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!