scholarly journals Decrease in MRSA Bacteremia After Implementation of Intranasal Mupirocin Decolonization Protocol

2021 ◽  
Vol 1 (S1) ◽  
pp. s58-s58
Author(s):  
Angela Beatriz Cruz ◽  
Jennifer LeRose ◽  
Teena Chopra ◽  
Mara Cranis ◽  
Lori Cullen ◽  
...  
Keyword(s):  
Total Body Surface Area ◽  
Skin Barrier ◽  
Patient Characteristics ◽  
Burn Victims ◽  
Medical Chart Review ◽  
Burn Surgery ◽  
Intranasal Mupirocin ◽  
Total Body ◽  
Hospital Acquired

Background: Methicillin-resistant Staphylococcus aureus (MRSA) remains a key pathogen in burn patients and is associated with increased morbidity and mortality. Disruption of skin barrier exposes these individuals to a myriad of infections. Various decolonization approaches, including chlorhexidine baths and intranasal mupirocin, have shown favorable outcomes in preventing MRSA infections in this cohort. Methods: In August 2020, a mupirocin decolonization protocol was implemented in Michigan’s largest trauma-level 1 burn intensive care unit. All patients admitted to the burn unit received daily intranasal mupirocin for the initial 5 days of hospitalization. We compared MRSA bacteremia rates per 1,000 patient days from January–July 2020 to those after August 2020. A hospital-acquired MRSA bacteremia infection was defined as a positive blood culture after hospital day 3. Patient characteristics and hospital course were collected through medical chart review. A 2-tailed t test was used for analysis. Results: We identified 5 cases of hospital-onset MRSA bacteremia and no cases of community-onset MRSA bacteremia. On average, there were 2.6 cases per 1,000 patient days before mupirocin implementation and 1.0 cases per 1,000 patient days after mupirocin implementation (P = .26) (Figure 1). In this patient cohort, the average total body surface area burned was 45.6% (range, 18%–90%), and 60% (n = 3) of patients had sputum culture positive for MRSA prior to developing bacteremia (Table 1). Also, 2 patients (40%) with MRSA bacteremia died. Notably, the patient in the postintervention cohort was admitted in July, prior to implementation. Conclusions: Implementation of a decolonization protocol with intranasal mupirocin in burn-surgery patients markedly decreased the incidence of MRSA bacteremia in this cohort. This is the first study to evaluate the use of mupirocin as a decolonizing agent in burn victims. Continued long-term surveillance is recommended, and this strategy has potential for application to other high-risk cohorts.Funding: NoDisclosures: None

112 Outbreak of Carbapenemase-Producing Enterobacteriaceae in a Regional Burn Centre

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S75-S75
Author(s):  
Sarah Rehou ◽  
Sydney Rotman ◽  
Melisa Avaness ◽  
Marc G Jeschke ◽  
Shahriar Shahrokhi
Keyword(s):  
Infection Control ◽  
Total Body Surface Area ◽  
Skin Barrier ◽  
Control Measures ◽  
Infection Prevention And Control ◽  
Environmental Cleaning ◽  
Infection Control Measures ◽  
Potential Source ◽  
Total Body ◽  
Hospital Acquired

Abstract Introduction Antimicrobial resistance is an increasing problem in hospitals worldwide, though the prevalence of carbapenemase-producing Enterobacteriaceae (CPE) in our region is low. Burn patients are among the most vulnerable to infection because of the loss of the protective skin barrier. Because of this, burn centres prioritize infection prevention and control with measures like additional precautions, enhanced environmental cleaning, dedicated facilities, and mandatory use of personal protective equipment (PPE). Methods This report describes a CPE outbreak in a regional burn centre. We hypothesized that contamination of in-room hand hygiene sinks with CPE was a potential source of transmission. In a period of 2.5 months, four nosocomial cases of CPE were identified, three containing the KPC gene and one VIM gene. There was more than one month between the first and second KPC case, with no overlap in patient stay or rooms. Results The first two cases were identified while there was no CPE patient source on the unit. CPE KPC gene was isolated in sink drains of three different rooms. In addition to the rigorous infection control practices already in place due to the unique patient population, additional outbreak control measures were implemented. The burn centre restricted admissions to complex burns or burns >10% total body surface area, in consultation with the attending surgeon. No elective admissions were permitted. To avoid CPE exposure to new patients, initial admissions were rerouted to the emergency department and, if possible, the patient was admitted to another unit. Patient cohorting was implemented through nursing team separation for CPE positive and negative patients and geographical separation of CPE positive cases to one side of the unit. Conclusions Despite aggressive infection control measures already in place at our burn centre, there was hospital acquired CPE colonization/infection. Given there was CPE acquisition when there was no positive patients on the unit and CPE contaminated sinks of the same enzyme were identified, it suggests that hospital sink drains can become a potential source of CPE.

scholarly journals Initial assessment of mortality rates of burn patients in a tertiary care hospital by total body surface area, depth and facial burns, and its correlation with serial total leucocyte count

2020 ◽  
Vol 7 (10) ◽  
pp. 3280
Author(s):  
Kavitha Jayanthi Balachandran ◽  
Manoj Kumar Nirmalanandan
Keyword(s):  
Surface Area ◽  
Body Surface ◽  
Leucocyte Count ◽  
Total Body Surface Area ◽  
Total Leucocyte Count ◽  
Burn Victims ◽  
Facial Burns ◽  
Inhalational Injury ◽  
Total Body ◽  
Wbc Count

Background: The pattern of burns in victims varies with the manner of infliction of burns. Age plays an important role in deciding the mortality and morbidity of burn victims. Other factors that decide the prognosis of burn victims are the total body surface area (TBSA), Depth of burns, and inhalational injury as evidenced by facial burns. Assessment of these epidemiological factors and inhalational injury can be done as a part of the initial evaluation. Such an assessment aid in resuscitation including emergent airway and decision making regarding the need for skin grafts or escharotomy. Serial measurement of total leucocyte count also helps in identifying the onset of infection and progress to septicaemia and increased mortality rates.Methods: As a part of the initial evaluation, we attempt to study the relation between TBSA, Depth of burns, facial burns, and total WBC count with mortality. A background of septicaemia was also noticed in the majority of patients.Results: For analysis, patients were divided into two groups- Survivors and Non-survivors. A fall in total WBC count coincided with the onset of sepsis and mortality. The other three factors also had a direct correlation with mortality rates.Conclusions: A scoring system constituting all the factors is essential as an initial diagnostic step and it will help in deciding early intubation, escharotomy, and aggressive fluid resuscitation.

564 Managing California’s Creek Fire Mass Casualty’s Incident

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S132-S132
Author(s):  
Shana M Henry ◽  
Nicole M Kopari ◽  
Mary Wolfe
Keyword(s):  
Operating Room ◽  
Disaster Response ◽  
Total Body Surface Area ◽  
Burn Patients ◽  
Rescue Operation ◽  
Burn Victims ◽  
Burn Center ◽  
Response Planning ◽  
Response Team ◽  
Total Body

Abstract Introduction California’s Creek Fire is not only the largest single wildfire in a state known for huge and destructive blazes, it spawned two rare fire tornados with winds over 100mph, a day after the fire started in early September. Huntington Lake and Mammoth Pool were the sites of these rare events leading to hundreds of trapped campers. An air rescue operation airlifted hundreds of trapped people to safety. Twenty days after the start of the fire, it had burned >300,000 acres with only 36% containment by fire crews. This review is an evaluation of our hospitals response team and the events surrounding that night. Methods Our on-call surgeon had called in the back-up surgeon to run a second trauma operating room. It was at this time, the news had reported trapped campers near Mammoth Pool. The burn surgeon was notified and reported to the emergency department (ED) as word of 65 possible victims spread. Local disaster response planning was initiated with an ED physician triaging patients at the regional airport. Initial calls were made to the division chief and burn medical director. The nursing director was notified along with any available nursing staff with 8 ICU nurses volunteering to report. Immediately, lateral transfer orders were placed for all burn patients housed in the burn center which has 10 ICU bed capabilities. Results The first helicopter landed with 5 of the burn victims presenting to our hospital. 4 of the victims were male and 1 female with ages ranging from 17 to 27. Total body surface area burn was estimated on each with 2 minor burns < 10% and 3 moderate sized burns of roughly 25%. These patients were quickly triaged in the ED and traumatic injuries evaluated. 3 of the patients were placed in ICU level care with the 2 remaining patients housed in the ED as word trickled in about another rescue effort with an additional 95 people. By morning, an additional 2 patients were transferred to our burn center from the surrounding hospitals and another 2 patients evaluated for burns sustained in separate events. All patients were taken to the operating room over the next 24–48 hours for excision and autologous spray on skin cells (ASCS) in combination with widely meshed skin grafts or ASCS alone. Conclusions Communication, teamwork, and personnel that are dedicated to the care of burn patients made this tragic incident manageable. The Creek Fire hit home for many of the burn staff not only because of the patients that were cared for, but because this area of California was a beloved respite for many. A debriefing with a chaplain, grief counselor, and psychotherapist, was held within 2 weeks of the incident to provide support to the staff during this devastating time.

Epidemiology and Management of Pediatric Head and Neck Burns: An Institutional Review

2020 ◽  
pp. 000313482095282
Author(s):  
Tyler K. Merceron ◽  
Rachael Y. Williams ◽  
Walter L. Ingram ◽  
Shelly Abramowicz
Keyword(s):  
Head And Neck ◽  
Average Length ◽  
Demographic Data ◽  
Total Body Surface Area ◽  
Acute Setting ◽  
Average Length Of Stay ◽  
Institutional Review ◽  
Total Body ◽  
Head Neck

Background Pediatric head and neck burns (HNBs) require special attention due to the potential for long-term disfigurement, functional impairment, and psychosocial stigma. Methods We performed a retrospective review of patients <18 years old admitted to Grady Memorial Hospital with a diagnosis of HNB from 2009-2017. Demographic data, burn characteristics, management, and hospital course were analyzed. Results Of the 272 patients included, 65.4% were male with a mean age of 63.2 months. Burn mechanism was primarily secondary to scalding liquids (70.2%) or flames (23.9%). The average total body surface area involved was 10.3%, and 3.0% for the head/neck. Average length of stay was 5.2 days and overall mortality was 1.1%. Twenty-five patients (9.2%) required surgery in the acute setting, and 5 (1.8%) required secondary surgery for hypertrophic scarring or contracture. Discussion Pediatric HNBs occur most commonly in males <6 years old secondary to scalding liquids or open flames. Most patients can be managed nonoperatively without long-term sequelae.

scholarly journals Relationship Between Patient Characteristics and Number of Procedures as well as Length of Stay for Patients Surviving Severe Burn Injuries: Analysis of the American Burn Association National Burn Repository

2020 ◽  
Vol 41 (5) ◽  
pp. 1037-1044 ◽  
Author(s):  
Eliza Kruger ◽  
Stacey Kowal ◽  
S Pinar Bilir ◽  
Eileen Han ◽  
Kevin Foster
Keyword(s):  
Length Of Stay ◽  
Total Body Surface Area ◽  
Patient Characteristics ◽  
The United States ◽  
Ordinary Least Squares ◽  
Inhalation Injury ◽  
Regression Methods ◽  
Diabetes Status ◽  
Total Body ◽  
The One

Abstract This study establishes important, national benchmarks for burn centers to assess length of stay (LOS) and number of procedures across patient profiles. We examined the relationship between patient characteristics such as age and total body surface area (TBSA) burned and number of procedures and LOS in the United States, using the American Burn Association National Burn Repository (NBR) database version 8.0 (2002–2011). Among 21,175 surviving burn patients (TBSA &gt; 10–60%), mean age was 33 years, and mean injury size was 19.9% TBSA. Outcomes included the number of debridement, excision, autograft procedures, and LOS. Independent variables considered were: age (linear, squared, and cubed to account for nonlinearity), TBSA, TBSAs of partial-thickness and mixed/full-thickness burns, sex, hospital-acquired infection, other infection, inhalation injury, and diabetes status. Regression methods included a mixed-effects model for LOS and ordinary least squares for number of procedures. A backward stepwise procedure (P &lt;0.2) was used to select variables. Number of excision and autografting procedures increased with TBSA; however, this relationship did not hold for debridement. After adjusting for sex, age, and comorbidities, predicted LOS for adults (18+) was 12.1, 21.7, 32.2, 43.7, and 56.1 days for 10, 20, 30, 40, and 50% TBSA, respectively. Similarly, predicted LOS for pediatrics (age &lt; 18) was 8.1, 18.8, 33.2, 47.6, and 56.1 days for the same TBSA groups, respectively. While average estimates for adults (1.12 days) and pediatrics (1.01) are close to the one day/TBSA rule-of-thumb, consideration of other important patient and burn features in the NBR can better refine predictions for LOS.

scholarly journals Biopsychosocial factors that interfere in the rehabilitation of burn victims: integrative literature review

2011 ◽  
Vol 19 (3) ◽  
pp. 622-630 ◽  
Author(s):  
Natália Gonçalves ◽  
Maria Elena Echevarría-Guanilo ◽  
Fernanda de Loureiro de Carvalho ◽  
Adriana Inocenti Miasso ◽  
Lidia Aparecida Rossi
Keyword(s):  
Literature Review ◽  
Total Body Surface Area ◽  
Health State ◽  
Rehabilitation Process ◽  
Social Reintegration ◽  
Burn Victims ◽  
The Social ◽  
Knowledge Area ◽  
Total Body

This study aimed to identify the biopsychosocial factors that influence the rehabilitation of burn victims, through an integrative literature review, from January 1987 to January 2007. Articles were searched in databases Scielo, Pubmed and Lilacs, resulting in 982 articles, of which 45 were selected, after the analysis and categorization processes. Most studies were descriptive and qualitative. The most frequently associated factors to the rehabilitation process were: mental health state before the accident, coping strategies and family support, besides the severity of the burn and the total body surface area burned. The quality of the selected studies, most classified as evidence level VI, shows the scarce production of strong evidences in this knowledge area, which needs more investment, considering the important implications of the sequelae of burns in the social reintegration of these people.

57 Safety and Cost Effectiveness of Outpatient Surgery in Acute Burn Care

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S41-S41
Author(s):  
Zach Z Zhang ◽  
Andrew Golin ◽  
Anthony Papp
Keyword(s):  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
Outpatient Surgery ◽  
Graft Loss ◽  
Total Body Surface Area ◽  
Split Thickness Skin Graft ◽  
Burn Care ◽  
Burn Surgery ◽  
Total Body

Abstract Introduction Outpatient burn surgery is increasingly utilized for delivery of acute burn care. Reports of its safety and efficacy are limited. The purpose of our study was to evaluate the safety and cost reduction associated with outpatient burn surgery and to describe our centre’s experience. Methods This was a single centre, retrospective cohort study of consecutive patients who underwent outpatient acute burn surgery requiring split thickness skin graft or dermal regenerative template from January 2010 - December 2018. Patients with insufficient follow up to evaluate operative site healing were excluded. Patient demographics, comorbidities, burn etiologies, operative data and postoperative care were reviewed. The primary outcome is complication involving major graft loss requiring reoperation. Results 165 patients and 173 procedures met the inclusion criteria. The average age was 44 years and 60.6% (100/165) were male. The number of annual outpatient procedures increased 48% from 23 to 34 cases over the 9-year period. The mean grafted total body surface area was 1.0 ± 0.9%. Rate of major graft loss requiring reoperation was 5.2% (9/172). Greater than 95% graft take was achieved in 80.9% of patients. Age, sex, co-morbidities, total body surface area, and procedure types were not significantly associated with postoperative complication rate. Outpatient burn surgery model was estimated to save CA$7,875 per patient from inpatient costs. This extrapolates to a total of over CA$1.36 million in savings over the 9-year study period. Conclusions Acute burn care at our centre is increasingly being delivered through an outpatient day surgery model. Our demonstration of its safety and considerable cost savings is compelling for further utilization. Our experience found the adoption of improved dressing care, appropriate patient selection, increased patient education, adequate pain control, and regimented outpatient multidisciplinary care to be fundamental for effective outpatient surgical burn care.

scholarly journals Acute Management of Deep Facial Burns

Folia Medica ◽  
2021 ◽  
Vol 63 (6) ◽  
pp. 847-857
Author(s):  
Katia I. Kalinova ◽  
Ralitsa D. Raycheva ◽  
Neli Petrova ◽  
Petar A. Uchikov
Keyword(s):  
Surgical Approach ◽  
Demographic Data ◽  
Total Body Surface Area ◽  
Length Of Hospital Stay ◽  
Acute Management ◽  
Late Sequelae ◽  
Medical Chart Review ◽  
Facial Burns ◽  
Total Body

Introduction: Management of deep facial burns is a serious challenge for many reasons: a considerable anatomic and functional diversity is concentrated in a small space, a uniform treatment does not exist, late sequelae are frequent and may be severe, and the literature on the subject is ambiguous. Aim: To analyse management of deep facial burns. Patients and methods: A retrospective medical chart review was conducted for 569 patients with deep facial burns hospitalized between January 2005 and January 2015. Demographic data, type, depth and size of burns, chronology and type of surgical treatment, length of hospital stay, and type and incidence of late sequelae were analysed and compared. Results: Over 10 years, 596 patients with deep facial burns, 216 (36.24%) females and 380 (63.76%) males, aged from 5 months to 95 years (mean 39.5&plusmn;26 years) were treated. The most common burn agents were hot liquids and flames. The mean total body surface area (TBSA) burned was 17&plusmn;13.3%. Concomitant eye injury was detected in 63 (10.6%) patients. Priority was given to the early, meticulous, staged surgical approach aimed at sparing the survived tissues and rapid wound closure. Follow-up ranged from 3 months to 5 years. Late functional sequelae were documented for 50 (8.38%) patients and ocular sequelae - for 33 (5.54%) of them. There was no incidence of secondary corneal perforation or definitive loss of vision. Conclusions: Adequate and up-to-date acute management of deep facial burns based on early, judicious, surgical approach could limit initial damage and reduce late sequelae.

40 Wildfire Burn Victims: A Unique Population

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S30-S31
Author(s):  
Sarah C Stokes ◽  
Kathleen S Romanowski ◽  
Soman Sen ◽  
David G Greenhalgh ◽  
Tina L Palmieri
Keyword(s):  
Wound Care ◽  
Total Body Surface Area ◽  
Wound Infections ◽  
Gram Positive ◽  
Burn Victims ◽  
Burn Center ◽  
Populations At Risk ◽  
Increased Risk ◽  
Hospital Systems ◽  
Total Body

Abstract Introduction In the past ten years, wildfires have burned an average of 6.8 million acres annually. The frequency of wildfires is expected to increase with climate change. Wildfire burn victims have not been previously well characterized in the literature. As we prepare for more wildfires it is necessary to target populations at risk for sustaining burns with prevention efforts and to prepare hospital systems to meet these patients’ needs. Methods A retrospective review of patients admitted to a burn center between 2016 and 2019 was performed. Patients who were admitted after sustaining a burn attributable to wildfires were identified from the burn center database. Controls were matched to wildfire burn patients by age, gender and total body surface area of burn. The primary outcome was mortality. Secondary outcomes included number of operations, length of stay (LOS), intensive care unit (ICU) LOS, development of wound infections and pneumonia, wound culture microbiology. Results A total of 16 patients who had sustained burns in wildfires were identified and matched with 32 controls. There was no difference in mortality (19% wildfire vs. 9% non, p=0.386), LOS (18 days wildfire vs. 15 days non-wildfire, p=0.406), ICU LOS (17 days wildfire vs. 11 days non-wildfire, p=0.991) and number of skin grafts (1 wildfire vs. 0.5 non-wildfire, p=0.519). Patients who had sustained burns in a wildfire trended towards higher rates of pneumonia (31% wildfire vs. 13% non-wildfire, p=0.117), and higher rates of wound infection (31% wildfire vs. 19% non-wildfire, p=0.361). On evaluation of wound cultures for the 5 wildfire patients and the 7 non-wildfire patients who developed wound infections, more patients who sustained burns in wildfires had gram positive bacteria cultured from their wounds (100% wildfire vs. 29% non-wildfire, p=0.027). Patients who had sustained burns in wildfires trended towards increased likelihood of readmission (23% wildfire vs. 3% non-wildfire, p=0.080). Conclusions Patients who sustain burns in wildfires are likely at increased risk of readmission, of developing pneumonia and of developing gram-positive wound infections. Interventions for these patients should focus on pneumonia prevention and assistance with wound care after discharge.

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