Synergistic Use of Novel Technological Advances in Burn Care Significantly Reduces Hospital Length of Stay Below Predicted: A Case Series.

Length of stay is an important metric in healthcare systems, primarily because it reflects the cost of care provided. In the United States, as in many countries, inpatient hospital stays are significantly more expensive than outpatient care across all healthcare conditions,1 so earlier discharge and transition to outpatient care is crucial to help control the ever-increasing cost of healthcare. In burn patients, length of stay has traditionally been estimated at 1 day per 1% total body surface area of burn. This estimation was first described in a round table discussion in 1986.2 However, since that time there has been significant evolution in the quality of care available to burn patients, in both the operating room and ICU. The use of new harvesting techniques, synthetic dermal substitution, and autologous epidermal skin cell suspension are allowing large, deep burns to be excised and covered in much quicker time frames than historically were possible. Examples include the skin harvesting and wound debridement device for grafting and excision, biodegradable temporizing matrix as a fully synthetic dermal template, and regenerative epidermal suspension concerning cell harvesting. Although these modalities can all be used separately, we believe that using them in conjunction has allowed us to shorten the length of stay in patients with severe partial and full-thickness burns. We present an initial case series of three patients with anticipated hospital lengths of stay of 54.5, 55, and 51 days, who were ready for discharge in 37, 35, and 43 days, respectively.

The Ideal Donor Site Dressing: A Comparison of a Chitosan-Based Gelling Dressing to Traditional Dressings.

Donor site wound management is critical in split-thickness skin graft surgeries. These sites typically recover in 7 to 14 days due to the dermal-imbedded keratinocytes that promote skin regeneration. An ideal donor site dressing can help to mitigate pain, reduce infection risk, promote hemostasis, and accelerate healing times. Additionally, this dressing would be easy to apply in the operating room, easily managed, and cost-effective. Chitosan-based gelling dressings (CBGD) possess many of these qualities that make an ideal donor site dressing. We conducted a retrospective chart review of patients who received CBGD as part of their postoperative wound care plan. We collected data on infections, hemostasis, dressing failure, and hospital course over a 14-month period where CBGD was used as the donor site dressing. One hundred and fourteen patients were evaluated. We found an infection rate of 7%, a bleed-through rate of 1.8%, and a re-application rate of 9.6%. The average CBGD cost per patient was $75.15. CBGD has acceptable infection rates, and pain scores as traditional donor site dressings. However, it possesses several qualities of a suitable donor site dressing notably swift healing rates, impressive hemostatic property, and low cost. Our study supports the idea that CBGD is a suitable donor site dressing for split-thickness skin graft surgeries.

Detection of culture-negative sepsis in clinical blood samples using a microfluidic assay for combined CD64 and CD69 cell capture.

Sepsis is a life-threatening disease that affects millions of people every year. Rapid detection of sepsis assists clinicians to initiate timely antibiotic therapy and to reduce mortality. At the same time, accurate point-of-care detection is needed to reduce unnecessary use of antibiotics. One of the principal challenges in sepsis diagnosis is that many sepsis cases do not result in positive blood cultures. These so-called culture-negative cases present a significant health threat. In this work, we present a microfluidic cells separation system for the detection of sepsis in both culture-positive and culture-negative cases. Leukocytes were captured in several affinity separation zones of a microchip based on CD64, CD69, and CD25 expression. To validate this assay 40 septic patients and 10 healthy volunteers were enrolled in this study. Septic patients were divided into culture-positive (n = 12) and culture-negative cases (n = 21). CD64 + cell capture demonstrated excellent accuracy for sepsis detection with an area under the receiver operating characteristic curves (AUC) of 0.962. A combined panel of CD64 + and CD69 + cell counts was constructed, and the new panel outperformed each of these two biomarkers alone with the AUC of 0.978. Our affinity microfluidic devices were validated by conventional flow cytometry analysis. Results showed that the cell capture number of specific affinity region increased along with the increase of its corresponding antigen expression. This clinical validation confirms that CD64 and CD69 cell separations are a powerful sepsis assay with the potential for point-of-care analysis in culture-positive and culture-negative cases.

Combined CD25, CD64, and CD69 biomarker panel for flow cytometry diagnosis of sepsis.

Sepsis is a highly prevalent syndrome in the United States. The use of cell surface markers, as an effective tool to diagnosis sepsis, has been widely investigated. However, the study of the combination of multiple biomarkers to achieve higher diagnosis accuracy is rare. This study, the panel combined with CD25, CD64, and CD69 was constructed and better diagnosis ability was observed. Septic patients (n = 40), with the mean age of 61 ±â€¯14, were enrolled in this study, along with healthy volunteers (n = 10), included as a control group. All blood samples were measured by flow cytometry based on different subtypes of leukocytes, including neutrophils, monocytes, and lymphocytes. Antigen expression and the antigen positive cell population were reported separately based on cell types. CD64 was the best biomarker in predicting sepsis. The area under Receiver Operating Characteristic (ROC) curve (AUC) was 0.928 and 0.934 for neutrophil CD64 expression and CD64 + neutrophil population, respectively, indicating an excellent diagnosis ability for sepsis. A significant increase was also observed in the populations of CD25 + lymphocytes and CD69 + lymphocytes (p = 0.02 and 0.042, respectively; 95% confidence interval). A panel of combined CD25, CD64, and CD69 was constructed. The parameters of neutrophil CD64 expression, CD64 + neutrophil population, CD25 + lymphocyte population, and CD69 + lymphocyte population were included. The AUC of the ROC curve for this new constructed panel was 0.978. This result indicated that the combination of CD25, CD64, and CD69 outperformed each one of the single parameters in predicting sepsis alone.

Multiparameter Affinity Microchip for Early Sepsis Diagnosis Based on CD64 and CD69 Expression and Cell Capture.

Sepsis is a leading cause of death worldwide. In this work, a multiparameter affinity microchip was developed for faster sepsis diagnosis, which can reduce the mortality caused by late validation. The separation device captured cells expressing CD25, CD64, and CD69 into discrete antibody regions. The performance of multiparameter cell separation microchips was compared with flow cytometry analysis and validated with samples of septic patients ( n = 15) and healthy volunteers ( n = 10). The total analysis time was 2 h. Results showed that total on-chip cell counts for both CD64 and CD69 regions were linear with antigen expression levels. The difference between cell capture for septic and healthy samples was statistically significant (CD64: p = 0.0033; CD69: p = 0.0221, 95% confidence interval), indicating that sepsis is distinguishable based on microfluidic cell capture. For on-chip detection of CD64+ and CD69+ leukocytes, the AUC was 0.95 and 0.78, respectively. The combination of CD64 and CD69 for sepsis diagnosis had the AUC of 0.98, indicating the improved and excellent diagnostic performance of multiple parameters.

Detection of sepsis in patient blood samples using CD64 expression in a microfluidic cell separation device.

A microfluidic affinity separation device was developed for the detection of sepsis in critical care patients. An affinity capture method was developed to capture cells based on changes in CD64 expression in a single, simple microfluidic chip for sepsis detection. Both sepsis patient samples and a laboratory CD64+ expression model were used to validate the microfluidic assay. Flow cytometry analysis showed that the chip cell capture had a linear relationship with CD64 expression in laboratory models. The Sepsis Chip detected an increase in upregulated neutrophil-like cells when the upregulated cell population is as low as 10% of total cells spiked into commercially available aseptic blood samples. In a proof of concept study, blood samples obtained from sepsis patients within 24 hours of diagnosis were tested on the chip to further validate its performance. On-chip CD64+ cell capture from 10 patient samples (619 ± 340 cells per chip) was significantly different from control samples (32 ± 11 cells per chip) and healthy volunteer samples (228 ± 95 cells per chip). In addition, the on-chip cell capture has a linear relationship with CD64 expression indicating our approach can be used to measure CD64 expression based on total cell capture on Sepsis Chip. Our method has proven to be sensitive, accurate, rapid, and cost-effective. Therefore, this device is a promising detection platform for neutrophil activation and sepsis diagnosis.

Is automated electronic surveillance for healthcare-associated infections accurate in the burn unit?

As monitoring requirements for healthcare-acquired infection increase, an efficient and accurate method for surveillance has been sought. The authors evaluated the accuracy of electronic surveillance in multiple intensive care unit settings. Data from 500 intensive care unit patients were reviewed to determine the presence of central line-associated blood stream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI). An electronic surveillance report was obtained to determine whether patients had a blood-line nosocomial infection marker or a urine nosocomial infection marker. Manual review was based on Centers for Disease Control and Prevention criteria. An infection preventionist then reviewed all discrepant cases and made a final determination, which was used as the gold standard. Sensitivity, specificity, false-positive rate, and false-negative rate were then calculated for electronic surveillance. In the burn population the sensitivity of electronic surveillance for CAUTI was 66.66%, specificity 96.5%, false-positive rate 3.44%, false-negative rate 33%; and for CLABSI the sensitivity was 100%, specificity 95%, false-positive rate 4.96%, false-negative rate 0%. In the nonburn population the sensitivity for CAUTI was 50%, specificity 97.9%, false-positive rate 2%, and false-negative rate 30%; and for CLABSI sensitivity was 60%, specificity 98.8%, false-positive rate 1%, and false-negative rate 60%. Burn centers may experience a higher false-positive rate for electronic surveillance of CLABSI and CAUTI than other critical care units.