Antiseptic and aseptic prophylaxis for burns: use of silver nitrate and of isolators.

Local applications of neomycin, chlorhexidine, and polymyxin have been shown in controlled trials to protect burns against colonization by various pathogens, including Pseudomonas aeruginosa and Staphylococcus aureus (Cason and Lowbury, 1960; Lowbury, Miller, Cason, and Jackson, 1962b) ; earlier studies had shown the effectiveness of polymyxin cream in prophylaxis against Ps. aeruginosa (Jackson, Lowbury, and Topley, 1951). Though clinically useful, these prophylactic effects were limited, especially in the more extensive burns, and the emergence of neomycin-resistant Staph. aureus reduced their value (Lowbury, Babb, Brown, and Collins, 1964). The search for more effective methods was therefore continued. Silver nitrate was formerly used on burns to accelerate the formation of dry slough (Bettman, 1936 ; Kalt, 1851). Recently Moyer, Brentano, Gravens, Margraf, and Monafo (1965) reported very successful results of treatment for extensive burns by application of compresses soaked in 0.5% silver nitrate solution ; the method was claimed to prevent infection by various pathogens, including Ps. aeruginosa, which is widely recognized as a primary cause of death in extensively burned patients. In the same year Lindberg, Moncrief, Switzer, Order, and Mills (1965) reported a comparable control of wound sepsis by the local application of a cream containing 10% p-aminomethylbenzene sulphonamide (Sulfamylon). Another approach in the control of infection has been the