Infections in Burns

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Abstract

Infections remain a leading cause of death in burn patients. This is as a result of loss of the environmental barrier function of the skin predisposing these patients to microbial colonization leading to invasion. Therefore, reconstitution of the environmental barrier by debriding the devitalized tissue and wound closure with application of allograft versus autograft is of optimal importance.

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Most cited references 40

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Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee.

, Melissa L. Anderson, R Besser … (2004)

This report updates, expands, and replaces the previously published CDC "Guideline for Prevention of Nosocomial Pneumonia". The new guidelines are designed to reduce the incidence of pneumonia and other severe, acute lower respiratory tract infections in acute-care hospitals and in other health-care settings (e.g., ambulatory and long-term care institutions) and other facilities where health care is provided. Among the changes in the recommendations to prevent bacterial pneumonia, especially ventilator-associated pneumonia, are the preferential use of oro-tracheal rather than naso-tracheal tubes in patients who receive mechanically assisted ventilation, the use of noninvasive ventilation to reduce the need for and duration of endotracheal intubation, changing the breathing circuits of ventilators when they malfunction or are visibly contaminated, and (when feasible) the use of an endotracheal tube with a dorsal lumen to allow drainage of respiratory secretions; no recommendations were made about the use of sucralfate, histamine-2 receptor antagonists, or antacids for stress-bleeding prophylaxis. For prevention of health-care--associated Legionnaires disease, the changes include maintaining potable hot water at temperatures not suitable for amplification of Legionella spp., considering routine culturing of water samples from the potable water system of a facility's organ-transplant unit when it is done as part of the facility's comprehensive program to prevent and control health-care--associated Legionnaires disease, and initiating an investigation for the source of Legionella spp. when one definite or one possible case of laboratory-confirmed health-care--associated Legionnaires disease is identified in an inpatient hemopoietic stem-cell transplant (HSCT) recipient or in two or more HSCT recipients who had visited an outpatient HSCT unit during all or part of the 2-10 day period before illness onset. In the section on aspergillosis, the revised recommendations include the use of a room with high-efficiency particulate air filters rather than laminar airflow as the protective environment for allogeneic HSCT recipients and the use of high-efficiency respiratory-protection devices (e.g., N95 respirators) by severely immunocompromised patients when they leave their rooms when dust-generating activities are ongoing in the facility. In the respiratory syncytial virus (RSV) section, the new recommendation is to determine, on a case-by-case basis, whether to administer monoclonal antibody (palivizumab) to certain infants and children aged <24 months who were born prematurely and are at high risk for RSV infection. In the section on influenza, the new recommendations include the addition of oseltamivir (to amantadine and rimantadine) for prophylaxis of all patients without influenza illness and oseltamivir and zanamivir (to amantadine and rimantadine) as treatment for patients who are acutely ill with influenza in a unit where an influenza outbreak is recognized. In addition to the revised recommendations, the guideline contains new sections on pertussis and lower respiratory tract infections caused by adenovirus and human parainfluenza viruses and refers readers to the source of updated information about prevention and control of severe acute respiratory syndrome.

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Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients.

Bruce Cook, Obi L. Griffith, D Leasa … (1998)

Understanding the risk factors for ventilator-associated pneumonia can help to assess prognosis and devise and test preventive strategies. To examine the baseline and time-dependent risk factors for ventilator-associated pneumonia and to determine the conditional probability and cumulative risk over the duration of stay in the intensive care unit. Prospective cohort study. 16 intensive care units in Canada. 1014 mechanically ventilated patients. Demographic and time-dependent variables reflecting illness severity, ventilation, nutrition, and drug exposure. Pneumonia was classified by using five methods: adjudication committee, bedside clinician's diagnosis, Centers for Disease Control and Prevention definition, Clinical Pulmonary Infection score, and positive culture from bronchoalveolar lavage or protected specimen brush. 177 of 1014 patients (17.5%) developed ventilator-associated pneumonia 9.0 +/- 5.9 days (median, 7 days [interquartile range, 5 to 10 days]) after admission to the intensive care unit. Although the cumulative risk increased over time, the daily hazard rate decreased after day 5 (3.3% at day 5, 2.3% at day 10, and 1.3% at day 15). Independent predictors of ventilator-associated pneumonia in multivariable analysis were a primary admitting diagnosis of burns (risk ratio, 5.09 [95% CI, 1.52 to 17.03]), trauma (risk ratio, 5.00 [CI, 1.91 to 13.11]), central nervous system disease (risk ratio, 3.40 [CI, 1.31 to 8.81]), respiratory disease (risk ratio, 2.79 [CI, 1.04 to 7.51]), cardiac disease (risk ratio, 2.72 [CI, 1.05 to 7.01]), mechanical ventilation in the previous 24 hours (risk ratio, 2.28 [CI, 1.11 to 4.68]), witnessed aspiration (risk ratio, 3.25 [CI, 1.62 to 6.50]), and paralytic agents (risk ratio, 1.57 [CI, 1.03 to 2.39]). Exposure to antibiotics conferred protection (risk ratio, 0.37 [CI, 0.27 to 0.51]). Independent risk factors were the same regardless of the pneumonia definition used. The daily risk for pneumonia decreases with increasing duration of stay in the intensive care unit. Witnessed aspiration and exposure to paralytic agents are potentially modifiable independent risk factors. Exposure to antibiotics was associated with low rates of early ventilator-associated pneumonia, but this effect attenuates over time.

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Eliminating catheter-related bloodstream infections in the intensive care unit*

Sean Berenholtz, Peter Pronovost, Pamela A Lipsett … (2004)

To determine whether a multifaceted systems intervention would eliminate catheter-related bloodstream infections (CR-BSIs). Prospective cohort study in a surgical intensive care unit (ICU) with a concurrent control ICU. The Johns Hopkins Hospital. All patients with a central venous catheter in the ICU. To eliminate CR-BSIs, a quality improvement team implemented five interventions: educating the staff; creating a catheter insertion cart; asking providers daily whether catheters could be removed; implementing a checklist to ensure adherence to evidence-based guidelines for preventing CR-BSIs; and empowering nurses to stop the catheter insertion procedure if a violation of the guidelines was observed. The primary outcome variable was the rate of CR-BSIs per 1,000 catheter days from January 1, 1998, through December 31, 2002. Secondary outcome variables included adherence to evidence-based infection control guidelines during catheter insertion. Before the intervention, we found that physicians followed infection control guidelines during 62% of the procedures. During the intervention time period, the CR-BSI rate in the study ICU decreased from 11.3/1,000 catheter days in the first quarter of 1998 to 0/1,000 catheter days in the fourth quarter of 2002. The CR-BSI rate in the control ICU was 5.7/1,000 catheter days in the first quarter of 1998 and 1.6/1,000 catheter days in the fourth quarter of 2002 (p = .56). We estimate that these interventions may have prevented 43 CR-BSIs, eight deaths, and 1,945,922 dollars in additional costs per year in the study ICU. Multifaceted interventions that helped to ensure adherence with evidence-based infection control guidelines nearly eliminated CR-BSIs in our surgical ICU.

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Contributors

Marc G. Jeschke: marc.jeschke@sunnybrook.ca

Lars-Peter Kamolz: 0043140400 , 0043140400 , lars.kamolz@medunigraz.at

Shahriar Shahrokhi: 416-480-5554 , 416-480-7832 , Shar.Shahrokhi@sunnybrook.ca

Shahriar Shahrokhi: shar.shahrokhi@sunnybrook.ca

Journal

Journal ID (publisher-id): 978-3-7091-1133-8

Journal ID (doi): 10.1007/978-3-7091-1133-8

Journal ID (nlm-ta): Burn Care and Treatment

Title: Burn Care and Treatment

Subtitle: A Practical Guide

ISBN (Print): 978-3-7091-1132-1

ISBN (Electronic): 978-3-7091-1133-8

Publication date (Electronic): 9 February 2013

Pages: 43-55

Affiliations

[ID1 ]GRID grid.413104.3, ISNI 0000 0000 9743 1587, Sunnybrook Health Sciences Centre, , Ross Tilley Burn Centre, ; Bayview Ave. 2075, Toronto, M4N 3M5 Ontario Canada

[ID2 ]GRID grid.11598.34, ISNI 0000000089882476, , Department of Surgery, , Medical University of Graz, ; Auenbruggerplatz 29, Graz, 8036 Austria

[ID3 ]GRID grid.17063.33, ISNI 0000 0001 2157 2938, , Ross Tilley Burn Centre, , University of Toronto, ; Bayview Ave 2075, Toronto, M4N 3M5 Ontario Canada

GRID grid.413104.3, ISNI 0000000097431587, Division of Plastic and Reconstructive Surgery, , Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, ; Bayview Ave 2075, Suite D716, Toronto, ON M4N 3M5 Canada

Article

Publisher ID: 4

DOI: 10.1007/978-3-7091-1133-8_4

PMC ID: 7120884

SO-VID: 67718b6b-eb78-48b9-8f67-bed73dfa1058

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This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

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Keywords: injured patient,focal dark,early excision,burn wound infection,optimal importance

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Keywords: injured patient, focal dark, early excision, burn wound infection, optimal importance

Infections in Burns

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Microbial Genomics

Most cited references 40

Guidelines for preventing health-care--associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee.

Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients.

Eliminating catheter-related bloodstream infections in the intensive care unit*

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