Elsevier

Burns

Volume 31, Issue 7, November 2005, Pages 845-849
Burns

Burn care standards in Israel: Lack of consensus

https://doi.org/10.1016/j.burns.2005.04.012Get rights and content

Abstract

In recent years, the need for a national burn center based on ABA guidelines has emerged in Israel. The formation of such a center is now underway in the Chaim Sheba Medical Center. As a first step in the standardization of burn care in Israel, we have conducted a nation-wide survey among burn care personnel (physicians, nurses and other burn team members), regarding different aspects of the treatment of burn patients.

Methods:

A questionnaire comprised of 30 questions regarding the severity of burns admitted, the site of initial management, wound care (both burn/skin-graft sites and donor sites), dressing changes protocols, sterility precautions, hydrotherapy, and pressure dressings was presented to 70 health-care professionals involved in the treatment of burns.

Results and discussion:

Seventy-seven percent of interviewed personnel participated in the survey. Consensus was found regarding most local (topical) wound care, (SSD for clean non-facial burns, Sulfamylon (mafenide-acetate) for contaminated non-facial burns, Threolone (chloramphenicol 3% and prednisolone 0.5%) or Bacitracin for facial burns, Paraffin gauzes with or without Sulfamylon for donor and graft sites). Dressing changes regimes were also agreed upon generally. However, there was no consensus regarding the ideal time for the removal of donor site dressings and this issue will need to be resolved. Other important findings are that both Edinborough University Solution of Lime (EUSOL), which has been deemed unsuitable for burn treatment due to toxic effects, and hydrotherapy, which has been proposed as a source of infection and contamination, are still widely used.

We anticipate that these issues will be settled in our unified national burn care protocols (which are currently under development and revision).

Section snippets

Background

Burns are a major trauma form in both traditional and modern groups of society in western countries, and burn care and rehabilitation is an ever evolving discipline. The methods applied in the treatment of burn patients vary from the simplest of dressings to the most complicated rehabilitative surgical procedures. Thus, numerous sets of guidelines for the treatment of each burn, according to degree, site, and size, have been adopted and abandoned over the years.

Israel is a small country, with a

Methods

A survey was conducted among 70 health-care professionals from 13 hospitals in Israel, involved in the treatment of burn patients. Interviews were conducted during a burn care convention or via personal telephone conversations. The questionnaire, comprised of 30 questions, regarded the severity of burns admitted, the site of initial medical treatment, wound care in different burn and donor (when appropriate) sites, the frequency of dressing changes in burn and donor sites, sterility precautions

Participants

Seventy questionnaires were distributed among burn care personnel. Of that total 54 (77%) questionnaires were filled out. Six (11%) questionnaires were filled out by plastic surgeons involved in burn care. Forty-seven (87%) questionnaires were filled out by burn units’ and plastic surgery departments’ nurses. One (2%) questionnaire was filled out by a burn unit physiotherapist.

Twenty-one (38.9%) survey participants represented plastic surgery departments, 19 (35.2%) participants represented

Discussion

The main finding of this study is that even though no national guidelines for the treatment of burn patients exist, most issues were under relative consensus, or were agreed upon by at least half of the participants. The only issues that were not agreed upon, and for which responses demonstrated a non-uniform pattern, were the timing of first dressing removal in donor sites, the local treatment for facial burns, and the local treatment for skin grafts with good take.

A possible explanation for

References (15)

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