The use of closed dressings in pediatric wound care has shortened hospital stays, decreased dressing changes, and lessened the need for feeding tubes and pain medication.
The use of closed dressings for wounds has dramatically altered the wound care provided for injuries from burns in the pediatric setting, according to the Medical Director of the Burn Unit of the Hospital for Sick Children in Toronto, Canada.
Speaking at a pediatric wound care symposium in Toronto, Joel Fish, M.D., FRCPC, a plastic surgeon and Associate Professor in the Department of Surgery and Research Director for the Division of Plastic Surgery at the University of Toronto in Toronto, notes that silver-based products and a closed dressing technique have advanced pediatric wound care such that fewer dressings are required and lengths of stay in hospital have decreased.
"The way that the silver materials are now formulated, they bond to different materials allowing (the dressing) to remain active for a number of days and changes what we do in pediatric burns units," said Dr. Fish.
Dr. Fish explains that dressings such as the Aquacel® Ag are adherent and the outer dressing has no drainage, so patients can be sent home with the dressings on and are later able to soak off the dressings.
Dr. Fish was involved with a retrospective case-matched comparison study where patients were treated with the Aquacel Ag dressing for partial thickness wounds. Patients were matched to historical controls in terms of variables like age and affected body surface area. Scalds were source of most of the burns, with flames and oil being the source of the balance of the burns.
Investigators compared outcomes with the closed dressings to outcomes without closed dressings, looking at measures like the number of dressing changes, the need for surgery, the number of outpatient dressings, medication use related to pain relief for dressing changes, and the need for satellite anesthesia.
There was a significant decrease in the use of anesthesia between patients with the Aquacel AG dressing and control subjects, as well as an increase in the number of procedures and dressing changes for control subjects. Duration of stays for in-patients was 9 days for patients who wore Aquacel AG closed dressings and 14 days for in-patients who did not wear closed dressings.
Despite technology advances in dressings, clinicians continue to change dressings frequently and so put pediatric patients through unnecessary pain, according to Dr. Fish.
"Unfortunately, we still hear about [practices] at pediatric hospitals in Ontario, of children going in for daily dressing changes," says Dr. Fish. "We know that is well below the standard of care. It's not appropriate to change a dressing daily on a child or even more often than daily for what is arguably a painful acute wound."
The investigation found that patients who did not have a closed dressing applied underwent 14 dressings while those who wore the Aquacel AG dressing underwent 3 dressing changes. "That is a huge difference," says Dr. Fish. "The multiplier effect of performing a dressing change in the population of pediatric burn patients in hospital is huge.
Indeed, more dressing changes means more supplies, more medication to provide pain relief, more nursing staff on site, and adverse events like inadequate bowel function due to morphine intake, explains Dr. Fish.
Even once discharged from hospital, those patients who underwent the closed dressing technique required fewer dressing changes, notes Dr. Fish.
One of the most significant outcomes, if not the most significant, is that length of stay was decreased with the closed dressing technique, and that change in practice has sustained this outcome, stresses Dr. Fish. Another outcome is that patients who underwent the closed dressing technique experienced less weight loss than their counterparts who did not have that technique administered, and they required fewer feeding tubes.
Even though there has been a steady climb in the number of admissions to the burn unit at the Hospital for Sick Kids, the direct cost of caring for a patient has fallen because of the implementation of the closed dressing technique.
Dr. Fish has no relevant disclosures.