Infection control in severely burned patients

Abstract

In the last two decades, much progress has been made in the control of burn wound infection and nasocomial infections (NI) in severely burned patients. The continiually changing epidemiology is partially related to greater understanding of and improved techniques for burn patient management as well as effective hospital infection control measures. With the advent of antimicrobial chemotherapeutic agents, infection of the wound site is now not as common as, for example, urinary and blood stream infections. Universal application of early excision of burned tissues has made a substantial improvement in the control of wound-related infections in burns. Additionally, the development of new technologies in wound care have helped to decrease morbidity and mortality in severe burn victims. Many examples can be given of the successful control of wound infection, such as the application of an appropriate antibiotic solution to invasive wound infection sites with simultaneous vacuum-assisted closure, optimal preservation of viable tissues with waterjet debridement systems, edema and exudate controlling dressings impregnated with Ag (Silvercel, Aquacell-Ag). The burned patient is at high risk for NI. Invasive interventions including intravenous and urinary chateterization, and entubation pose a further risk of NIs. The use of newly designed antimicrobial impregnated chateters or silicone devices may help the control of infection in these immunocomprimised patients. Strict infection control practices (physical isolation in a private room, use of gloves and gowns during patient contact) and appropriate empirical antimicrobial therapy guided by laboratory surveillance culture as well as routine microbial burn wound culture are essential to help reduce the incidance of infections due to antibiotic resistant microorganisms.

Keywords: Infection control; Infection control programs; Severe burn injury; Survelliance; Wound care.

Figure 1

Vicious circle for increased infection risk in severely burned patient. SWI: Surgical wound infections; NI: Nasocomial infections; TBSA: Total burned surface area.

Figure 2

An example for burn wound infection. Top: Nine days following admission a severe edema and inflammation at the periphery of the wound is seen with a positive wound culture for pseudomanas auerginosa; Bottom: Following treatment with topical octenidine dihydrochlorure (octenidex, senamed medical, Turkey) and sterile petroleum gauze (jelonet, Smith and nephew, United Kingdom), and peroral ofloxacine 500 mg × 2 for day, rapid epitheliazation and decreased edema was achieved at the 10th day of the treatment.

Figure 3

Diagram showing the management of infection problems in severe burns.

Figure 4

V-link luer activated device with Vitalshield protective coating, non-DEHP catheter extension set (Baxter ref vmc 8374).