Compassion Fatigue in the Burn Unit: A Review of Quantitative Evidence

Healthcare staff across varied clinical settings are faced with varied stressors that can lead to compassion fatigue. However, there is currently no review examining the phenomenon in-depth in the burn unit. Thus, the current study sought to scope existing studies to ascertain the prevalence, contributing factors, and effects of compassion fatigue in the burn unit. Compassion fatigue was conceptualised as comprising of burnout and secondary traumatic stress. Arksey and O’Malley scoping review approach was used and reported according to the PRISMA extension guidelines. Searches were undertaken across peer-reviewed databases and grey literature sources for quantitative studies. Following the search and screening process, nine studies were retained. Codes were formulated across studies following which narrative synthesis was undertaken. Majority of the studies (n=5) focused on burn care nurses. High levels of emotional exhaustion and depersonalization and comparatively low level of personal achievement were reported among burn care staff which is indicative of burnout. Compassion fatigue was also observed to be high among burn care staff. Contributing factors are varied albeit some variables such as age, staffing levels, remuneration, nature of the work environment, and number of years worked were consistent across some studies. In conclusion, working in the burn unit is challenging with significant stressors that can lead to burnout, traumatic stress, and subsequently, compassion fatigue. Interventions to promote resilience, hardiness, optimal working environment, peer, and psychosocial support are greatly needed.

Electrical injuries in adult patients – 3 years overview

Electrocutions are a particular type of trauma, usually affecting young active people, leading to high morbidity and mortality rates in extensive injured patients. Those patients require complex, multidisciplinary treatment in specialized burn centers. We conducted a three-year retrospective study in the Burn Unit of the Clinical Emergency Hospital Bucharest, Romania, aiming to identify different factors that characterize electrical injuries, with the goal to improve our clinical practice, in order to decrease overall complications, the morbidity and mortality rates and obtain an optimal functional prognosis for those severely injured patients. Patient-related and injury-related parameters were analyzed, and particularities observed in our burn unit were noted. A clear understanding of the physiopathology of those injuries and their complications is essential for providing an optimal therapeutic strategy. Rapid initiation of systemic supportive measures, accurate diagnostic and an adequate surgical treatment, correctly conducted, are essential for improving the vital and functional prognostic of patients who suffer electric injuries.

MRSA COLONITATION DETECTION IN OBJECT NEAR PATIENTS IN BURN UNIT RSUD DR. SOETOMO - INDONESIA

Background: Burn unit is a unit where patients with a burn wound in which the patient’s skin is not intact are taken care of. Methicillin-resistant Staphylococcus aureus (MRSA) as the prototype of a nosocomial pathogen is usually transmitted through contact from the surfaces of the object to the non-intact skin. Therefore, the possibility of MRSA infection increase in the burn unit. Purpose: The purpose of this research is to find out whether there is any colonization of MRSA on the objects around burn unit patients that can contribute to the spreading of MRSA in the RSUD Dr.Soetomo Indonesia. Method: The sampling period was started from October 2019 until March 2020. Samples were taken randomly from 28 patients in the Burn unit RSUD Dr.Soetomo -ndonesia and then tested for identification in the microbiology laboratory of the medical faculty, Universitas Airlangga. Result: Nineteen bacterial growths were obtained from twenty-eight samples taken, nine of them were confirmed as Stahylococcus aureus and one from nine of them was confirmed as MRSA. Conclusion: MRSA contamination was found on an object around the patient burn unit Dr. Soetomo-Indonesia which comes from the stethoscope membrane.

The Difference in TBSA Estimation Between Emergency Room and Burn Unit in Second Tier Hospital in Central Jakarta

Introduction: Burn TBSA estimation is essential to administer fluid resuscitation. There are some methods, including Rule of 9 and Lund-Browder Chart. This study aims to identify the difference in TBSA estimation in Emergency Room & Burn Unit. Method: We conducted a retrospective cross-sectional study in design. The Inclusion criteria are patients admitted to the Jakarta Islamic Hospital Cempaka Putih (JIHCP) burn unit between April 2015-September 2018, acute patients who have complete demographic data, complete TBSA estimation in the emergency room (ER) and burn unit (BU). Exclusion criteria are patients who do not have complete demographical data and incomplete TBSA estimation between the emergency room and burn unit. The estimation of TBSA in the emergency room is done by General Practitioner, while in the burn unit is done by Plastic Surgeon. Result: Of all 160 patients admitted, 142 patients are eligible in the inclusion criteria. Most of it was adult males with an average of 28.3 years old, suffering a grade II burn injury caused by scald. There is a higher mean of TBSA estimation in the Emergency room with 15.83 (SD 12.21) compared to the Burn Unit with 12.92 (SD 12.00). The maximum TBSA overestimation in ER reaches 24% TBSA than BU, while the minimum is 0.5%. The Maximum TBSA underestimation in ER reaches 20% TBSA than BU, while the minimum underestimation is also 0.5%. On average, ER overestimates about 6.7% TBSA and underestimates about 2.8% TBSA compared to BU. Conclusion: The emergency room tends to overestimate the TBSA, with an almost 3% difference in mean (p<0.05). There is an occurrence of a maximum 24% TBSA overestimation while averaging 6.7% TBSA.

26 Clogged Feeding Tubes: Why Does It Matter?

Introduction Many patients treated on a burn unit require tube feeding as their primary caloric source or as supplemental feeding due to their injuries. Burn patients specifically require higher caloric intake due to the hypermetabolic state of burn injuries. Inadequate nutritional support contributes to longer ICU stays and higher mortality. Clogged feeding tubes reduce nutrition provided due to temporary discontinuation of feeding. The objective of this study was to identify risk factors for the incidence of tube clogging. Methods This was a single-center retrospective chart review of all patients admitted to an American Burn Association-verified Burn Unit between August 2017 and October 2019 who received tube feeds during their admission. Data collected included baseline demographics, clinical outcomes, and details about tube feed formulations, number of clogs, and details leading up to the clog. Baseline demographics were compared using descriptive statistics. Nominal data was compared using Chi-square test. Continuous data was analyzed using student’s t-test or Mann-Whitney U test. Results A total of 170 patients were included; admission diagnoses included burn (97), soft tissue infections (29), SJS/TEN (11), and others (33). At least one clogged feeding tube was experienced by 51 patients and some experienced up to seven separate clogs. SJS/TEN patients were less likely to experience a clog (9.2 vs 0%, p = 0.035) and frostbite patients were more likely to experience a clog (0 vs 5.9%, p = 0.026). Burn mechanism did not affect incidence of tube feed clog, but patients with larger total body surface area (TBSA) burned were more likely to have a clog (15.55 vs 25.03%, p = 0.004). It was a median of 12 days until the first clog occurred (IQR 7.8–17.3). Two tube feed formulas demonstrated an increased likelihood of clog: a renal formulation (16.8 vs 33.3%, p = 0.017) and a polymeric concentrated product (5.0 vs 17.6%, p = 0.008). Both products have a high viscosity. Patients who experienced a clog had a longer length of stay (21.5 vs 44.0 days, p = 0.001). Conclusions This study identified several risk factors associated with higher incidence of clogged feeding tube in the burn unit including tube feed formulation and viscosity, admission diagnosis, and larger TBSA in burn patients. This study also confirms that clogged feeding tubes, and the resultant insufficient nutritional support, may contribute to an increased length of stay.