Interviews with experts

Interviewing Laura Jakobsen

Do you see our product usable for patients with burns?

“With a bit of change, the product could become useful.”

What kind of wishes have you had earlier for a useful product to burn patients?

“A better handling of the liquid production of the wound, that is often a major problem in the first week after the accident (includes first and second degree burns).”

According to you, is it a type of product that should be focused more on, even though the number of burn patients is decreasing?

“Yes, there is always a need to develop a better, cheaper and more patient friendly bandage.”

Could you imagine our product being used for a different condition or type of wound?

“It could be used as a bandage after surgery in the inguinal region. It is often a quite problematic healing region due to the serum that can create pressure and tighten the region. Serum tapping is a passage for infection every time tapping is made. It is a region of contamination due to tight bandage, patients can not avoid to create pressure on the wound (when they sit), often very moist region (due to sweat) and many more challenges are encountered with diabetics, smoking and overweight patients.”

Should there be added anything to our product so it could be more effective or making the burn treatment easier?

“ A better fluid handling.”

Have you ever encountered resistant bacteria in your working department of the hospital? What measurements have been taken into account to treat these patients?

“Yes, and many different kinds of them. Isolation, protection, hand hygiene and antibiotic treatment after current guidelines for every kind of bacteria, are being followed.”

Can you see a potential in covering the silk in lidocain* to reduce the amount of pain burn patients have to go through? Are there any cons in giving this (today patients who come in to get their bandage removed and gets fibrin** scratched off are not receiving any kind of pain killer)? Can anything be done to get the bandage easier off when it has to be changed after the first couple of days (this type of wound is typically very wet the first couple of days after the injury)?

“Typically, the caregivers recommend the patient to take pain killers (paracetamol and ibumetin, and sometimes morphine preparates) approximately an hour before changing the bandage to reduce any kind of discomfort if the bandage should grab or got stucked in some skin. It could be a possibility to cover the silk with for example Ibumetin (NSAID-preparate), so you could kill the pain locally and avoid the side effects which Ibumetin can have (such as increased stomach acid production, blood thinner effect and much more), or could expand the movement and not prevent limitation of movement under rehabilitation of for example fingers. If the patient is hospitalized, the bandage will be washed off with lukewarm water mixed with NaCl (commonly known as salt). This can not be done in the ambulance or elsewhere due to the time and the space that is needed for this kind of treatment. When the wound is kept moist it increases the movement and the flexibility of the surrounding skin/new skin. The pain is minimized because the skin is not as tight and the bandage will not grab skin.”

Footnote

*Lidocain:is a local analgesic widely used in ambulatory surgeries in Denmark.

**Fibrin: is created in the body under the healing process of a wound. Fibrin and granulation has to be present for an effective healing of the wound. If there is only fibrin when healing, the healing process stops. It is therefore important to ensure that the excess of fibrin is scratched off (often made by a nurse or a doctor).

Interviewing Hans Jørn Kolmos

From your point of view, how big is the resistance problem?

He believes that it is an increasing problem, but it should not be the cause of any panic yet. New strategies should be devolved in the use of antibiotics so the increase in antibiotic resistance becomes limited. Antibiotics should not be used to treat infections that we do not know the cause of. Instead a more careful approach in the distribution should be taken. He suggested a simple approach to this issue: three simple steps should undertaken before giving an antibiotic treatment to an infection. First step is to isolate the bacteria. This can be done by evaluating the microorganisms species, its concentration and the origin of isolation. The second step is to conclude whether the isolated microorganism is the cause of infection. This can be done in association with e.g. a prosthesis where an infection has occurred. The third step is to evaluate whether antibiotics can be used against the infection. If the infection occurred in a prosthesis, the bacteria would most likely develop a biofilm. If treated with antibiotics, the infectious bacteria will only be exposed to small concentrations of antibiotics and this will provide time to develop resistance. Under these circumstances, the prosthesis should be removed before given any form of treatment. We should be more retained with the use of antibiotics.

“Nature is smart. Humans have only been here for a few millenniums and microorganisms have been here for billions of years. It would be foolish to believe that we could outsmart nature in only 100 years.” - Hans Jørn Kolmos

Does the media highlight antibiotic resistance as a bigger problem than it actually is?

A documentary in danish television called: “When Penicillin doesn’t work anymore.” says that the resistance problem is huge. The documentary shows families experiencing MRSA, and how health care deal with the problem. We asked Mr. Kolmos if the media makes a bigger problem out of it, that it is? He replied that: No, the documentary gave a realistic perspective of the problem.

Is there any possibility that we could face a dead end in functional antibiotics if we keep the distribution to this level?

Mr. Kolmos stated there is a potential risk for a multiresistant bacteria. If we kept using antibiotics like we do today, we could potentially get a resistant bacteria, that we could not kill with any of our antibiotic resources.

Are there any cases with patients that could not be treated because of an infection caused by multiresistant bacteria?

Mr. Kolmos told us that under the civil war in Libya, the country did not have the resources to treat all the wounded soldiers. Therefore some of them were sent to Denmark. As we treated them, we observed very odd sorts of infections that are not common in Denmark. There were bacterias with other types of resistance than the ones the doctors knew about. The worst were the Gram-negative, ESBL (Extented-Epectrum Beta-lactamase).

He also estimated 30 % of the population are carrier of S.aureus, of these 1-2 % are MRSA. The resistance problem is not just a problem on the hospitals. It is also a part of political debates.

Is there any precautions, the ordinary family can contribute with?

He told us that people could get checked if they were carrier of MRSA. S.aureus is often found in human nostrils, but if the patient got in contact with the MRSA bacteria, it could outperform the normal flora. The patient would now be a carrier. The MRSA bacteria can be killed by use of antibiotics, but an ordinary family should also take precautions. “Wash your hands, do not sneeze on people, and just be clever about bacteria and how it spreads” - quote Hans Jørn Kolmos.

What is the biggest cause to MRSA?

It is hard to isolate a single source that contributes to the development of MRSA, but we know it is a combination of the farming industry and antibiotic distribution.

The media has a tendency to blame the pigs for MRSA. It is actually estimated that only 40% of all pigs are carriers.

What antibiotics are used to treat MRSA:CC398, MRSA:USA300 and VISA(Vancomycin-intermediate-S. Aureus)?

Tough question, but Vancomycin can treat both the MRSA:CC398 and MRSA:USA300.

Can you see any potential in our project?

It could be a part of a treatment, but it could also be nice to test the bacteriocins on gram-negative bacteria. Bacteriocins could also be used for oral treatment, eg. in the nose, were MRSA is normally found on carriers.

Interviewing PHB companies

Each company was asked the following questions:

• Do you have any specific attitudes towards sustainability?
• Would you want to work with plastic which have been produced by bacteria?
• Do you know the plastic PHA, or poly-beta-hydroxybutyrate (PHB)?
• If the price of biodegradable plastic was considerably lower than it is as its present), would you then as a company have any interest in this? (it cost 4 times as much to produce at the moment
• Would you be able to incorporate such a product in your business?

The companies which responded:

• Agstrup Plast ApS
• AMP (Advisory Manufacturing Polymer) A/S
• AMU SYD
• Fast Plast A/S
• Bogense Plast A/S
• DAMVIG Develop A/S
• HN Group A/S
• Letbæk Plast A/S
• Malte Haaning Plastic A/S
• Martin Høft A/S
• MiM Plast A/S
• Ossi Connectors A/S
• RPC Superfos A/S
• Schoeller-Plast-Enterprise A/S
• SP Medical A/S