Control of methicillin-resistant Staphylococcus aureus in a burn unit: role of nurse staffing.

We investigated retrospectively the spread of methicillin-resistant Staphylococcus aureus (MRS) in a burn unit. During 8 months, 34% of the patients acquired MRS, and transmission continued despite barrier isolation precautions and treatment of colonized personnel with topical intranasal antibiotics. Several findings suggested MRS was spread primarily by contact transmission involving personnel: case-control comparison showed burn size to be the major host risk factor for colonization; correlation analysis of environmental factors revealed a significant (p = 0.001) association of new cases with increased patient load and with staffing by overtime or temporary nurses; and environmental sampling yielded few colonies of MRS. The outbreak halted following implementation of control measures, among which assignment of separate nurses to colonized patients appeared to be essential. The association of different nurse staffing variables with persistence then eradication of MRS suggests nurse staffing may have been an important factor in staphylococcal transmission.

Burn epidemiology: a basis for burn prevention.

An appreciation of the causes of burn injury is essential in order to direct burn prevention programs. Toward this goal, 1,564 patients treated at the UCI Burn Center were studied. There were 699 patients admitted acutely and 865 outpatients. The most common cause of thermal injury in both adults and children was scalding. In children scald burns accounted for 42% of the total number of children treated. In children under 4 years old scalds caused 75% of all burn injuries, most in the kitchen. Flammable liquids were responsible for the majority of the severe burns in the adult group (19% of acute admissions). Housefires, while accounting for only 5% of the adults treated, were responsible for 44% of the adult deaths. Continued public education in safety practices at home especially in the kitchen and bath, and with automobiles and outdoor stoves and fires is recommended, as well as planned escapes from homes and use of smoke detectors.

Nutritional therapy based on positive caloric balance in burn patients.

Oxygen consumption and caloric expenditure was 1 1/2 to 2 times normal in 15 major burn patients from the time of burn to the time of surface coverage. This hypermetabolic state was quite consistent hour-to-hour and day-to-day, and correlated best with the extent of full-thickness burn. Nutritional management and caloric intake can be intelligently planned using simple spirometry and indirect calorimetry to measure caloric requirements. Weight gain and prompt healing can be achieved by positive caloric balance. Based on daily metabolic studies, a positive caloric balance feeding protocol has been used in the treatment of 556 patients. This regimen, in combination with many other factors in physiologic and surface care, has resulted in high survival rates, short hospitalization, and rapid rehabilitation.

Acute management of the upper airway in facial burns and smoke inhalation.

Among 740 patients with acute burns who were admitted to our burn center from 1972 through, 1975, thirty-six required upper airway access within the first 24 hours after burn for oral and facial burns or smoke inhalation. Nasotracheal intubation was initially used. Twelve survived; 11 were successfully extubated and one required a tracheostomy. If the patient had not sustained major smoke inhalation, extubation was usually possible without tracheostomy when edema subsided between one and six days after the burn. It is concluded that endotracheal intubation is a satisfactory method of gaining airway control in severe oral and facial burns and in smoke inhalation. The mortality associated with orofacial burns or smoke inhalation is related to the degree of lung damage, patients' s age, and the extent of the burn; it is not related to the method of upper airway control.