Complete occlusive dressing for hypospadias in children

Background: Dressing after hypospadias repair is particularly important to provide adequate pressure, hemostasis and prevent edema. Ideal dressing remains a challenge and multiple methods of dressings after hypospadias repair have been reported. Not many types of dressings are described in children and it varies from places and institutes. Present study describes the method of application of complete occlusive dressing in the children undergoing hypospadias repair.Methods: It is a prospective analysis of the operated patients of hypospadias who were offered complete occlusive dressing of the penis following surgery in a tertiary teaching hospital. The outcome was assessed on the basis of cosmetic and functional appearance after removal of the dressing namely, edema, ischemia, fistula formation if anyResults: A total of 100 patients were operated during the study period of two years. The age ranged from 1 year to 16 years. All patients were provided complete occlusive dressing of the penis following surgery (urethroplasty). The patients tolerated the dressing very well with minimal postoperative edema with good functional and cosmetic outcome. There were some minor complications associated with this type of dressing.Conclusions: The complete occlusive dressing in the hypospadias surgery is an alternative type of dressing in children after hypospadias surgery. The dressing is easily available, and the method can be easily learned and reproduced. There is no need for repeated changes or pain on removal, the patients are comfortable with the dressing and it keeps them mobile. It is helpful in reducing the postoperative edema and subsequent complications.

P1132EXIT-SITE CARE PROTOCOLS IN PORTUGAL AND ITS ASSOCIATION WITH CATHETER-RELATED INFECTIONS RATE

Background and Aims Exit-site infections (ESi) are frequent complications in peritoneal dialysis (PD) patients and their prevention and treatment are key aspects to lower peritonitis’ risk. The aim of this study was to evaluate the annual incidence rate of ESi and peritonitis in Portugal and to study possible associations between exit-site (ES) care protocols in each Portuguese unit and the number / rate of ESi and peritonitis. Method We performed a national study using two questionnaires at each Portuguese PD Unit: one about the incidence of catheter-related infections, the other characterizing patients’ education and ES care protocols. ESi and peritonitis were defined according to ISPD guidelines. Associations between variables were performed using T-student test or pairwise correlation test. STATA software was used. Results Of the 23 Portuguese PD Units, 14 units answered both questionnaires. In the last two years (2017 & 2018), those units followed 1453 patients. Portuguese ESi incidence rate was 0.41 episodes per year [1 episode per 29.2 months (MSSA incidence rate 0.13; MRSA incidence rate 0.03; Pseudomonas incidence rate 0.07)] and the peritonites incidence rate was 0.37 (1 episode per 32.5 months). We found a trend between the absolute number of ESi episodes and the number of peritonites in each unit (r=0.5, p=0.05). Although ESi prevention guidelines were known by 100% of the Portuguese units, only three out of 5 of the selected guidelines for this study were followed by 100% of the units: monitoring catheter-related infections on a yearly basis; using antibiotic prophylaxis at time of catheter placement and treating nasal carriage of S. aureus. The other 2 guidelines have variable implementation: 12 out of 14 units (86%) perform screening of nasal carriage of S. aureus and only 6 out of 14 (43%) of the units recommend daily topic antibiotic cream at the ES. We didn’t find associations between those differences and ESi incidence. Whenever S. aureus carriage is detected, 100% of the units proceed treating with mupirocine using different posology (twice or three times a day, 5 or 7 or 21 days, with/out chlorexidine). Also, the screening of nasal carriage of S. aureus is different: only pre catheter implantation (n=4); annually (n=4); semi annually (n=3); bimonthly (n=2). Oral antibiotics are prescribed after catheter placement in 4 units. We didn’t find statistical differences in ESi / peritonitis, comparing those practices. Regarding to ES care protocols, ESi rate was lower with non-occlusive dressing (0.38 vs. 0.57) immediately after catheter insertion. ESi and peritonitis rate were lower in units where bathing without ES dressing is advocated (n=9, 0.58 & 0.37 vs. 0.32 & 0.34). The use of bath sponge is associated with higher ESi rate (0.57 vs. 0.34). The use of colostomy bags in beach baths was associated with lower incidence rate of ESi compared to regular dressing or waterproof dressing (o.32 vs. 0.54). 100% of units use two different empirical antibiotics for initial ESi treatment. In the presence of chronic ESi, 3 units don’t perform shaving of external cuff and peritonitis rate is higher in those who do not apply this procedure (0.38 vs. 0.31). Conclusion in Portuguese PD units there is a wide variability in ISPD guidelines implementation and ES care protocols. We found that using non-occlusive dressing immediately after catheter insertion, removing ES dressing before shower, bathing not using a sponge and using colostomy bags at beach baths were associated with lower incidence rate of ESi. Shaving of the external cuff was associated with lower incidence rate of peritonitis. A regular national audit of PD Units is an important tool of quality improvement to clarify the best procedures for reduction of catheter-related infections in PD.

Experience with the Use of Splint Caps for the Management of Fingertip Amputation Injuries

Background: Fingertip amputation injuries are common hand injuries amongst all ages. If occurring as a result of workplace accidents, these injuries has the potential to lead to significant socioeconomic costs. Non-surgical techniques can treat these injuries with the potential to alleviate the burden of these socioeconomic costs. The aim of our study is to describe an alternative, cost-effective device to manage fingertip amputation injuries, and to present our short-term outcomes with this treatment modality. Methods: A retrospective study of patients with isolated fingertip amputation injuries who received treatment with semi-occlusive dressing and splint cap from 1 February 2018–21 December 2018 was conducted. The semi-occlusive dressing used was UrgoTul. The splint cap is a 3-dimensional thermoplastic splint to cover the semi-occlusive dressing of the injured finger. Results: There were 28 patients and 31 digits. The average age was 39.9 ± 12.7 years. 89.3% were male, 75% were foreign workers, 96.4% were blue-collared workers, 40% had dominant hand injuries and 25.8% had nailbed involvement. The average duration of follow-up was 66 ± 37.4 days and the average duration of hospital leave was 6.5 ± 4 weeks. The splint cap was applied for an average of 18.1 ± 6.2 days. The total time for tissue regrowth was 27.5 ± 8.8 days. 14.8% had residual nail deformities and return of sensation took 31.5 ± 11 days. Grip strength was 82.5% of unaffected hand. The mean range of motion at the distal interphalangeal, proximal interphalangeal and metacarpophalangeal joint was 58.8 ± 21.3°, 86.9 ± 15.5°, 81.4 ± 6.0° respectively, and 63.9 ± 23.6° and 66.3 ± 17.3° at the interphalangeal and metacarpophalangeal joint of the thumb respectively. Cost analysis will be further elaborated in the paper. Conclusions: Fingertip amputation injuries have a potential for regeneration through healing by secondary intention under semi-occlusive dressing conditions. The splint cap provides an easy to fashion, cost-efficient and comfortable addition to semi-occlusive dressings for fingertip injuries.

601 A Simple Dressing for Prevention of Central Line Infections in Pediatric Burn Patients

Introduction Between 2017 and 2018, the burn unit saw 16 patients with major burns. A major burn is considered a total body surface area of 20% or greater. The burns ranged from 20% to 85% total body surface area averaging 44.14 %. Of those 16 patients, 8 patients required central lines that could not utilize a traditional occlusive central line dressing. Central line access is often placed near a burn or grafted site, and an occlusive dressing cannot be maintained. On average, a central line was changed in the operating room every seven days for infection prevention or sooner if an infection is suspected. The lines were changed preferably to a new site or over a wire if limited sites. In 2017, our Burn unit’s central line associated bloodstream infection rate of 4.1 infections per 1000 catheter days. This was higher than the national benchmark centerline from the Children’s Hospital Solutions for Patient Safety national collaborative for pediatric intensive care units of 1.365 infections/1000 catheter days. The unit implemented the use of a 4x4 betadine dressing for microbial coverage as an innovative strategy to prevent central line associated blood infections. The method not only proved to be effective but also cost efficient. Methods While the standard of changing the central line every 7 days remained the same, our unit began using a 4x4 gauze soaked in betadine and placed over the central line insertion site. The gauze is moistened with the betadine solution, then rung out so that the gauze is not oversaturated. That gauze is placed directly over the insertion site using sterile technique. A dry gauze is then placed over the wet one to protect from pathogens in the environment. Both gauze pads are then changed every 4 hours to keep the betadine moist and working as an antimicrobial agent. Results In 2018, 4 patients with various central lines utilized the betadine technique with our overall central line associated blood infection rate for 2018 decreased to 0 infections/1000 catheter days. The cost of each occlusive central line dressing in our facility is $2.10, whereas the betadine method costs $0.97. These supplies can be used for more than one dressing change on each patient compared to the occlusive dressing that is used once. Conclusions Using the betadine dressing technique to protect against central line associated bloodstream infections has proven to be an effective, low cost technique to prevent line infections and improve patient outcomes for major burn patients with compromised skin integrity. By utilizing this technique, our overall central line infection rate has dropped significantly below the national average, while decreasing cost by over 50%. Applicability of Research to Practice Maintaining a low cost, effective dressing to help prevent line infections in major pediatric burn patients.