595 The COVID Effect: Exploring the Impact of Coronavirus on an Academic Burn Center

Abstract Introduction Globally, medical centers have faced unprecedented times with the onset of the Novel Coronavirus pandemic. Emergency departments (ED) and burn units have had to adapt to uncertainty and new challenges. At our institution, we had to alter our daily burn practice, physically moving our burn unit to our surgical intensive care unit to accommodate staff cohorting. While some hospitals have seen patient surges, most have endured dramatic decreases in productivity. A UK burn unit documented lower ED presentations and reduced referrals from other centers, with 50% fewer patients admitted to their burns ward (Farroha). In Israel, a 66% decrease in adult burn patients was noted (Kruchevska et al.). We sought to identify the impact of COVID-19 on burn injury epidemiology in our burn unit based in a large, urban, academic medical center. Methods We conducted a retrospective review of our burn database for ED visits and admissions related to burn injuries between March 1st and June 30th in the years 2017, 2018, 2019, and 2020. We looked at the age and sex of patient, type of visit, length of stay (LOS), the mechanism of injury, the setting in which injury occurred, and the details of the injury. We compare annual trends, with emphasis on comparison of 2020 to previous years. Results From admissions and ED data records, 215 patient encounters were reviewed. We saw a yearly rise in total burn patients seen in the ED or admitted to our burn unit 2017–2020 (39, 43, 63, and 70 respectively) with the highest volume of patients in 2020. Mean patient age ranged from 45 (2020) to 51 (2017). More males were burned in all years (male:female ratio 3.9 in 2017, 2.1 in 2018, 2.5 in 2019, 1.9 in 2020). Median LOS in 2020 was 2.5 days, consistent with 2017–2019 values (2, 3, 3, respectively). Between 2017 and 2019, 10%, 2%, and 8% respectively of patients evaluated were treated on an outpatient basis, while in 2020, 20% were outpatient. Rates of flash, scald, flame, chemical, electrical, and contact burns were stable over the period. Of those patients who were admitted, 1.8% sustained work-related burns in 2020 versus 8.9% over 2017–2019. In 2020, 23% of burns were cooking related versus 18% over the prior 3 years. Conclusions Despite documented decreased burn admissions in some units, our unit saw an increase in burn injuries presenting for evaluation in the first 3 months of the COVID-19 pandemic as compared to the analogous period in the three years prior. Burns were less often tied to work-related incidents and more frequently related to cooking injuries. Even with more patients treated and released from the ED, inpatient admission numbers were maintained. These findings support the importance of protecting our staffing and burn unit resources in a pandemic setting in order to appropriately treat regional patients and an increase in home-based injuries.

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11 Vitamin D Deficiency on Admission and the Association with Length of Stay in Patients with Thermal Injury: A Multi-center Analysis

Journal of Burn Care & Research ◽

10.1093/jbcr/irab032.016 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

pp. S13-S14

Author(s):

Sarah Zavala ◽

Kate Pape ◽

Todd A Walroth ◽

Melissa A Reger ◽

Katelyn Garner ◽

...

Keyword(s):

Vitamin D ◽

Length Of Stay ◽

Vitamin D Deficiency ◽

Burn Injury ◽

Total Body Surface Area ◽

Inhalation Injury ◽

Hospital Length Of Stay ◽

Burn Patients ◽

Comfort Care ◽

The Impact

Abstract Introduction In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). Methods This was a multi-center retrospective study of adult patients at 7 burn centers admitted between January 1, 2016 and July 25, 2019 who had a 25-hydroxyvitamin D (25OHD) concentration drawn within the first 7 days of injury. Patients were excluded if admitted for a non-burn injury, total body surface area (TBSA) burn less than 5%, pregnant, incarcerated, or made comfort care or expired within 48 hours of admission. The primary endpoint was to compare hospital LOS between burn patients with vitamin D deficiency (defined as 25OHD < 20 ng/mL) and sufficiency (25OHD ≥ 20 ng/mL). Secondary endpoints include in-hospital mortality, ventilator-free days of the first 28, renal replacement therapy (RRT), length of ICU stay, and days requiring vasopressors. Additional data collected included demographics, Charlson Comorbidity Index, injury characteristics, form of vitamin D received (ergocalciferol or cholecalciferol) and dosing during admission, timing of vitamin D initiation, and form of nutrition provided. Dichotomous variables were compared via Chi-square test. Continuous data were compared via student t-test or Mann-Whitney U test. Univariable linear regression was utilized to identify variables associated with LOS (p < 0.05) to analyze further. Cox Proportional Hazard Model was utilized to analyze association with LOS, while censoring for death, and controlling for TBSA, age, presence of inhalation injury, and potential for a center effect. Results Of 1,147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, p < 0.001), acute kidney injury (AKI) requiring RRT (7.3 vs 1.7%, p = 0.009), more days requiring vasopressors (mean 1.24 vs 0.58 days, p = 0.008), and fewer ventilator free days of the first 28 days (mean 22.9 vs 25.1, p < 0.001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, the best fit model included only deficiency and days until vitamin D initiation. Conclusions Patients with thermal injuries and vitamin D deficiency on admission have increased length of stay and worsened clinical outcomes as compared to patients with sufficient vitamin D concentrations.

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Once-Daily Amikacin Dosing in Burn Patients Treated with Continuous Venovenous Hemofiltration

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00374-11 ◽

2011 ◽

Vol 55 (10) ◽

pp. 4639-4642 ◽

Cited By ~ 19

Author(s):

Kevin S. Akers ◽

Jason M. Cota ◽

Christopher R. Frei ◽

Kevin K. Chung ◽

Katrin Mende ◽

...

Keyword(s):

Burn Injury ◽

Continuous Venovenous Hemofiltration ◽

Burn Patients ◽

Small Reduction ◽

Target Attainment ◽

Clinical Pharmacokinetics ◽

Once Daily ◽

Renal Replacement Therapies ◽

Rapid Clearance ◽

The Impact

ABSTRACTAmikacin clearance can be increased in burn injury, which is often complicated by renal insufficiency. Little is known about the impact of renal replacement therapies, such as continuous venovenous hemofiltration (CVVH), on amikacin pharmacokinetics. We retrospectively examined the clinical pharmacokinetics, bacteriology, and clinical outcomes of 60 burn patients given 15 mg/kg of body weight of amikacin in single daily doses. Twelve were treated with concurrent CVVH therapy, and 48 were not. The pharmacodynamic target of ≥10 for the maximum concentration of drug in serum divided by the MIC (Cmax/MIC) was achieved in only 8.5% of patients, with a small reduction ofCmaxin patients receiving CVVH and no difference in amikacin clearance. Mortality and burn size were greater in patients who received CVVH. Overall, 172 Gram-negative isolates were recovered from the blood cultures of 39 patients, with amikacin MIC data available for 82 isolates from 24 patients. A 10,000-patient Monte Carlo simulation was conducted incorporating pharmacokinetic and MIC data from these patients. The cumulative fraction of response (CFR) was similar in CVVH and non-CVVH patients. The CFR rates were not significantly improved by a theoretical 20 mg/kg amikacin dose. Overall, CVVH did not appear to have a major impact on amikacin serum concentrations. The low pharmacodynamic target attainment appears to be primarily due to higher amikacin MICs rather than more rapid clearance of amikacin related to CVVH therapy.

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Five-Year Outcomes After Implementing a Pain, Agitation, and Delirium Protocol in a Mixed Intensive Care Unit

Journal of Intensive Care Medicine ◽

10.1177/08850666211063404 ◽

2021 ◽

pp. 088506662110634

Author(s):

Jeffrey T. Fish ◽

Jared T. Baxa ◽

Ryan R. Draheim ◽

Matthew J. Willenborg ◽

Jared C. Mills ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Academic Medical Center ◽

Admission Diagnosis ◽

Surgical Intensive Care Unit ◽

Standardized Mortality Ratio ◽

Surgical Intensive Care ◽

Mechanically Ventilated ◽

Mortality Ratio ◽

Apache Iv

Objective: Assess for continued improvements in patient outcomes after updating our institutional sedation and analgesia protocol to include recommendations from the 2013 Society of Critical Care Medicine (SCCM) Pain, Agitation, and Delirium (PAD) guidelines. Methods: Retrospective before-and-after study in a mixed medical/surgical intensive care unit (ICU) at an academic medical center. Mechanically ventilated adults admitted from September 1, 2011 through August 31, 2012 (pre-implementation) and October 1, 2012 through September 30, 2017 (post-implementation) were included. Measurements included number of mechanically ventilated patients, APACHE IV scores, age, type of patient (medical or surgical), admission diagnosis, ICU length of stay (LOS), hospital LOS, ventilator days, number of self-extubations, ICU mortality, ICU standardized mortality ratio, hospital mortality, hospital standardized mortality ratio, medication data including as needed (PRN) analgesic and sedative use, and analgesic and sedative infusions, and institutional savings. Results: Ventilator days (Pre-PAD = 4.0 vs. Year 5 post = 3.2, P < .0001), ICU LOS (Pre-PAD = 4.8 days vs. Year 5 post = 4.1 days, P = .0004) and hospital LOS (Pre-PAD = 14 days vs. Year 5 post = 12 days, P < .0001) decreased after protocol implementation. Hospital standardized mortality ratio (Pre-PAD = 0.69 vs. Year 5 post = 0.66) remained constant; while, APACHE IV scores (Pre-PAD = 77 vs. Year 5 post = 89, P < .0001) and number of intubated patients (Pre-PAD = 1146 vs. Year 5 post = 1468) increased over the study period. Using the decreased ICU and hospital LOS estimates, it is projected the institution saved $4.3 million over the 5 years since implementation. Conclusions: Implementation of an updated PAD protocol in a mixed medical/surgical ICU was associated with a significant decrease in ventilator time, ICU LOS, and hospital LOS without a change in the standardized mortality ratio over a five-year period. These favorable outcomes are associated with a significant cost savings for the institution.

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Nosocomial infections in a pediatric surgical intensive care unit: An unicentric cross-sectional study

Medicinski pregled ◽

10.2298/mpns2104112p ◽

2021 ◽

Vol 74 (3-4) ◽

pp. 112-116

Author(s):

Marina Pandurov ◽

Izabella Fabri-Galambos ◽

Andjela Opancina ◽

Anna Uram-Benka ◽

Goran Rakic ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Nosocomial Infections ◽

Hospital Length Of Stay ◽

Surgical Intensive Care Unit ◽

Negative Consequences ◽

Surgical Intensive Care ◽

Acinetobacter Baumanii ◽

Cross Sectional ◽

The Impact

Introduction. Nosocomial infections are a common complication in patients hospitalized in intensive care units. The aims of this research were to examine the incidence of nosocomial infections in patients admitted to the pediatric surgical intensive care unit, the impact of hospital length of stay and type of surgical disease on the incidence of nosocomial infections, the frequency of microorganisms causing nosocomial infections and their antibiotic susceptibility profile. Material and Methods. Data on 50 subjects were extracted from the database. The following data were taken from the medical histories of the examinees: age, sex, diagnosis, number of days at the hospital before admission to the intensive care unit, number of days in the intensive care unit, levels of C-reactive protein, applied antimicrobial drugs, isolated microorganisms and their susceptibility to antibiotics. Results. The incidence of nosocomial infections in the study period was 52%. Patients who developed nosocomial infection remained longer in the intensive care unit than those who did not develop it (p = 0.003). Patients with the diagnosis of acute abdomen had a statistically significantly higher incidence of nosocomial infections compared to other patients (p = 0.001). Gram-negative bacteria were the most commonly isolated pathogens (46.8%). Acinetobacter baumanii proved to be the most resistant species in this study, since 80% of the strains did not show sensitivity to any of the tested antibiotics. Conclusion. Nosocomial infections are present in slightly more than half of the patients treated at the pediatric surgical intensive care unit. Patients who developed nosocomial infections stayed longer in the pediatric surgical intensive care unit, which had negative consequences for their health and treatment costs.

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Chlorhexidine Gluconate Bathing Program to Reduce Health Care–Associated Infections in Both Critically Ill and Non–Critically Ill Patients

Critical Care Nurse ◽

10.4037/ccn2021340 ◽

2021 ◽

Vol 41 (5) ◽

pp. e1-e8

Author(s):

Leigh Chapman ◽

Lisa Hargett ◽

Theresa Anderson ◽

Jacqueline Galluzzo ◽

Paul Zimand

Keyword(s):

Health Care ◽

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Chlorhexidine Gluconate ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Telemetry Unit ◽

Health Care Associated Infections ◽

The Impact

Background Critical care nurses take care of patients with complicated, comorbid, and compromised conditions. These patients are at risk for health care–associated infections, which affect patients’ lives and health care systems in various ways. Objective To gauge the impact of routinely bathing patients with 4% chlorhexidine gluconate solution on the incidence of health care–associated infections in a medical-surgical intensive care unit and a postoperative telemetry unit; to outline the framework for a hospital-wide presurgical chlorhexidine gluconate bathing program and share the results. Methods A standard bathing protocol using a 4% chlorhexidine gluconate solution was developed. The protocol included time studies, training, monitoring, and surveillance of health care–associated infections. Results Consistent patient bathing with 4% chlorhexidine gluconate was associated with a 52% reduction in health care–associated infections in a medical-surgical intensive care unit. The same program in a postoperative telemetry unit yielded a 45% reduction in health care–associated infections. Conclusion A comprehensive daily 4% chlorhexidine gluconate bathing program can be implemented with standardized protocols and detailed instructions and can significantly reduce the incidence of health care–associated infections in intensive care unit and non–intensive care unit hospital settings.

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Epidemiological study of burn injury with special reference to its prevention- A Nine-year retrospective study from a tertiary care hospital of West Bengal, India

Asian Journal of Medical Sciences ◽

10.3126/ajms.v7i1.13044 ◽

2015 ◽

Vol 7 (1) ◽

pp. 70-75 ◽

Cited By ~ 1

Author(s):

Shib Shankar Kuiri ◽

Bikash Chandra Ghosh ◽

Nilay Mandal ◽

Mintu Mohan Nandi ◽

Tusar Kanti Saradar ◽

...

Keyword(s):

Retrospective Study ◽

Injury Risk ◽

West Bengal ◽

Burn Injury ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Burn Injuries ◽

Care Hospital ◽

Burn Patients ◽

Age Group

Aims and Objectives: We conducted a retrospective analysis among 1984 burn patients to study the incidence, prevalence of burn injury, its various types and modes (actual event behind the burn injury), risk factors and to find out the preventive measures.Materials and Methods: The retrospective study was carried out among 1984 patients having burn injuries, admitted in a tertiary care hospital of West Bengal, India over a period of nine years. The sources of information were the admission registers and the patients' folders from the medical records department. The Ethical clearance was taken from the Institutional Ethical Committee. The information obtained included age, sex, whether accidental or suicidal, etiology of burn injury and particularly the mechanism of injury. Results: Females were mostly affected (83%) in comparison to males. Among the study population, most of the burn patients were in the age group of 21-30yrs i.e. 35.3%. The number of burn patients were less in number in the age group of 11-20yrs i.e. 7.3%. Most of the burn injuries (87%) were accidental. Suicidal burns occurred in 10% cases. Of which about 1/3rd of the cases were due to dowry related issues. A significant number of teenagers also attempted suicides due to trivial reasons (e.g. failure in examination, quarrelling with parents). Gas oven related injuries occurred in 2.7% cases. Oil lamps (‘kupi’), candles and hurricane-lanterns, diyas were also responsible to some extent in rural India for flame burns(5%). Smoking related burn injuries occurred in 1.7% cases. Scald injuries occurred in 14% cases. Chemical injuries (0.3%) were due to spillage of unlabelled bottles of acid/alkali. Electrical burn injury occurred in 4.9% cases. Conclusion: Burn injury prevention is not easy, but to avoid the significant morbidity and mortality following injury we have to prevent it by any means. A coordinated and dedicated approach among social workers , medical and paramedical personnel, administrators can only minimize the incidence of burn.Asian Journal of Medical Sciences Vol.7(1) 2015 70-75

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Serratia marcescans Contamination of Antiseptic Soap Containing Triclosan: Implications for Nosocomial Infection

Infection Control ◽

10.1017/s0195941700060690 ◽

1984 ◽

Vol 5 (9) ◽

pp. 427-430 ◽

Cited By ~ 29

Author(s):

M. Anita Barry ◽

Donald E. Craven ◽

Theresa A. Goularte ◽

Deborah A. Lichtenberg

Keyword(s):

Intensive Care Unit ◽

Pseudomonas Aeruginosa ◽

Intensive Care ◽

Nosocomial Infection ◽

Surgical Intensive Care Unit ◽

Minimal Bactericidal Concentration ◽

Surgical Intensive Care ◽

Time Kill ◽

The Impact

Abstract During a recent investigation in our surgical intensive care unit, we found that several bottles of the antiseptic handwashing soap, OR Scrub®, were contaminated with Serratia marcescens. OR Scrub® contains 1% triclosan, lanolin, and detergents. The antimicrobial efficacy of OR Scrub® was examined in vitro using serial two-fold dilutions of soap inoculated with various concentrations of different nosocomial pathogens. The minimal bactericidal concentration (MBC) of OR Scrub® against Pseudomonas aeruginosa and several strains of S. marcescens was ≤1:2 By comparison, a non-antiseptic soap from the same manufacturer (Wash®) and 4% chlorhexidine (Hibiclens®) had MBCs for all strains tested of at least 1:64. Time-kill curves confirmed the findings of the initial experiments.This is the first report of extrinsic contamination of antiseptic soap containing triclosan. No infections could be attributed to the contaminated soap, but sporadic outbreaks of Serratia have occurred in the intensive care unit with no identifiable source. Although there have been few studies on the impact of antiseptic soap in reducing nosocomial infection, we question whether a soap with the limitations of OR Scrub® should be used in intensive care units or operating rooms.

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Using online blogs to explore positive outcomes after burn injuries

Journal of Health Psychology ◽

10.1177/1359105316638549 ◽

2016 ◽

Vol 22 (13) ◽

pp. 1755-1766 ◽

Cited By ~ 3

Author(s):

Kirsty Garbett ◽

Diana Harcourt ◽

Heather Buchanan

Keyword(s):

Thematic Analysis ◽

Burn Injury ◽

Burn Injuries ◽

Positive Outcomes ◽

Self Perception ◽

Vast Amount ◽

Novel Technique ◽

Burn Survivors ◽

The Impact ◽

Insight Into

This study uses blog analysis, a new and novel technique, to explore the positive outcomes experienced by burn survivors. This study examined 10 burn survivor blogs to offer a unique, longitudinal insight into burn survivor recovery. Using thematic analysis, three themes emerged: shift in self-perception, enhanced relationships and a change in life outlook. Many of these themes contained stories and experiences unique to a traumatic burn injury, suggesting that standardised trauma scales are not effectively measuring the impact of a burn in this population. Reflections on blog analysis are discussed, along with a recommendation that health researchers utilise the vast amount of data available from online blogs.

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Inpatient Data of Occupational Burn Injuries Treated at a Tertiary Burn Center

Journal of Burn Care & Research ◽

10.1093/jbcr/irz193 ◽

2019 ◽

Vol 41 (2) ◽

pp. 398-401

Author(s):

Abdulkadir Basaran ◽

Ozer Ozlu

Keyword(s):

Hospital Stay ◽

Burn Injury ◽

Health And Safety ◽

Length Of Hospital Stay ◽

Burn Injuries ◽

Occupational Accidents ◽

Cross Sectional ◽

Work Related ◽

Burn Center ◽

Electrical Burns

Abstract Occupational burns are among the important causes of work-related injuries. We aimed to investigate the epidemiology and reasons of occupational burns and thereby to emphasize preventive measures. Between January 2017 and December 2018, the data of major occupational burn injury patients admitted to our burn center were evaluated in this cross-sectional retrospective study. During the study period 342 patients older than 16 years were admitted to the burn center. Among them 80 patients with occupational burns (23.4%) were identified. The mean age of the patients was 34.73 ± 12.3 years. Seventy-eight patients (97.5%) were male. Electrical burns and flame burns were the two leading type of occupational burns. The most common occupation of our patients was construction work. Dangerous behavior, carelessness, lack of protective equipment, and failure to follow instructions were causes of injury. Only 14 patients (17.5%) experienced unavoidable accident. Thirty-seven patients (46.3%) worked on temporary basis. Occupational experience was under 5 years in majority of the cases (62.5%). For the occupational burns the percentage of burned TBSA was 17.08 ± 14.5 (1–60) and the length of hospital stay was 23.94 ± 21.9 days (2–106). There were no significant differences between occupational and nonoccupational burn injuries considering TBSA, total length of hospital stay, and complications (P > .05). Occupational burn injuries are common in less experienced and younger workers. Therefore, recognition of the problem and maintaining awareness is important. In order to prevent occupational accidents and burns, occupational health and safety rules must be obeyed.

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A Diagnostic Stewardship Intervention To Improve Blood Culture Use among Adult Nonneutropenic Inpatients: the DISTRIBUTE Study

Journal of Clinical Microbiology ◽

10.1128/jcm.01053-20 ◽

2020 ◽

Vol 58 (10) ◽

Author(s):

Valeria Fabre ◽

Eili Klein ◽

Alejandra B. Salinas ◽

George Jones ◽

Karen C. Carroll ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Blood Culture ◽

Surgical Intensive Care Unit ◽

Surgical Intensive Care ◽

Control Units ◽

Stewardship Program ◽

Academic Center ◽

Before And After ◽

The Impact

ABSTRACT Interventions to optimize blood culture (BCx) practices in adult inpatients are limited. We conducted a before-after study evaluating the impact of a diagnostic stewardship program that aimed to optimize BCx use in a medical intensive care unit (MICU) and five medicine units at a large academic center. The program included implementation of an evidence-based algorithm detailing indications for BCx use and education and feedback to providers about BCx rates and indication inappropriateness. Neutropenic patients were excluded. BCx rates from contemporary control units were obtained for comparison. The primary outcome was the change in BCxs ordered with the intervention. Secondary outcomes included proportion of inappropriate BCx, solitary BCx, and positive BCx. Balancing metrics included compliance with the Centers for Medicare and Medicaid Services (CMS) SEP-1 BCx component, 30-day readmission, and all-cause in-hospital and 30-day mortality. After the intervention, BCx rates decreased from 27.7 to 22.8 BCx/100 patient-days (PDs) in the MICU (P = 0.001) and from 10.9 to 7.7 BCx/100 PD for the 5 medicine units combined (P < 0.001). BCx rates in the control units did not decrease significantly (surgical intensive care unit [ICU], P = 0.06; surgical units, P = 0.15). The proportion of inappropriate BCxs did not significantly change with the intervention (30% in the MICU and 50% in medicine units). BCx positivity increased in the MICU (from 8% to 11%, P < 0.001). Solitary BCxs decreased by 21% in the medicine units (P < 0.001). Balancing metrics were similar before and after the intervention. BCx use can be optimized with clinician education and practice guidance without affecting sepsis quality metrics or mortality.

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