B U R N S 3 7 S (2011) S1 –S2 5
models operating with planktonic bacteria. The experiments further open the perspective to create in vivo models using bioﬁlms as infectious agents.
O26.2 Ethical decision-making in a French burn centre: results of a local survey A.U.R.E. L Dehaudt ∗ . HIA PERCY, Clamart, France
O25.5 Inﬂammatory response of pneumocytes type II to LPS P.C. Fuchs, D. Gaida ∗ , C. Suschek, N. Pallua. RWTH Aachen, Aachen, Germany
Introduction: Ethical decisions to withdraw or withhold care for burns are particularly serious and frequent. These decisions must be taken by a multidisciplinary team. Study Purpose: A survey was designed to analyse the opinion of healthcare team
Rationale: Inhalation injury is a severe comobidity in burned patients and is a
about actual management of ethical problems.
well known promoter of lethality. This work tries to elucidate the pulmonary
Method: A blinded questionnaire consisted of multi-choice questions and
proinﬂammatory role in developing SIRS after a severe burn and inhalation
personal comments or proposals were given to physicians and paramedics (head
injury. In an in vitro model the pneumoctyes type II are cultivated and their
nurses, nurses and nurse’s aide).
stress reaction is examined.
Results: The response rate was 75% (36 responses in 48 caregivers). Distribution
Material and Methods: In a modiﬁed technique as described by Dobbs the
of answers was: 7 of 8 physicians (87%), 2 head nurses (100%), 18 of 22 nurses
lungs of healthy Sprague-Dawley-Rats are rinsed with a special solution and
(82%), 9 nurse’s aide of 16 (56%). Mean active duty in burn centre was 3.5 years
afterwards excised. For removal of intraalveolar macrophages a bronchio-
alveolar lavage is performed. Afterwards the lungs have been cut into small
100% of care givers have been confronted with an end of life decision. 34 were
pieces and a suspension of elastase has been added. This solution was brought
informed orally (94%), 9 by medical prescription (25%), 5 by medical records
into wells coated with speciﬁc antibodies for separation of the pneumocytes
(14%) and 9 by chance (25%). Only 11 caregivers (30%) have been invited to give
type II. After veriﬁcation of the speciﬁc cell count by phosphin-3-dyeing the
their opinion about an ethical decision. 13 of 29 paramedics (45%) thought they
cells were seed with 400,000 cells/cm2. One half of the cultures received now a
had a role in decision making.
proinﬂammatory impulse by LPS. At day 2, 3, 4, and 5 cytokine-levels of IL-1,
17 out of 36 caregivers (47%) are systematically well-informed about care
IL-6 and TNF-α were measured by ELISA. Statistical analysis was done by ANOVA
decision: 7 physicians (100% of physicians) and 10 paramedics (34%). 34 of 36
and signiﬁcance was assigned to p<0.05.
caregivers (94%) would like to participate in ethical meetings.
Conclusion: For TNF-α after 48 h a very strong increase (300 pg vs. 6000 pg) was
Regular attendance at meetings will allow a better management of patient for
observed wich was almost constant for 120 h.
27 caregivers (75%), to better understand the care decisions for 30 caregivers
IL-1 was not measurable in the controls but showed also a constant elevation in
(83%), to understand the prognosis for 23 caregivers (64%) or to understand the
the LPS-exposed cells.
functional outcome for 22 caregivers (61%).
The IL-6 levels demonstrated also an elevation in the early phase. But here the
Currently 30 caregivers in burn centre (83%) don’t agree with the process of
controls had also an increase after 96 h.
decision to withdraw burn care.
Discussion: Patients with an inhalation injury often demonstrate a more severe
Conclusion: Too many caregivers are usually unaware or not well-informed
course of the inﬂammatory response to the trauma. Due to our cell culture
about end of life decision. Changes are strongly necessary to increase involve-
experiments we have been able to underline the cellular role of pneumocytes
ment of paramedics in decision-making processes according to legal French
II as an immunologic active responder to proinﬂammatory stress. This may
partially help to explain the strong reaction of inhalation injured patients to the SIRS in severe burns.
O26.8 O25.8 Keratinocyte suspension for the treatment of facial burns
High-intensity narrow-spectrum light decontamination of a staff changing room in a burns ward A. Coyle ∗ . NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
H. Rennekampff ∗ , C. Herold, M. Vogt. Medical School Hannover, Hannover, Germany Rationale: Healthcare associated infection (HAI) is a growing problem in hospital Introduction: Treatment of thermal and chemical burns of the face is challeng-
care and in the burn patient is a leading cause of morbidity and mortality and
ing. A prolonged healing phase or deep partial thickness burns may leed to scar
remains one of the most challenging problems for the burn team. Increasingly
formation. Split skin grafting may also result in functional and aesthetic com-
cross-infection from environmental contamination is being recognised as a
plications. The rationale is to avoid hyperthrophic scars and contractures. Non
signiﬁcant source of HAI therefore methods of reducing environmental bacterial
cultured keratinocyte suspension (ReCell© -Kit) may offer a bedside technology to
load have become increasingly important. The High-Intensity Narrow-Spectrum
process a sprayable cell suspension as an alternative to cultivated keratinocytes.
light Environmental Decontamination System (HINS-light EDS) is a novel
Patients: The technique with advantages and possible limitations will be
technology that is installed as a ceiling-mounted light source, to provide
described. Five patients with burns that have been treated with the ReCell© -Kit
continuous environmental disinfection in occupied clinical environments.
are presented. They have been followed up clinically and scars have been
Methods: Contact plate sampling using a selective media for staphylococcal type
evaluated using the Vancouver scar scale and the Cutometer.
bacteria was used to assess the environmental bacterial load in ﬁve selected
Results: There are markedly differences in adhesion receptors between cultured
areas within the plastic surgery unit including nursing station, staff changing
and non cultured keratinocytes which affect adhesion on matrix proteins.
room, preparation room, outpatient cubicle and operating theatres. For sampling
In our patients reepithelialisation was achieved 7–9 days after application of the
20 contact plates were collected on 3 different occasions. The HINS-light
cell suspension. There were neither hyperthrophic scars nor severe contractures.
EDS was then installed in the area with the highest levels of environmental
The skin pigmentation was slightly reduced in comparison to surrounding non
contamination, and contact plate sampling was carried out in within this area
injured skin. Full thickness burns required skin grafting.
before, during and after use of the HINS-light EDS.
Discussion: The ReCell© -Kit offers an interesting technology for autologous skin
Results: Assessment of the environmental contamination in the ﬁve areas
cell transplantation. The bed side solution obviates the need for time – and
demonstrated that the staff changing room had by far the greatest bacterial
resource – consuming cultivation of keratinocytes. The application is simple and
load with an average of 193 colony-forming units per contact plate. The other
additional cells from the skin like melanocytes are co-transplanted. The method
areas had an average of 14–83 CFU/plate. Use of the HINS-light EDS within the
is limited to partial thickness burns as it does not replace dermal components
staff changing room was shown to successfully signiﬁcantly reduce the levels of
of the skin. The ReCell© -Kit is indicated in partial thickness burns of small areas
environmental bacteria on contact surfaces around the room.
in exposed and aesthetically crucial regions like the face or neck. Costs remain
Conclusion: The HINS-light EDS is effective at reducing environmental con-
a crucial factor for this technology.
tamination in an area with a high bacterial load. Its use in conjunction with existing infection control measures will minimise environmental contamination and consequently contribute to minimising the risks of HAI in the burns patient.