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The International Nurses Scientific ConferenceThe International Nurses Scientific Conference
EFFECT OF HYDROTHERAPY EFFECT OF HYDROTHERAPY ON SEVERE BURN PATIENTS ON SEVERE BURN PATIENTS
Cao Thuy Dung RN.
Vietnam National Institute of Burns
INTRODUCTIONINTRODUCTION
Burn infection resulting prolong wound healing, sepsis, low Burn infection resulting prolong wound healing, sepsis, low
rate of taken graft skin rate of taken graft skin
Hydrotherapy: reducing burn wound infection, making good Hydrotherapy: reducing burn wound infection, making good
conditions for wound healingconditions for wound healing
Worldwide: Hydrotherapy is taken right after patients admitted Worldwide: Hydrotherapy is taken right after patients admitted
to hospital and regularly.to hospital and regularly.
Vietnam: Hydrotherapy has been taken in mild burns patientsVietnam: Hydrotherapy has been taken in mild burns patients , ,
initially performed for severe burn patientsinitially performed for severe burn patients
AIMS OF STUDYAIMS OF STUDY
1.1. Evaluating the effect of hydrotherapy in the clinical Evaluating the effect of hydrotherapy in the clinical
manifestration in severe burns patients.manifestration in severe burns patients.
2.2. To investigate changes of isolated burn wound To investigate changes of isolated burn wound
bacteria under hydrotherapybacteria under hydrotherapy
PATIENTS AND METHODSPATIENTS AND METHODS
A prospective study was A prospective study was
conducted on 39 severe burn conducted on 39 severe burn
patients admitted to Burn ICU patients admitted to Burn ICU
during the first 72 hours from during the first 72 hours from
10/2011 to 9/201210/2011 to 9/2012..
+ ARIOHUNT LEIGH sink + ARIOHUNT LEIGH sink
+ Chlorhexidine 0.05% Solution+ Chlorhexidine 0.05% Solution
+ Sterilized water resource + Sterilized water resource
BATHING PROCEDUREBATHING PROCEDUREPatients Preparation
- Clinical Exam, explain procedure- protect the food of catheters- Choose temparature of water resource
Bathing, cleaning with chloherxidine
Caring after bathing- Drying and Warm up- Cover with local treatment drugs- Preventing hypothermia, size effect of anaesthesia
ANAESTHESIA- Pain killer: Dolargan 0,1g, Morphin 10 mg- Intravenous Ketamin
Supplement ing anaesthetic medication
in bath process
BATHING THERAPY FOR SEVERE BURN PATIENTS
Evaluating Criteria Evaluating Criteria
The clinical manifestrationThe clinical manifestration + Bathing frequency and duration, the water temperature Bathing frequency and duration, the water temperature + Anaesthesia size effectsAnaesthesia size effects+ Body temperatureBody temperature+ Complete wound healing time for partial burn and taken rate of Complete wound healing time for partial burn and taken rate of
auto-graft skin auto-graft skin Bacterial culture: Bacterial culture:
− Water, bathing Stretcher (prior and after bathing)Water, bathing Stretcher (prior and after bathing)+ Burns wound: prior and after bathing, day 1, 2, 3 after Burns wound: prior and after bathing, day 1, 2, 3 after
hydrotherapyhydrotherapy
RESULT AND DISCUSSIONRESULT AND DISCUSSION
PATIENT’S CHARACTERISTICSPATIENT’S CHARACTERISTICS
CharacteristicsX ± SD Min – Max
Age (year) 23,51 1 – 621 – 62
Burns area (%) 49,23 ± 19.73 11 – 9011 – 90
Deep burns area (%) 26,28 ±12.82 0 – 700 – 70
Admitted time after burns (h) 8,34 ± 2.16 1 – 471 – 47
Male/ female rate 4,6
Inhalation injury n (%) 13 (33.3)
Average age: 23,51 year old All patients were severe burn ( ABA criteria, 1984)
Number of bathing n %
22 0707 17,9517,95
3 19 48,72
44 1212 30,7730,77
55 11 2,562,56
Total 3939 100100
Bathing frequencies
Patients who was bathed 3 times have the hinghest percentage (48,72%)
ANAESTHESIA METHODSANAESTHESIA METHODS
Patients Ketamin Pain-killer Total
AdultsAdults 1 (6,67%)1 (6,67%) 24 (93,33%)24 (93,33%) 25 (100%)25 (100%)
ChildrenChildren 13 (92,86%)13 (92,86%) 1 (7,14%)1 (7,14%) 14 (100%)14 (100%)
• Intravenous anaesthesia was mainly used in children (92,86%), while pain-killer was mostly used in adults (93,33%).
Bath-time(min) X±SD Min-Max
Children 21 ± 5.3 15 - 28
Adults 28,46 ± 5,36 18 - 38
Temparature of water (°C)
Children 35,48 ± 2,3 34 - 36
Adults 34,45 ± 4,37 30 - 38
BATH AND WATER TEMPARATURE
• Bath-time: 28 mins in adults, 21 mins in children• Proper water temp: 34,45°C in adult, 35,48°C in children Petrofsky J et al (2010) : Time of hydrotherapy should not over 20 mins due to the high risk: drop in patients’ temp
Patient n %
Hypothermia< 36.50C
Children 0 0
Adult 0 0
Normal Temp Children 11 28,2
Adult 24 71,8
Hyperthermia > 38 0C
Children 1 2,56
Adult 0 0
Shivering Cold 03 7,69
Anaesthesia complication 0 0
PATIENT’S MANIFEATRATION
No No Hypothermia; Hypothermia; 3 patients with trembling cold sign.3 patients with trembling cold sign. Safe anaesthesiaSafe anaesthesia
CULTURING THE BATH WATER
n (%) Positive negative
40 (100%) 0 (0%) 40 (100%)
With 40 times of cultures, there was no positive sampleWith 40 times of cultures, there was no positive sample
ISOLATED BURN WOUND CULTURE
There are many bacterial species before hydrotherapy, number of groun samples after hydrotherapy decreased considerably. Palmieri TL và Greehalgh DG (2002): Hydrotherapy helps to control the burns wounds, clean up baterium
Bacteria
TIME POINT
Before bathing (n = 90) After bathing (n = 90)
n % n %
Positive sample (*) 61 67,77 15 16,67
S. aureus 5 5,56 0 0
P. aeruginosa 20 22,22 7 7,78
K. pneumonia 12 13,33 5 5,56
P. aeruginosa –
K.pneumonia
4 4,44 0 0
Ent.faecium 7 7,78 3 3,33
Aci.Baumanii 5 5,56 0 0
S. aureus - P.aeruginosa 4 4,44 0 0
S. aureus – Ent.faecium 4 4,44 0 0
BURN WOUND BACTERIAL QUANTITY
Bacterial quantity after bathing decrease ; p <0,05
Bacteria Time point p
Before bathing After bathing
S.aureus 537,34 ± 29,2 112,34 ± 15,3
< 0,05
P.aeruginosa 582,36 ± 11,51 94,2 ± 9,28
K.pneumonia 383,53 ± 16,36 57,15 ± 6,26
Ent.faecium 560,36 ± 21,80 83,26 ± 9,13
Aci.Baumanii 312,7± 11,24 0
BURNS WOUND PRIOR AND AFTER HYDROTHERAPY
BACTERIAL QUANTITIES AFTER HYDROTHERAPY D1 – D3 (x 103)
• The number of bacteria after hydrotherapy increased gradually and reached at equivalent threshold prior hydrotherapy 3 day later Other authors: hydrotherapy should be taken every 2-3 days to reduce re-infectious risk.
WOUND HEALING OF PARTIAL BURNS
Burn degree Patient Number of hydrotherapy
Once Twice ≥ 3 times
Superficial
dermal burn
Children 7,3 ± 1,8 6,1 ± 0,9
Adults 10,3 ± 1,2 9,2 ± 1,6 8,3 ± 1,7
Dermal burn
Children 11,7 ± 1,1 10,0 ± 1,5 9,1 ± 1,7
Adults 13,5 ± 1,8 12.8 ± 1,2 11.5 ± 1,1
Shorter time for wound healing for patients with more frequency of bathing
SKIN AUTO-GRAFT STICKING RESULT
Bathing before surgery: making good condition for skin graft Palmieri TL (2002): cleaned wound→decrease infectionous fators → making good wound bed
Taken graft skin
Prior surgery bathing
Without bathing
Amount % Number %
GoodGood 3232 94,1194,11 22 4040
FairFair 22 5,895,89 33 6060
TotalTotal 3434 100100 55 100100
Prior surgery bathing Without bathing
CONCLUSION CONCLUSION
1.1. Effect of hydrotherapy and clinical development Effect of hydrotherapy and clinical development Hydrotherapy carried out safely in severe burns patientsHydrotherapy carried out safely in severe burns patients Wound healing time for partial burns was shorter if taken Wound healing time for partial burns was shorter if taken
hydrotherapy regularlyhydrotherapy regularly Patients taking hydrotherapy before surgery have the high Patients taking hydrotherapy before surgery have the high
ratio skin auto-graft sticking (32/34 patients; 94,11%). ratio skin auto-graft sticking (32/34 patients; 94,11%).
1.1. Bacteria in burns wound after hydrotherapy Bacteria in burns wound after hydrotherapy The quantities of bacteria were all declined remarkably after The quantities of bacteria were all declined remarkably after
hydrotherapy, the difference has statistic significant with p < hydrotherapy, the difference has statistic significant with p < 0,05.0,05.
The bacterial quantity after hydrotherapy on the burns wound The bacterial quantity after hydrotherapy on the burns wound increased gradual reaching the initial threshold after 3 days.increased gradual reaching the initial threshold after 3 days.
SUGGESTIONSUGGESTION
1. Continue studying to evaluate the effect of hydrotherapy in severe patients with the higher number of patients
2. Setting up and completing the process of hydrotherapy for severe burns patients required mechanical ventilation, the elder…
Thank you for attention!Thank you for attention!