Innovation to treat paediatric burns

The future treatment of burns patients has received a huge boost with the award of major funding to develop a revolutionary dressing that utilises nanotechnology to detect and treat infection in wounds. The Bacteriosafe dressing will work by releasing antibiotics from nanocapsules triggered by the presence of pathogenic bacteria, initiating treatment before the infection takes hold and changing colour as an alert that the wound is infected. The “smart” dressing is being developed in the first instance in response to the problem of burns in young children and is backed by a ?4.5 million European Commission 7th Framework grant. The project is a collaboration of 11 partners across Europe and Australia, coordinated by Dr Renate Förch at the Max Planck Institute for Polymer Research in Germany, which will develop the dressing over the next few years. In England and Wales alone, up to 38,000 children suffer burns injuries each year, 80% of these in under-fives, who are particularly vulnerable to toxic shock if their wound becomes infected. Many (55%) of these are scalds from hot drink spillages and most are small in size. However, wound size has no bearing on whether toxic shock will develop and up to half of cases of toxic shock in very young children will be fatal unless treated early.

Children with scalds or burn injuries are currently treated depending on the depth of the burn. While the worst cases will require skin grafting, most will not need surgery and are treated with stateof- the-art dressings designed to support skin cell growth and prevent microbial infection. By encouraging cell growth these “biological” dressings speed up the healing process resulting in shorter hospital stays and less need for skin grafting. In children, these dressings need to be applied under general anaesthetic following surgical cleaning of the wound – effectively making the burn area sterile. However, burns are still vulnerable to infection by organisms such as Stapylococcus aureus (the most common culprit in toxic shock), Streptococcus pyogenes, Pseudomonas aeruginosa and Klebsiella pneumoniae from the surrounding non-sterile skin. Currently, the only way to diagnose an infected burn injury in a child is from the child’s clinical condition or by removing the dressing, usually under general anaesthetic. Not only is this costly, but more importantly it can severely set back the whole healing process as these dressings can only be applied in the first 24 hours after the burn and cannot be re-applied.

Yet removal of the dressing may ultimately prove unnecessary as signs of an infection in a young child, such as a raised temperature, may not be related to the burn at all. This leaves clinicians with a conundrum: ensuring that a child is not at risk from a dangerous infection while also optimising healing conditions for the burn, and also avoiding premature treatment with broad spectrum antibiotics. The concept for the new dressing grew originally from the work of Dr Toby Jenkins, project leader at the University of Bath. “For a clinician the number one concern is to detect if an infection is present in the wound before you even know what’s causing it,” he said. “Increasing antibiotic resistance means you do not want to treat with antibiotics too soon, so what is really needed is a technology that can be used with current biological dressings that gives a straightforward ‘yes’ or ‘no’ answer as to whether infection is present. “This would mean that children could spend less time in hospital and could, instead, be monitored at home by their parents. Young children can die of toxic shock within 18 to 24 hours so a dressing with a colour alert would provide a fast indication of when a child needs to be returned to clinical care.”