661 Burns in the Time Of COVID: The Use Of a Poly Lactic Acid Polymer Skin Substitute Helped A Combined Adult/Pediatrics Burn Unit Change Clinical Practice During the Coronavirus Lockdown

Abstract

IntroductionAs a verified burn center, we prepare for mass casualty & constantly strive to remain at the forefront of the burn technology & research. There was nothing that prepared us for a statewide stay-at-home order nor the hospital lockdown that would come with the coronavirus pandemic. The hospital lockdowns resulted in disheartening loneliness that would prohibit the visitation of family to the ill or injured patients. The difficulty of locking down well parents proved challenging. Our new hospital policy restricted parent movements & their anxiety of exposure also heightened the desire to discharge. We questioned whether the peds patient was better suited in the hospital or at home. This shifted our usual practice. During March-May, our hospital restricted parent movements out of the patient’s room, no visitors, no swap outs during the day. This resulted in early debridements, often at the bedside, & application of the polylactic acid polymer substitute. This allowed for a discharge within 24 hrs & return to clinic in 48 hrs.MethodsWe reviewed the charts of 10 pediatric patients that normally would have remained hospitalized pre-COVID & these patients were admitted underwent debridement & early application of a polylactic acid polymer skin substitute. The charts were reviewed to determine if there were any readmissions, ER visits, delays in wound healing, delays in OR time, if needed, opposition from parents or nurses from about readiness for discharge.ResultsThe charts indicated there was one return admission. The readmit was from a planned split thickness skin graft & the polylactic acid polymer was used to stage the deeper area while allowing the majority to heal. Charts demonstrated satisfaction of the parents that didn’t want to be in the hospital during COVID. No nurses felt uncomfortable & all patients demonstrated stable vitals & good UOP at the time of discharge. This indicates several initial application on admission & was discharged within 24 hours.ConclusionsThis could at face value be a simple means to an end. The review of records indicates this was successful by most definitions of outcome. The limitation discovered was the ability to optimize outpatient therapy. Burns in the time of COVID, made use reexamine how we have cared for burns & whether there was room to perform more without an inpatient or a decreased inpatient stay. This change in practice also illustrated the ability to the wounds we initially thought may be deeper & possibly need excision actually healed well with no current development of hypertrophic scarring. Our institution will consider the early practice of debridement & lactic acid polymer application even when the restriction are eased. It also forced us to reevaluate how much we are grafting & reexamine what can heal on its own.