The implementation of an infection control bundle within a Total Care Burns Unit.

AIM: To evaluate the impact of the implementation of a best practice infection prevention and control bundle on healthcare associated burn wound infections in a paediatric burns unit. BACKGROUND: Burn patients are vulnerable to infection. For this patient population, infection is associated with increased morbidity and mortality, thereby representing a significant challenge for burns clinicians who care for them. METHODS: An interrupted time series was used to compare healthcare associated burn wound infections in paediatric burn patients before and after implementation of an infection prevention and control bundle. Prospective surveillance of healthcare associated burn wound infections was conducted from 2012 to 2014. Other potential healthcare associated infection rates were also reviewed over the study period, including urinary tract infections, pneumonia, upper respiratory tract infections and sepsis. An infection prevention and control bundle developed in collaboration between the paediatric burn unit and infection control clinicians was implemented in 2013 in addition to previous standard practice. RESULTS: During the study period a total of 626 patients were admitted to the paediatric burns unit. Healthcare associated burn wound infections reduced from 34 in 2012 to 0 in 2014 following the implementation of the infection prevention and control bundle. Pneumonia and sepsis also reduced to 0 in 2013 and 2014, however one upper respiratory tract infection occurred in 2013 and urinary tract infections persisted in 2013. CONCLUSION: The implementation of an infection prevention and control bundle was effective in reducing healthcare associated burn wound infections, pneumonia and sepsis within our paediatric burns unit. Urinary tract infections remain a challenge for future improvement.

Sexuality following trauma injury: A literature review.

Restoration of the quality of life (QoL) of trauma injury survivors is the aim of trauma rehabilitation. It is generally acknowledged that sexuality is an important component of QoL; however, rehabilitation services frequently fall short of including sexuality as a matter of routine. The literature was reviewed to examine the experiences of trauma survivors from three groups: spinal cord injury (SCI), traumatic brain injury (TBI) and burns. The focus was on the impact of trauma on the QoL to identify future research directions and to advocate for the inclusion of sexuality as an integral part of rehabilitation. Databases searched were Proquest, Ovid, Cinahl, Medline, PsycInfo and Cochrane Central Register of controlled trials. A total of 36 eligible studies were included: SCI (n = 25), TBI (n = 6), burns (n = 5). Four themes were identified across the three trauma groups that were labeled as physiological impact of trauma on sexuality, cognitive-genital dissociation (CGD), sexual disenfranchisement (SD) and sexual rediscovery (SR). Trauma injury has a significant impact on sexuality, which is not routinely addressed within rehabilitation services. Further sexuality research is required among all trauma groups to improve rehabilitation services and in turn QoL outcomes for all trauma survivors.

Sexuality following burn injuries: a preliminary study.

Responses to the sexuality and body image subdomains of the Burn Specific Health Scale - Brief Version (BSHS-B) were analysed, to identify the incidence of sexuality and body image changes in burn survivors from hospital discharge - 12 months post injury. Data were collected through examination of BSHS-B questionnaires (BSHS-B), from burns patients at hospital discharge and one, three, six and twelve month time points after burn injury. The results demonstrate that burn injuries have a significant negative impact on sexuality and body image satisfaction for burn survivors. The results raise concerns regarding potential long term quality of life (QoL) issues for burn survivors in these domains. Sexuality and body image following burn injuries are important QoL domains that should be addressed during post injury rehabilitation. This preliminary study shows that further empirical research regarding changes to sexuality and body image in the burns population is required.

Local and systemic treatments for acute edema after burn injury: a systematic review of the literature.

Burn injury is a complex trauma that results in local and generalized edema. Edema fluid limits the exchange of vital nutrients in healing the burn wound and will compromise vulnerable tissues. Although the importance of edema control in tissue salvage is recognized, treatments targeted at edema control have not been critically reviewed. Thus, the objective was to assess the evidence for the effectiveness of local and systemic treatments for edema management immediately after burn injury. Searches for randomized controlled trials were conducted of online databases, research and thesis registers, and grey literature repositories. Handsearches included journals, bibliographies, and proceedings. Authors were contacted to clarify and submit extra study details. Eight studies were included. Management of acute major burn resuscitation including colloid increases lung edema (mean difference [MD], 0.04 ml/ml alv vol; 95% confidence interval [CI], 0.03-0.04; P < .00001) and mortality (risk ratio, 3.67; 95% CI, 1.16-11.58; P = .03). Continuous administration of vitamin C in acute burn resuscitation reduces local wound edema (MD, -3.50 ml/g; 95% CI, -4.63 to -2.37; P < .00001) and systemic fluid retention (MD, -8.60 kg; 95% CI, -13.47 to -3.73; P = .0005). Local acute hand burn edema is reduced (MD, -29.00 ml; 95% CI, -53.14 to -4.86; P = .02), and active hand motion increased (MD, 10.00°; 95% CI, 4.58-15.42; P = .0003), using electrical stimulation with usual physiotherapy. Each review outcome was based on a small single-facility study. Thus, future research in intervention for acute burn edema must focus on multicentre trials and validation of outcome measures in the burn population.

Objective measurement of scarring by multiple assessors: is the tissue tonometer a reliable option?

Depending on the patient population, the incidence of scarring is as great as 75% after burns. Skin pliability and functional recovery are affected negatively by hypertrophic scarring. Therapists use various treatment strategies to improve scar outcomes. However, a simple, objective, clinically useful method of measuring scar response to treatment eludes us. This study examines the inter-rater reliability and validity of scar pliability measures using the modified tissue tonometer (MTT). Twenty-four patients were tested by two blinded, randomly allocated raters. The MTT was used to assess scar pliability with a standardized, repeated-measures design. One normal and up to three scar points were assessed for each subject. One subject was excluded from the data analyses. Concerning inter-rater reliability, the intraclass correlation coefficient for averaged measures between measurers was 0.957, and the standard error of measurement was 0.025 mm. For validity, a significant difference (P = .0000) between scar (2.64 +/- 0.5 mm) and normal tissue (3.23 +/- 0.46 mm) measurements was demonstrated. Scar pliability scores between raters are extremely reliable and reproducible using the MTT. It can differentiate between injured and uninjured tissue. Hence, it provides clinicians with a reliable, transportable, and objective tool to document scar outcomes. The MTT provides a standardized method to longitudinally measure scar tissue pliability after burn injury.