A preliminary report on the spray application of topical silver sulfadiazine to burn wounds


Denny, A.D.; Twomey, J.A.; Hitchcock, C.R.

Journal of Trauma 18(10): 730-731

1978


A simple, flexible system for spray application of topical antimicrobials has been developed in the Burn Unit at Hennepin County Medical Center. In contrast to previous attempts, this method allows spray application of silver sulfadiazine without dilution. Because of the viscosity of the micronized cream, aerosol spread is minimal. Inexpensive commercially available components are used without modification. This system can be readily adapted to most hospital situations and provides rapid topical antimicrobial application. Time required for dressing changes has been reduced in our Burn Unit by 75% and fewer nursing personnel are required. Spray application avoids direct physical contact with burn wounds, eliminating potential contamination and greatly reducing pain associated with dressing changes. Patient acceptance is high.

0022-5282/78/0018-073002.00/0
THE
JOURNAL
OF
TRAUMA
Vol.
18,
No.
10
Copyright
©
1978
by
The
Williams
&
Wilkins
Co.
Printed
in
U.S.A.
A
Preliminary
Report
on
the
Spray
Application
of
Topical
Silver
Sulfadiazine
to
Burn
Wounds
ARLEN
D.
DENNY,
M.D.,
JOHN
A.
TWOMEY,
M.D.,
AND
CLAUDE
R.
HITCHCOCK,
M.D.,
PH.D.
A
simple,
flexible
system
for
spray
application
of
topical
antimicrobials
has
been
developed
in
the
Burn
Unit
at
Hennepin
County
Medical
Center.
In
contrast
to
previous
attempts,
this
method
allows
spray
application
of
silver
sulfadiazine
without
dilution.
Because
of
the
viscosity
of
the
micronized
cream,
aerosol
spread
is
minimal.
Inexpensive
commercially
available
components
are
used
without
modification.
This
system
can
be
readily
adapted
to
most
hospital
situations
and
provides
rapid
topical
antimicrobial
application.
Time
required
for
dressing
changes
has
been
reduced
in
our
Burn
Unit
by
75%
and
fewer
nursing
personnel
are
required.
Spray
application
avoids
direct
physical
contact
with
burn
wounds,
eliminating
potential
contamination
and
greatly
reducing
pain
associated
with
dressing
changes.
Patient
acceptance
is
high.
Application
of
topical
antimicrobials
to
the
burn
wound
has
increased
control
of
burn
wound
sepsis
(2).
The
present
method
of
applying
fine
mesh
gauze
strips
impregnated
with
silver
sulfadiazine
to
the
burn
wound
is
time
consuming,
often
painful,
and
represents
a
poten-
tial
mechanism
for
spread
of
contamination
from
one
burn
wound
area
to
another.
A
system
for
spray
appli-
cation
of
topical
antimicrobials
could
be
useful
and
effi-
cient.
Currently
we
are
testing
such
a
device
developed
in
the
Burn
Unit
at
the
Hennepin
County
Medical
Center.
Previous
attempts
at
spray
application
of
silver
sulfadi-
azine
required
dilution
of
the
product
to
a
degree
which
rendered
it
ineffective
against
bacteria
(1).
By
using
commercially
available
equipment
without
modification,
we
have
been
able
to
spray
silver
sulfadiazine
in
micron-
ized
cream
form
directly
onto
the
burn
wounds.
No
alteration
of
the
commercial
silver
sulfadiazine
has
been
necessary.
MATERIALS
AND
METHODS
Silver
sulfadiazine
(Silvadene,
Marion)
is
used
as
sup-
plied
by
Marion
Laboratories.
The
spray
system
consists
of
four
mechanical
components:
a
Devilbiss
CGA
#501
spray
gun,
100
gauge
(Devilbiss,
Elmhurst,
IL),
with
nozzle
#Z-46FF,
an
adjustable
air
pressure
regulator
(#27767A,
Dayton
Elect.
Manufacturing
Co.,
Chicago,
IL)
and
a
length
of
3
/
4
inch
flexible
rubber
air
hose
with
wall
fitting
(Model
33A,
Ohio
Medical
Products,
Madi-
son,
WI),
and
pop-off
connector,
1
/
4
"
inside
diameter
From
the
Burn
Unit
and
Department
of
Surgery,
Hennepin
County
Medical
Center,
Minneapolis,
Minnesota.
Address
for
reprints:
Department
of
Surgery,
Hennepin
County
Medical
Center,
701
Park,
Minneapolis,
MN
55415.
(Dayton
Elect.
Manufacturing
Co.)
(Fig.
1).
If
central
compressed
air
is
not
available,
portable
air
tanks
or
a
small
compressor
capable
of
delivering
30
pounds
per
square
inch
pressure
at
3
cubic
feet
per
minute
can
be
used.
Procedure.
After
connecting
the
air
line
to
pressurized
air
source,
the
pressure
regulator
is
adjusted
to
30
pounds.
Using
sterile
technique,
the
product
container
is
filled
with
topical
antimicrobial.
Container
pressure
is
adjusted
to
maximum
by
the
thumb
screw
on
the
container.
Delivery
rate
is
controlled
by
adjusting
the
screw
on
the
handle.
The
air
line
is
connected
and
spraying
of
the
burn
wound
commences.
Care
is
taken
to
point
the
discharge
nozzle
away
from
the
patient's
face.
At
a
distance
of
4
to
6
inches
from
the
burn
wound,
several
passes
with
the
sprayer
allow
coverage
of
the
wound
with
a
thickness
of
2
to
3
mm
of
silver
sulfadiazine
and
minimize
overspray
to
the
surroundings
(Fig.
2).
Because
of
the
viscosity
of
the
agent,
aerosol
spread
is
minimal.
The
time
required
to
cover
an
entire
back
or
chest
and
abdomen
is
about
1
minute
of
spraying.
Absorbent
dressings
are
then
placed
onto
the
coated
burn
wound
and
held
in
place
with
flexible
netting.
No
direct
contact
with
the
wounds
is
necessary.
Alternatively,
this
method
is
ideal
for
open
wound
treatment.
DISCUSSION
There
are
several
significant
advantages
to
using
this
method.
Spray
application
of
topical
agents
promotes
rapid
dressing
changes.
Our
previous
method
of
impreg-
nated
gauze
application
often
required
2
hours
for
a
major
burn
dressing.
The
spray
method
has
allowed
a
75%
reduction
in
time
required.
Fewer
nurses
are
needed
for
a
dressing
change
and
therefore
are
available
for
other
essential
duties.
Decreased
time
for
dressing
changes
reduces
metabolic
demands
on
the
patient
from
uncontrolled
heat
loss
during
open
exposure.
Spray
application
of
topical
antimicrobials
eliminates
the
physical
contact
with
the
open
wound
inherent
to
the
730
Vol.
18,
No.
10
Spray
Application
of
Silver
Sulfadiazine
to
Burn
Wounds
731
_40.111
01
V
.
-
Fic.
1.
Equipment
used
in
spray
application
of
silver
sulfadiazine:
Devilbiss
CGA
#501
spray
gun,
adjustable
air
pressure
regulator,
and
flexible
air
hose
with
pop-off
connectors.
application
of
impregnated
gauze.
This
precludes
the
potential
for
contamination
and
spread
of
infection
from
one
area
to
another.
Since
the
sprayer
has
no
patient
contact,
multiple
patients
can
be
rapidly
dressed
using
the
same
sprayer
without
cross-contamination.
The
sprayer
is
cleaned
and
cultured
on
a
regular
basis.
All
cultures
to
date
have
been
negative.
If
positive
cultures
are
obtained
the
spray
unit
can
be
readily
gas
autoclaved.
Patient
acceptance
of
this
method
is
high.
Rapid
dress-
ing
changes
without
wound
contact
necessitated
by
im-
pregnated
gauze
application
are
much
less
painful.
Our
two
initial
patients
had
impregnated
gauze
dressings
applied
several
times
before
the
spray
equipment
was
available.
After
each
patient
had
experienced
the
spray
Fic.
2.
Third-degree
burns
of
left
lower
extremity
after
spray
appli-
cation
of
silver
sulfadiazine.
application
method
they
requested
it
for
all
future
dress-
ing
changes.
Reasons
cited
were
the
decreased
pain
and
time
involved.
This
level
of
acceptance
has
remained
unchanged
through
our
experience
with
10
patients
and
over
200
spray
applications.
Acknowledgment
The
technical
assistance
of
Lowell
F.
Wood
is
gratefully
acknowledged.
REFERENCES
1.
Mangus,
J.
M.,
Morgan,
L.
R.,
Gilchrist,
D.:
The
use
of
topical
solutions
in
antibacterial
burn
wound
therapy.
Burns,
3:
257-260,
1977.
2.
Moncrief,
J.
A.:
Topical
antibacterial
therapy
of
the
burn
wound.
Clin.
Plast.
Surg.,
1:
563-575,1974.
MANAGEMENT
OF
PATIENTS
WITH
THERMAL
INJURIES
DECEMBER
14-16,
1978
DENVER,
COLORADO
The
Colorado
Committee
on
Trauma
of
the
American
College
of
Surgeons
will
sponsor
a
3-day
symposium
on
bums
December
14-15-16,1978
at
the
Denver
Hilton
Hotel,
Denver,
Colorado.
The
course
meets
the
criteria
for
22
hours
credit
in
Category
I
for
the
Physicians
Recognition
Award
of
the
American
Medical
Association.
Continuing
education
credit
has
been
requested
by
the
American
Academy
of
Family
Physicians
and
the
Colorado
Nurses
Association.
For
further
information
contact:
John
A.
Boswick,
Jr.,
M.D.,
4200
E.
9th
Avenue—Box
C-309,
Denver,
Colorado
80262
(303)
394-8718