key: cord-0951117-ldbiq30h
authors: Almeida, Juliano Baron; Paiva, Sabina Aparecida Alvarez; Coltro, Pedro Soler; Farina Junior, Jayme Adriano
title: An outbreak of Covid-19 in a Burn Unit: The impact on the health system and management strategies for infected patients
date: 2020-12-14
journal: J Plast Reconstr Aesthet Surg
DOI: 10.1016/j.bjps.2020.12.026
sha: 6195ab71d9cd667acc702bd6b06ab89dd4d79c6e
doc_id: 951117
cord_uid: ldbiq30h

nan

The coronavirus pandemic that started in Asia probably arrived in Brazil in February 2020. Isolation and quarantine strategies positively influenced transmission control. However, the increasing of the ethyl alcohol storage at home during quarantine seems to increase the chances of domestic accidents such as burns, for example. 1 Health professionals are on the front line, exposing themselves to infectious cases. The direct contact with burned patients is prolonged by the need for daily dressing changes for burns with silver sulfadiazine cream 1%. 2 , 3 In this report, we describe an outbreak of Covid-19 in a burn treatment unit, from an initially asymptomatic patient, its transmission to health professionals, the management measures adopted to control the infectious event, and its impact on the health system.

We reviewed the electronic medical record of the burned patient infected with Covid-19, as well as an interview with the health professionals who attended the Burn Unit of the Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, Brazil.

The initial patient was a 52-year-old man, a victim of a second and third-degree burn due to direct flame, totaling 12% of the body surface area. After 11 days of hospitalization, he started with fever, odynophagia, and runny nose. Due to the pandemic context, he was transferred to an isolation room and collected respiratory secretion using a swab, which was positive for the RT PCR test for Covid-19.

To minimize the time of contact with the patient after the diagnosis of Covid-19, the use of long-term dressings was adopted to treat the areas of residual burns and the maintenance of dressings with negative pressure device for the areas already grafted. We decided to use polyurethane and silicone sheets with impregnated silver ions (Mepilex Ag TM ) to the injured regions, which allowed dressing changes to happen only once a week. This alternative considerably minimized the contact time between health professionals and patients, when compared to the most used dressing in our burn unit, silver sulfadiazine cream 1%, which requires daily changes.

The use of long-term dressings is already well established, as advocated by Silverstein et al. in 2011, who found relevant efficacy of them in comparison with 1% silver sulfadiazine. 2 , 3 Currently, in the context of a pandemic, another opportune possibility arises for its utilization. In areas of deep burns treated with a split-thickness skin graft, the use of a negative pressure dressing (Avelle TM ) was maintained, which also allowed less contact time between the infected patient and employees, to be changed in five to seven days. The use of negative pressure dressings on skin grafting areas showed 96.7% integration with a pressure of 80 mmHg, according to Petkar et al. and could be a valid alternative for a pandemic context. 4 Our burn unit has 34 health professionals in their routine of assisting inpatients who work in relay shifts. After extensive testing of all health professionals in our Burn Unit, seven individuals were found to be contaminated ( Table 1 ) , which represents approximately 20% of them. For the employees who were able to work, the continuous use of personal protective equipment (PPE) was reinforced during the entire period of their care routines in the health service. In agree with this, Canova et al. found a low risk of Covid-19 transmission for health workers who were strict adherence to basic standard hygiene and facemasks were included, once it offers considerable protection during short periods of contact with symptomatic Covid-19 patients. 5 The decrease in the number of health workers generated the need to close two hospital beds due to the lack of specialized labor. The outbreak in a Burn Unit is of great concern because it is an important public health resource. The removal of employees contaminated by Covid-19 directly affects the quantity and quality of care to be offered to the population dependent on the public health system in a period that could see an increase in burn accidents due to the greater availability of ethyl alcohol in Brazilian households. 1 The high transmissibility of Covid-19 demands for strong measures to control outbreaks within Burn Units. Priority should be given to the identification of patients and employees possibly infected through high clinical suspicion and laboratory testing to avoid further impacts on the provision of specialized services in the health system. These outbreaks may make it impossible to maintain the original number of beds available due to the lack of specialized labor. Longterm dressings are interesting strategies to be considered in the treatment of burned patients infected by the new coronavirus, because they reduce the time of exposure of health professionals to these patients, and consequently reduce the risk or the magnitude of an outbreak in the Burn Units. 

None declared.

None.

Not required.

Covid-19 quarantine has increased the incidence of ethyl alcohol burns

An open, parallel, randomized, comparative, multicenter study to evaluate the cost-effectiveness, performance, tolerance, and safety of a silver-containing soft silicone foam dressing (intervention) vs silver sulfadiazine cream

Ionic silver dressings as substitute for sulfadiazine for deep burn wounds: case report [Curativos de prata iônica como substitutos da sulfadiazina para feridas de queimaduras profundas: relato de caso

A prospective randomized controlled trial comparing negative pressure dressing and conventional dressing methods on split-thickness skin grafts in burned patients

Transmission risk of SARS-CoV-2 to healthcare workers -observational results of a primary care hospital contact tracing