-tolerated treatment regime in burn patients and that it is in use in UK burns services. There are no current randomised controlled trials that evaluate the usage of acetic acid. The variation in usage suggests that there is scope for further study in order to develop evidence to generate a UK wide approach based on national standardised guidelines.

Topics: Acetic Acid; Anti-Infective Agents; Bandages; Burns; Humans; Pseudomonas; Pseudomonas Infections; Silver; Sodium Hypochlorite; Soft Tissue Injuries; State Medicine; United Kingdom; Wound Infection

Burn wounds cause high levels of morbidity and mortality worldwide. People with burns are particularly vulnerable to infections; over 75% of all burn deaths (after initial resuscitation) result from infection. Antiseptics are topical agents that act to prevent growth of micro-organisms. A wide range are used with the intention of preventing infection and promoting healing of burn wounds.. To assess the effects and safety of antiseptics for the treatment of burns in any care setting.. In September 2016 we searched the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Ovid MEDLINE, Ovid MEDLINE (In-Process & Other Non-Indexed Citations), Ovid Embase, and EBSCO CINAHL. We also searched three clinical trials registries and references of included studies and relevant systematic reviews. There were no restrictions based on language, date of publication or study setting.. We included randomised controlled trials (RCTs) that enrolled people with any burn wound and assessed the use of a topical treatment with antiseptic properties.. Two review authors independently performed study selection, risk of bias assessment and data extraction.. We included 56 RCTs with 5807 randomised participants. Almost all trials had poorly reported methodology, meaning that it is unclear whether they were at high risk of bias. In many cases the primary review outcomes, wound healing and infection, were not reported, or were reported incompletely.Most trials enrolled people with recent burns, described as second-degree and less than 40% of total body surface area; most participants were adults. Antiseptic agents assessed were: silver-based, honey, Aloe Vera, iodine-based, chlorhexidine or polyhexanide (biguanides), sodium hypochlorite, merbromin, ethacridine lactate, cerium nitrate and Arnebia euchroma. Most studies compared antiseptic with a topical antibiotic, primarily silver sulfadiazine (SSD); others compared antiseptic with a non-antibacterial treatment or another antiseptic. Most evidence was assessed as low or very low certainty, often because of imprecision resulting from few participants, low event rates, or both, often in single studies. Antiseptics versus topical antibioticsCompared with the topical antibiotic, SSD, there is low certainty evidence that, on average, there is no clear difference in the hazard of healing (chance of healing over time), between silver-based antiseptics and SSD (HR 1.25, 95% CI 0.94 to 1.67; I. It was often uncertain whether antiseptics were associated with any difference in healing, infections, or other outcomes. Where there is moderate or high certainty evidence, decision makers need to consider the applicability of the evidence from the comparison to their patients. Reporting was poor, to the extent that we are not confident that most trials are free from risk of bias.

Topics: Adult; Anti-Bacterial Agents; Anti-Infective Agents, Local; Apitherapy; Bacterial Infections; Bandages; Burns; Chlorhexidine; Disinfectants; Honey; Humans; Merbromin; Plant Preparations; Povidone-Iodine; Randomized Controlled Trials as Topic; Silver Sulfadiazine; Sodium Hypochlorite; Sulfadiazine; Wound Healing

While treatment conduction of 38 patients with severe burns and poisoning with carbonic oxide in complex of antishock measures there was applied a nondirect electrochemical oxidation of blood and internal laser irradiation of blood. There was used He-Nd laser. The mortality lowering by 3.3 times in comparison with 40 patients, in whom the traditional intensive therapy was applied, was noted.

Topics: Blood; Burns; Carbon Monoxide Poisoning; Combined Modality Therapy; Critical Care; Electrochemistry; Humans; Laser Therapy; Oxidants; Oxidation-Reduction; Shock, Traumatic; Sodium Hypochlorite; Time Factors

Burn wound infections are a major cause of morbidity and mortality. The bactericidal action of sodium hypochlorite has been known for centuries and it has been in clinical practice for over 70 years. Whereas a buffered sodium hypochlorite solution is not universally available, an un-buffered solution is cheap and easy to prepare.. The aim of this study was to determine the optimum concentration with regard to safety and efficacy, as well as shelf life of an un-buffered sodium hypochlorite solution for the topical management of burn wound infections.. Human fibroblasts were exposed to serial dilutions of un-buffered sodium hypochlorite solutions for 30 min and assessed for viability. Isolates of Pseudomonas aeruginosa, Staphylococcus aureus and Streptococcus pyogenes were exposed to the same dilutions of un-buffered sodium hypochlorite to establish the minimum bactericidal concentration. The pH, osmolality and electrolyte concentrations were measured. These experiments were repeated with solution stored at room temperature for 6 consecutive days.. 24% of fibroblasts were viable after exposure to a 0.025% solution and 98.9% with a 0.003% solution. The MBC for the P. aeruginosa isolates was 0.003%, for S. aureus was 0.006% and for S. pyogenes was 0.0015%. This remained constant for 6 consecutive days. The un-buffered 0.0025% solution has a pH of 10, an osmolality of 168 sodium concentration of 89 mmol/dl and chloride of 84 mmol/dl. This remained stable for 14 days.. An un-buffered solution of sodium hypochlorite with a concentration of 0.006% would be suitable for the topical management of burn wound infections caused by common pathogens. It has a shelf life of at least 6 days.

Topics: Burns; Cell Proliferation; Cell Survival; Disinfectants; Fibroblasts; Humans; Hydrogen-Ion Concentration; Microbial Sensitivity Tests; Pseudomonas aeruginosa; Sodium Hypochlorite; Staphylococcus aureus; Streptococcus pyogenes

Topics: Anti-Infective Agents; Borates; Burns; Honey; Humans; Skin Care; Sodium Hypochlorite; Tanzania; Wound Healing

Topics: Anti-Infective Agents; Borates; Burns; Developing Countries; Humans; Sodium Hypochlorite; United Kingdom; Wound Healing

Many products are currently promoted for use on wounds. Edinburgh University Solution of Lime (Eusol) has recently received adverse publicity regarding its use in wound management. One hundred and twenty-four consultant plastic surgeons were surveyed regarding their use of Eusol. Ninety-five replies were obtained (77%); of those who replied, 78 (82%) still use Eusol, while nine out of 17 who do not are prevented from using it as they are unable to obtain necessary supplies. In plastic surgery, Eusol is still being used by plastic surgeons in specific situations.

Topics: Anti-Infective Agents; Attitude of Health Personnel; Borates; Burns; Humans; Skin Transplantation; Sodium Hypochlorite; Surgery Department, Hospital; Surgery, Plastic; Wound Infection

Topics: Administration, Topical; Anti-Infective Agents, Local; Burns; Electrochemistry; Humans; Sodium Hypochlorite; Solutions; Wound Infection

Cultured skin grafts administered clinically for closure of burn wounds may be contacted by topically applied antimicrobial agents. A study was performed to assess whether commonly used topical antimicrobial agents are toxic to cultured human keratinocytes (HK) in vitro. Serum-free MCDB 153 culture medium containing Neosporin G.U. irrigant (Neomycin, 40 micrograms/ml-polymyxin B sulfate, 200 units/ml) and a standard tissue culture antimicrobial agent of penicillin (10,000 units/ml)-streptomycin (10,000 micrograms/ml)-amphotericin B (25 micrograms/ml) had no effect on the keratinocyte growth rates when compared to standard MCDB 153 medium without antibiotics. Medium containing Sulfamylon (mafenide acetate, 0.85%), Polysporin (polymyxin B sulfate, 1 x 10(4) units/ml-bacitracin, 500 units/ml), gentamicin sulfate (0.1%), modified Dakins solution (25%), and acetic acid (0.25%) all showed statistically significant (P less than 0.01) decreases in keratinocyte growth rates. This data suggests that commonly applied antimicrobials may not be appropriate for cultured grafts in the concentrations that are used clinically.

Topics: Acetates; Acetic Acid; Anti-Infective Agents, Local; Bacitracin; Burns; Cells, Cultured; Drug Combinations; Drug Therapy, Combination; Gentamicins; Humans; Keratinocytes; Mafenide; Neomycin; Polymyxin B; Sodium Hypochlorite

Data from 45 adult patients with flame burns covering up to 20 per cent EAB (Group 1), 21-40 per cent (Group 2), and 41-60 per cent (Group 3) are presented. Each group contains 15 patients with 29 females and 16 males, and females had the more extensive burns. All the patients were treated by the exposure method followed by Eusol dressings beginning between post burn days 5 and 7, i.e. as soon as infection was detected or the eschar had started separating. Eusol is an effective antibacterial agent and also assists in slough separation. It appears to be inactive against living tissues and helps obtain healthy granulation tissue. The bed thus created is ideal for grafting. A burn wound up to 40 per cent EAB is suitable for treatment by the exposure-Eusol method. Septicaemia was the common cause of mortality and its incidence was directly related to the extent of injury.

Topics: Adolescent; Adult; Anti-Infective Agents; Borates; Burns; Female; Humans; Male; Postoperative Complications; Skin Transplantation; Sodium Hypochlorite

The ability of sodium hypochlorite to decontaminate skin while leaving sufficient epidermal cell viability for growth in tissue culture was investigated with an in vitro system. Split-thickness cadaveric skin was infected with Staphylococcus aureus, Pseudomonas aeruginosa, and Candida albicans and subsequently treated with various concentrations of sodium hypochlorite for various time intervals. Exposure to a 0.5% solution of sodium hypochlorite for 6 min effectively decontaminated the skin while leaving 66% of the basal cells viable. The basal cells were subsequently grown to confluency in tissue culture. This study demonstrates that microbial colonization of skin can be eliminated by exposure to dilute hypochlorite. This procedure, while decontaminating the skin, leaves sufficient viability of epidermal cells for subsequent growth and expansion in tissue culture, elements essential for grafting over wounds.

Topics: Bacteria; Burns; Cadaver; Candida albicans; Cell Survival; Culture Techniques; Decontamination; Humans; Skin; Skin Transplantation; Sodium Hypochlorite

Topics: Burns; Dermatologic Agents; Humans; Povidone-Iodine; Silver Nitrate; Silver Sulfadiazine; Sodium Hypochlorite

Topics: Acinetobacter Infections; Adolescent; Bacterial Infections; Baths; Burns; Candidiasis; Child; Child, Preschool; Escherichia coli Infections; Female; Humans; Hydrogen-Ion Concentration; Male; Microbial Sensitivity Tests; Pseudomonas Infections; Skin; Sodium Hypochlorite; Staphylococcal Infections; Streptococcal Infections; Wound Infection

Topics: Attitude of Health Personnel; Bacteria; Bacteriological Techniques; Bedding and Linens; Borates; Burns; Consumer Behavior; Cross Infection; Fires; Gossypium; Humans; Hydrogen Peroxide; Hydrogen-Ion Concentration; Laundering; Nylons; Polymers; Skin Diseases; Skin Tests; Sodium; Sodium Hypochlorite; Textiles

Topics: Animals; Burns; Complementary Therapies; History, 15th Century; History, 19th Century; History, Medieval; Humans; Milk; Sodium Chloride; Sodium Hypochlorite; Solutions

Topics: Burns; Burns, Chemical; Caustics; Child; Eating; Esophageal Stenosis; Esophagoscopy; Humans; Sodium Hypochlorite; Toxicology