Think Plastic Wrap as Wound Dressing for Thermal Burns

ACEP News
August 2008

By Patrice Wendling
Elsevier Global Medical News

CHICAGO - Ordinary household plastic wrap makes an excellent, biologically safe wound dressing for patients with thermal burns en route to the emergency department or burn unit.

The Burn Treatment Center at the University of Iowa Hospitals and Clinics, Iowa City, has advocated prehospital and first-aid use of ordinary plastic wrap or cling film on burn wounds for almost two decades with very positive results, Edwin Clopton, a paramedic and ED technician, explained during a poster session at the annual meeting of the American Burn Association.

"Virtually every ambulance in Iowa has a roll of plastic wrap in the back," Mr. Clopton said in an interview. "We just wanted to get the word out about the success we've had using plastic wrap for burn wounds," he said.

Dr. G. Patrick Kealey, newly appointed ABA president and director of emergency general surgery at the University of Iowa Hospital and Clinics, said in an interview that plastic wrap reduces pain, wound contamination, and fluid losses. Furthermore, it's inexpensive, widely available, nontoxic, and transparent, which allows for wound monitoring without dressing removal.

"I can't recall a single incident of its causing trouble for the patients," Dr. Kealey said. "We started using it as an answer to the problem of how to create a field dressing that met those criteria. I suppose that the use of plastic wrap has spread from here out to the rest of our referral base."

Although protocols vary between different localities, plastic wrap is typically used for partial- and full-thickness thermal burns, but not superficial or chemical burns. It is applied in a single layer directly to the wound surface without ointment or dressing under the plastic and then secured loosely with roller gauze, as needed.

Because plastic wrap is extruded at temperatures in excess of 150° C, it is sterile as manufactured and handled in such a way that there is minimal opportunity for contamination before it is unrolled for use, said Mr. Clopton of the emergency care unit at Mercy Hospital, Iowa City. However, it's best to unwind and discard the outermost layer of plastic from the roll to expose a clean surface.

To assess concerns about sterility, Mr. Clopton and his associates at the University of Iowa obtained samples of plastic wrap from 5 newly opened rolls and 13 rolls that were already in use. Two samples - one taken from the already exposed outer layer and one from a freshly unrolled surface - were taken from each roll, pressed against the surface of a blood agar culture plate, and incubated at a temperature of 35° C.

After 48 hours of incubation, 14 (39%) of the 36 samples showed no bacterial growth and 29 (81%) of the 36 samples grew 3 or fewer colonies. No growth was observed on freshly unrolled surfaces in 4 of the 5 new rolls and in 7 of the 13 rolls already in use, Mr. Clopton reported in the poster.

Contaminating organisms that were identified in the culture plates were typical of the flora normally found on human skin. The organisms included Bacillus (which were identified on seven samples), Enterobacter (two samples), Micrococcus (seven samples), and Staphylococcus (four samples).

"Plastic wrap is sufficiently clean for first-aid and prehospital use to dress burn wounds that will promptly receive medical attention, especially if freshly exposed film is used," he wrote.

Concerns have been expressed about the toxicity of certain plasticizers, especially diethylhexyl phthalate (DEHP), used in toys and medical equipment, and formerly in food packaging. DEHP is no longer used in food packaging in the United States.

Moreover, because a patient's exposure to plasticizers from a wound dressing usually is only for a brief period of time, lasting a few hours at most, Mr. Clopton suggested that plasticizer toxicity is of minimal concern.

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