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Bacterial infections are a serious problem for patients with burns and other wounds. Such burn wound infection accounts for the pathogenic bacteria by colonising onto burned areas. Therefore, the need for detection and inhibition of such bacterial colonisation requires a methodology for sensing/killing pathogenic bacteria. This research project aims to design a ‗smart‘ wound dressing system which can respond to the microbiological environment of the wound via a simple colour change and will release antimicrobials only when required. Two strains of pathogenic bacteria Staphylococcus aureus (MSSA 476) and Pseudomonas aeruginosa (PAO1) were used in the study. The non-pathogenic bacterium E.coli (DH5α) was used as a control organism as it does not secrete virulence factors and therefore does not lyse membranes of vesicles. The key contributions of this thesis are outlined below. Firstly, an initial responsive nanocapsule system was studied. The fundamental work with giant unilamellar vesicles proved such a responsive system can provide antimicrobial properties when antimicrobial agents were encapsulated within the vesicles. Secondly, partially polymerised vesicles—polydiacetylene/phospholipid vesicles were then developed to improve vesicle stability. The vesicle system was optimised by varying molar concentration of diacetylene monomers (TCDA) in order to obtain relatively stable vesicles as well as sensitivity to the toxins secreted by the pathogenic strains. Measurements proved that the polydiacetylene/phospholipid vesicles can respond to pathogenic bacteria when fluorescent dye/antimcirobials were encapsulated in the vesicles. Finally, a simple prototype dressing was constructed. Plasma polymerised maleic anhydride (pp-MA) deposited onto non-woven polypropylene was shown to be a good method to stabilise vesicles via covalent bonding. Vesicle adhered to pp-MA non-woven polypropylene showed the ability to inhibit/kill the pathogenic strains, quantified by the Japanese Industry Standard assay and also gave a fluorimetric colour response in the presence of pathogenic bacteria when a fluorescent dye is encapsulated within vesicles. Other simple prototypes were also attempted by using hydrogels (gelatine and collagen) to maintain vesicle stability as well as promote tissue healing.

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No / Nanotechnology can offer new opportunities in the fight against infection. The aim of current work was to investigate an eco-friendly method for synthesis of silver nanoparticles (AgNP) which have the ability to load lipophilic compounds onto their surface. Pharmaceutically acceptable hydrophilic lipid (Gelucire® 50/13) has been used as a reducing agent for in situ reduction of silver nitrate so as to obtain silver nanoparticles. Propolis is used as model molecule for loading onto surface of AgNP owing to its well reported broad range of pharmacological activities including anti-inflammatory, antioxidant and antimicrobial activity. Propolis loaded silver nanoparticles (PLSN) were prepared and characterized for silver content, surface plasmon resonance, particle size, XRD, FTIR, TEM, antibacterial activity and burn wound healing in wistar rats. Propolis constituents were successfully loaded onto surface of AgNP using the proposed conceptual method. The formation of PLSN having size 24.3 ± 2.5 nm was confirmed using surface plasmon resonance, FTIR, XRD and TEM. The combination of propolis with AgNP significantly reduced minimum inhibitory concentration of AgNP alone when tested against Staphylococcus aureus. PLSN gel showed comparable burn wound healing in wistar rats when tested against marketed silver sulfadiazine gel. The use of Gelucire® as solubilizing agent for lipophillic drugs was effectively utilized for loading lipophillic constituents of propolis onto the AgNP. This potentially provides an effective method for the green synthesis of AgNP which can be used to load lipophillic molecules onto their surface whenever such combination is required.

It has been reported by the American Burn Association that 4,000 people die every year due to burn injury. After survival of the initial trauma, the next major obstacle that must be overcome is combating bacterial infection, the primary cause of mortality for burn victims (Chapter 1). The polyacrylate nanoparticle drug delivery system was created to provide a water-based solution for delivery of highly lipophilic antimicrobials; such as N-thiolated β-lactams, however, with the success of this system for these antimicrobials, it was extended towards other, commercially-available water-soluble antimicrobials through acrylation of the drug monomers, including those with observed bacterial resistance (Chapter 2). Various antibiotics were incorporated into this polyacrylate nanoparticle delivery system by either encapsulation or covalent attachment, and the antibacterial activity was determined in vitro (Chapter 3). Since current treatment of burn wound infections calls for numerous antimicrobials in order to combat the vast array of microbes that may be present in the wound, a multi-drug conjugated nanoparticle system was constructed and analyzed for antibacterial activity against many pathogens commonly found in burn wounds (Chapter 4). In vitro antibacterial assays suggest that the nanoparticle delivery system rejuvenated the activity of penicillin-based antibiotics against formerly resistant microbes, such as methicillin-resistant Staphylococcus aureus. The multi-drug conjugated nanoparticle emulsion had the added benefit of forming a drug-conjugated polyacrylate polymer film through air-drying and polymer coalescence. Upon topical application to a skin abrasion in a mouse model, a protective barrier was created over the wound. This film exhibits mechanical properties similar to elastin, a pliant biological material, giving it the elasticity and flexibility required to move and interact with the wound in the same fashion as intact skin (Chapter 5). This film also permits diffusion of essential nutrients and small molecules (such as oxygen and water) required for wound healing. The emulsion was able to be combined with other biological materials, such as collage, to form a biocomposite material expressing the most optimal properties from each constituent (Chapter 6). In vitro cytotoxicity analysis (Chapter 7) and in vivo toxicity studies (Chapter 8) produced positive results indicating that the multi-drug conjugated nanoparticle emulsion is a promising new treatment for the burn wound and other topical skin and soft tissue infections.

Bakteriologinis nudegimo žaizdų tyrimas svarbus nustatant esamus potencialius patogenus, padeda diagnozuoti infekciją, leidžia įvertinti sepsio tikimybę, nustatyti tinkamą laiką žaizdos audinių rekonstrukcijai. Tačiau iki dabar tęsiasi diskusijos, kuris mėginio paėmimo metodas yra optimalus žaizdos mikroflorai arba infekcijai nustatyti. Lietuvoje toks tyrimas iki šiol nebuvo atliktas, o kitų šalių mokslininkų skelbiami rezultatai gana prieštaringi. Atlikto darbo metu tyrėme, kuris bakteriologinio tyrimo metodas (kiekybinis bei pusiau kiekybinis tepinėliai ar biopsija) yra kliniškai vertingiausias žaizdos mikrofloros stebėjimui ligos periodu, infekcijos patvirtinimui atsižvelgiant į klinikinius žaizdos pokyčius. Vienodas bakterijų rūšis tose pačiose žaizdose dažniausiai nustatė biopsija ir pusiau kiekybinis tepinėlis. Šių metodų bendras rezultatų sutapimas buvo labai geras. Abiem metodais nustatomo bakterijų kiekio koreliacija – vidutinė. Tačiau geriausiai rezultatai sutapo žaizdoje esant nedideliam bakterijų kiekiui. Esant klinikiniams žaizdos infekcijos požymiams reikšmingai dažniau bakterijos ir didesnis jų rūšių kiekis nustatytas biopsijos tiriamojoje medžiagoje. Biopsijos metodu reikšmingai dažniau nustatytas labai gausus (>105 KFV) bakterijų kiekis. Nudegimo žaizdų užteršimui bakterijomis stebėti, kai nėra infekcijos požymių, pusiau kiekybinis tepinėlio metodas yra tinkamiausias. Kliniškai nustatytą žaizdos infekciją geriausiai atspindi biopsijos tyrimo rezultatai. / Evaluation of microorganisms in burn wound is important not only in determining potential pathogens present, but also allows diagnosing an infection, evaluating possibility of sepsis, and determining the appropriate time for wound tissue reconstruction. However, there are still many discussions about the optimal wound sample taking method to determine wound microflora or infection, and the opinions about sample taking methods for identification of microorganisms are controversial. We have compared three methods (quantitative swab, semi-quantitative swab, biopsy) and determined significant differences. Similar species of bacteria in the same wounds were most frequently identified by biopsy and the semi-quantitative swab method. The general concordance of the results of these methods was very good. There was a medium correlation of the bacterial amount identified by these methods. However, there was the best concordance of the results in presence of a small amount of bacteria in a wound.In presence of clinical wound infection signs, bacteria and larger number of their species were significantly more frequently identified in the biopsy material. The biopsy method significantly more frequently identified a very large amount (>105 CFU) of bacteria. The semi-quantitative swab method is most appropriate to monitor burn wound contamination with bacteria when there are no infection signs. A clinically determined wound infection was best reflected by the results of biopsy.

The prevalence of antibiotic resistant bacteria has made the choices for topical treatments for patients who experience burns wounds extremely limited. The Staphylococcus genus is naturally occurring in and on the human body but can become harmful once it enters the bloodstream. A novel antimicrobial gel has been shown by our laboratory to inhibit both the planktonic growth and biofilm formation of Staphylococcus aureus in previous studies. The antimicrobial gel is made of seven natural compounds including antioxidants (vitamin C and E). We wanted to examine the effects of the antimicrobial gel on numerous other Staphylococcal species because it is prevalent on the body and becomes harmful when the immune system is compromised. The species tested were Staphylococcus capitis, Staphylococcus epidermidis, and Staphylococcus saprophyticus. A planktonic broth challenge test, biofilm attachment test, and biofilm maturation test were all performed in order to test this hypothesis. These tests showed a significant inhibition of the Staphylococcus species as a result of the effects of the antimicrobial gel. The antimicrobial gel inhibited the attachment, maturation, and growth of Staphylococcus colonies in a 10% antimicrobial gel solution. The antimicrobial gel shows promise as an option in treating burn patients and should be considered in further testing for its uses in other areas of medicine.

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Bakgrund: Omläggning av brännskador är förenat med stort lidande för patienten i form av smärta och ångest. Det finns forskning som belyser enskilda strategier för att lindra detta lidande men det saknas forskning som sammanställer strategierna.    Syfte: Uppsatsens syfte var att sammanställa och värdera olika strategier, som kan användas av specialistsjuksköterskan inom intensivvård, för att lindra smärta och ångest hos brännskadade patienter vid såromläggning.  Metod: Uppsatsen var en deskriptiv litteraturöversikt som inkluderade 20 kvantitativa artiklar. Artikelgranskningen utfördes med hjälp av mallar från SBU och GRADE. Katie Erikssons teori om lidande var uppsatsens teoretiska utgångspunkt.    Resultat: I resultatet framkom olika kategorier för lindring av smärta, ångest och smärtrelaterad ångest vid omläggning av brännskador. Dessa var komplementära och medicinska strategier. Komplementära strategier var den kategori som visade på störst potential att minska smärta, ångest och smärtrelaterad ångest.   Slutsats: Komplementära och vissa medicinska strategier lindrar signifikant lidande i kombination med opioider och uppnår största möjliga lindring när den upprepas flera dagar i följd. För att lindra lidande vid omläggning av brännskador behöver specialistsjuksköterskan inom intensivvård anpassa vården efter patientens behov och önskemål. / Background: Burn wound dressing is associated with great suffering for the patient in the form of pain and anxiety. There is research that investigates strategies to alleviate this suffering, however there is a lack of research compiles these strategies.   Purpose: The purpose of the essay was to compile and evaluate different strategies, which can be used by specialist nurses in intensive care to relieve pain and anxiety in burn patients during wound dressing.   Method: The essay was a descriptive literature review that included 20 quantitative articles. Article review was performed using templates from SBU and GRADE. Katie Eriksson’s theory of suffering was the essay’s theoretical outset.   Results: Different categories for the relief of pain, anxiety and pain-related anxiety during dressing change of burn wounds emerged. These were complementary and medicinal strategies. Complementary strategies was the category that showed the greatest potential to reduce pain, anxiety and pain-related anxiety.   Conclusion: Complementary and certain medical strategies significantly alleviate suffering in combination with opioids and achieve the greatest possible relief when repeated over several consecutive days. In order to alleviate suffering when performing dressing changes of burn wounds, the specialist nurse in intensive care needs to adapt the care to the patient's needs and wishes.

No description available.