Impacts of intelligent monitoring technology installation and additional modalities on hand hygiene compliance in a burn center: A quasi-experimental longitudinal trial.

BACKGROUND: The increasing development of intelligent technologies for hand hygiene (HH) compliance audit has the potential to create an alternative to direct observation (DO), which is still considered the gold standard but has disadvantages such as lack of standardized monitoring practices, Hawthorne effect, insufficient sample size, and time/resource consumption. We aimed to share our preliminary results on the impacts of intelligent monitoring technology installation (IMTI) and additional modalities on healthcare workers' (HCWs') HH compliance in a Burn Center, according to the "5 Moments of HH" concept defined by the World Health Organization (WHO). METHODS: A quasi-experimental longitudinal trial was conducted over eleven months.The first phase of the three-stage study evaluated basic HH compliances obtained by DO. The system-defined HH performances, which IMTI recorded, were assessed in the second phase. Finally, the effect of IMTI and additional modalities was determined in the third stage. RESULTS: 15202 HH events were performed by 41 HCWs, and a total of 20095 HH opportunities were observed. Four hundred fifty-five opportunities were in the preinstallation phase, and 19640 were during the total post-installation period. IMTIdefined performance rates in both Phase 2 (71.2%) and Phase 3 (80.5%) were generally considerably higher than HH compliances obtained from DO (58.5%). Nurses, physical therapy /anesthesia technicians, and housekeeping personnel showed significant increases, which was insignificant in physicians in phase 2. Meanwhile, a sustained increase was observed regarding IMTI and additional modalities of HH compliance of all HCWs in Phase 3. CONCLUSION: IMTI has significantly increased HH performance rates. Furthermore, combining the IMTI with additional modalities as components of a multimodal strategy recommended by WHO appears to affect the sustainability of the increasing trend of HCWs' HH compliance.

Analysis of Inpatient Burn Patients Treated After the February 2023 Kahramanmaras Turkiye Earthquake and Examination of the Burn Profile According to Injury Time.

On February 6, 2023, a 7.7 and about 9 hours later, a 7.6 Richter's scale earthquake struck south of Turkiye, affecting more than 9 million people in 11 cities. This study aims to assess injury mechanisms, patient characteristics, and the outcome related to the earthquakes and the newly emerging living conditions. This study was conducted between February 6, 2023, and May 6, 2023, in a referral burn center. Patients who experienced burns either during the earthquakes or within three months in the region were included. The patient characteristics, time and place of burn injury, etiology, latency time to hospital admittance, outcome, and mortality were evaluated retrospectively. Sixty-three patients were included in our study cohort with a mean age of 21.84±20.3 years. The burned total body surface area was 15.56±20.3%. The burns that occurred during the earthquakes were mainly minor scalds, but the median time to hospital admission was 55 hours. The burns after the first week to the end of day forty-five were mainly flame burns that occurred in tents. The following burns up to the end of the third month included flame burns resulting in high mortality, and electrical burns mainly occurred during the restoration of the destroyed environment. In major disasters like earthquakes, burns during catastrophes are inevitable. Accommodating survivors in fireproof tents will be essential for avoiding fatalities from fires. In the restoration period of the settlements, the workers should be adequately informed about precautions when dealing with electric transmission lines.

Elderly burns: Clinical frailty scale and functional ambulation classification in predicting prognosis.

BACKGROUND: The study was to investigate the role of mobility and frailty in predicting the prognosis of elderly burns along with the burn severity. METHODS: In this retrospective study, 67 patients aged 65 and over who were hospitalized between October 1, 2017, and Septem-ber 30, 2020 in our burn center are included in the study. The demographic data, etiological data, clinical variables, the percentage of burned total body surface area (TBSA), Abbreviated Burn Severity Index (ABSI), Functional ambulation classification (FAC) scores, and Clinical frailty scale (CFS) scores are evaluated. RESULTS: Mean age of the study population was 71.58±7.4 years and most of the patients were female (65.7%). The percentage of TBSA was 11.34±12.2. The flame burns were the most common etiology (87.5%) of deaths (n=8), whereas 52.5% of the survivors were scalds. Most of the survived patients were functional ambulatory (93.2%). On the other hand, only 25% of patients who died were functional ambulatory (p<0.001). Also, 83% of the survivors were normal according to CFS scoring, whereas 25% of the patients who did not survive were vulnerable and 75% was frail (p<0.001). CONCLUSION: The percentage of elderly burns is low, yet the mortality is high in these patients which emphasize the importance of elderly burns. The ABSI is of great help, but ambulation status and comorbid diseases should be taken into consideration in terms of elderly burns. The current study demonstrated that FAC and CFS will be helpful to better predict the outcomes of elderly burn patients along with ABSI.

Clinical outcome of pediatric hand burns and evaluation of neglect as a leading cause: A retrospective study.

BACKGROUND: Majority of the pediatric burns happen when an adult is nearby the child. This suggests the role of adult carelessness or neglect as a cause of burns. The aim of this study is to provide clinical data on pediatric hand burns and to draw attention to the role of neglect in pediatric burn injuries. METHODS: Children admitted to a tertiary burn center between September 2017 and October 2018 were included in the study. Epidemiological data including age, sex, etiology and place of injury, presence of caregiver nearby, physical signs of neglect or abuse, clinical outcomes including burned total body surface area, length of admittance, and complications were recorded. RESULTS: A total of 335 pediatric burns were admitted to the burn center. Among them 89 patients with hand involvement were included in the study. Most of the patients were under the age of 6 (79.8%) and 88.8% of the burn accidents occurred indoors. Scalding was the main mechanism for hand burns. There was an adult nearby in 71.9% of the patients. Among patients with hand involvement, 19 (21.35%) were considered as neglect. All the neglect cases were under the age of 6. CONCLUSION: Pediatric burn accidents occurred mainly at home, mostly with an adult around. Habits of drinking hot beverages, dangerous cooking practices and lack of awareness are some important issues leading to burn accident. Neglect is found in 21.35% of hand burns as the etiology. In addition to general preventive measures special attention should be paid to the signs of neglect in the evaluation of patients. These burns should also be reported to official services, as they may reflect inadequate supervision or neglect by the caregiver.

Epidemiology and outcome of 1442 pediatric burn patients: A single-center experience.

BACKGROUND: Burns are common injuries among children resulting with significant mortality and morbidity, especially in developing countries. Epidemiological data may guide for the preventive measures and contribute reducing the incidence of burns in children. The aim of this study is to report the epidemiological features of pediatric burn patients treated in a tertiary burn center and to suggest preventive measures. METHODS: Between January 1, 2015, and June 30, 2019, a total of 1442 children hospitalized in our burn center were evaluated retrospectively. Demographic, epidemiological, and clinical data including burn etiology, percentage of burned total body surface area (TBSA), hospital stay, infection, and mortality rate were reported. RESULTS: The percentage of burned TBSA was 11.23±10.70 and the length of hospital stay was 14.38±18.1 days. In total, 89.18% of the patients (n=1286) experienced burn injury indoors. With regard to the etiology, scalding with hot water and tea was the most common in all age groups. Flame burn incidence increases after infancy, and electrical burns occur more in school age. A total of 10 patients (0.69%) were died and seven of them were delayed referrals from other hospitals. CONCLUSION: Infants and males consist of the majority of our pediatric burn patients. The percentage of burned TBSA and length of hospital stay increased as the patient age increased. Childhood burn injuries are mainly scald burns that occur indoors, while their parents were nearby. Therefore, education programs focusing on primary prevention addressing family members are required to avoid pediatric burns.

Infections in Patients With Major Burns: A Retrospective Study of a Burn Intensive Care Unit.

Burn-related infections are challenging conditions to manage and can cause several complications entailing a complicated treatment. In this study, infection in burn patients hospitalized in burn intensive care unit (ICU) of a tertiary care hospital is investigated. This retrospective study was conducted between January 1, 2018 and December 31, 2020 in burn ICU of a tertiary care hospital. Patients with an ICU stay less than 48 hours and survival less than 72 hours were not included in the study. The demographic and clinical data as well as referral status, the type of infections and the isolated microorganisms, antibiotics used for prophylaxis, outcomes, and the mortality rate are evaluated retrospectively from patient files and the hospital registries. A total of 311 patients were included in our study cohort with a mean age of 22.11 ± 20.9 years. The burned TBSA was 28.07 ± 17.1 and abbreviated burn severity index was 5.76 ± 2.3. There were 155 patients with 283 infections and the infection rate was 45.8 per 1000 patient days. The most commonly isolated microorganisms were Candida species in bloodstream and urinary tract infections, Pseudomonas aeruginosa in burn wound infections. Most of the deaths (86.7%) occurred in patients with infections. In major burns strict adherence to isolation procedures, avoiding delays in referrals, early excision, and early wound closure are important measures to reduce infections. Each burn center should develop appropriate antibiotic strategies due to their culture results and prophylaxis with broad-spectrum antibiotics should be avoided.

Most Prominent Factors Contributing to Burn Injury-Related Amputations: An Analysis of a Referral Burn Center.

Amputations are uncommon surgical procedures in patients with severe burn injuries. However, these patients often face extreme physical and psychological challenges that result in social stigmatization and inadequate rehabilitation facilities. A retrospective cohort study was designed for the patients admitted to the Burn Center of Adana City Training and Research Hospital (ACTRH). During the study period, 2007 patients aged 0.5 to 92 years were hospitalized at the burn center from January 2016 to June 2020. The incidence of amputation observed among inpatient burn injuries regardless of the etiology was 1.9%, and 87.2% were male. The univariate and multivariate logistic regression analyses were performed to detect the most prominent factors contributing to burn-related amputations. Considering the leading factors of amputations in patients with severe burns, the cause of burns appears to be one of the main factors in past research, and electrical burns were prominent in this context. Also, "the fire-flame-related burns," "full-thickness burns," "the presence of infection," "male gender," "patients within the 18 to 64 age group," and "the burns involved 10% to < 50% of total body surface area (TBSA)" were found to be the most prominent factors of amputations among patients having severe burns. Although they are rare, amputations related to burns commonly cause a decrease in quality of life. Therefore, besides increasing occupational health and safety methods for these risk groups, especially for adults of working age; also, it is essential to increase the importance and awareness of the precautions to be taken in daily life.

Telemedicine in burn patients: reliability and patient preference.

INTRODUCTION: Burn care is demanding and time intensive. After initial evaluation and treatment, remote follow-up of suitable patients might reduce the on-site workload and efficiency. In this study, the reliability of telemedicine assessment of burn patients and preference of patients to use telemedicine was investigated. METHODS: The study was designed as cross-sectional, and included 100 acute burn patients admitted to our burn service between 1 December 2018 and 31 May 2019. Informed consent was obtained from the patients for imaging of the burn wound. Burn wounds were evaluated in the outpatient clinic by an experienced burn specialist, and lesion images that were sent using WhatsApp were evaluated by another. Patients were offered telemedicine follow-up using WhatsApp communication without being present. The data of assessments, demographic and epidemiological data, and reasons for preference of follow-up via telemedicine were examined. RESULTS: The mean age of our patients was 21.21 ± 21.7 years. The percentage of burned total body surface area was 3.66 ± 3.4 on examination and 3.44 ± 3.2 on WhatsApp and the level of concordance was very high (ICC = 0.993). The inter-rater reliability values for the face-to-face examination and telemedicine groups in terms of "burn depth" and "decision of hospitalization" was congruent. Of the patients, 61% did not choose follow up with telemedicine. Demand of face-to-face assessment by burn expert was the most common reason (60.7%). In 26 patients who chose to be followed up with telemedicine, the most common reason was "living distance from the burn center" (92.3%). The remaining 13 patients indicated they did not have a preference. CONCLUSIONS: In the assessment of burn wounds, telemedicine and face-to-face examination resulted in agreement in terms of burn depth, decision of hospitalization and percentage of total body surface area. Although WhatsApp is a reliable method, the majority of patients preferred a face-to-face follow-up. WhatsApp application can be used in remote follow up of eligible burn patients after giving brief information about the procedure.

Surgical and histopathologic outcomes of gastrointestinal stromal tumors.

BACKGROUND: Gastrointestinal stromal tumors are encountered more frequent as a result of increased imaging examinations. The purpose of the study is to define the patient profile, histopathologic and treatment outcomes of cases that underwent surgical treatment for neoplasms of the gastrointestinal tract and diagnosed as gastrointestinal stromal tumor. METHODS: The outcomes of 32 patients operated in our department of general surgery for tumors of the gastrointestinal tract and diagnosed as gastrointestinal stromal tumor between January 2014 and December 2019 are evaluated retrospectively from the medical records and hospital treatment registry. RESULTS: Within the study period a total of 32 patients were operated and diagnosed gastrointestinal stromal tumor. There were 19 male (59.4%) and 13 female (40.6) patients and the average age of the patients was 60.2 11.8 years. The average tumor size was 5.95 3.3 centimeters. The tumor localization was mainly the stomach (n=17) and the small bowel (n=11). Distant metastasis was detected in 6 (18.75%) patients, four of them in the liver and two in the peritoneum and omentum. In half of the cases (n=16) there were reactive lymph nodes and 5 (83.3%) of the metastatic patients were within them. CONCLUSION: Gastrointestinal stromal tumors are more frequently encountered by the surgeons with the help of imaging techniques. The primary treatment is surgery and the results are promising. Patients with reactive lymph nodes should be examined for metastasis. Chemotherapy with imatinib can be used for inoperable patients. Patients should be followed up with computed tomography. KEY WORDS: Gastrointestinal System, Histopathology' Stromal Tumor, Surgery.

Electrical burns and complications: Data of a tertiary burn center intensive care unit.

BACKGROUND: To review the records of electrical burn patients hospitalized in our burn intensive care unit (ICU) and to report the complications together with our treatment results. METHODS: Demographic data, burn mechanism, presentation, percentage of burn total body surface area (TBSA), abbreviated burn severity index (ABSI) scores, complications and treatment approaches of electrical burn patients admitted to our burn ICU between September 2017 and August 2018 were evaluated retrospectively in this study. RESULTS: Electrical burn injury patients consisted of 17.9% of the patients who were hospitalized in burn ICU (n=139). All patients were male, and the median age was 27.0 years. Twenty-three patients (92%) were burned with high voltage electricity. The median percentage of burn TBSA score was 20.0. Eight patients had an accompanying head, a vertebra or extremity injuries. Sixteen patients (64%) were injured at work. Sixteen patients (64%) recovered with complications. ICU stay and total hospital stay were significantly higher in the group that healed with complications (p=0.005 and p=0.001, respectively). However, no significant differences were detected in burn TBSA and ABSI scores. TBSA and ABSI scores were correlated with ICU and total hospital stay. CONCLUSION: The proportion of our electrical burn patients is higher than reported in the literature. Burn TBSA and ABSI scores seem unrelated to prognosis. As the majority of patients are burned with high-voltage electricity at work, these injuries can be reduced by following occupational safety principles. Because of the high rate of complications in electrical burns, an experienced health team in well-equipped centers should treat patients in accordance with updated guidelines.

Inpatient Data of Occupational Burn Injuries Treated at a Tertiary Burn Center.

Occupational burns are among the important causes of work-related injuries. We aimed to investigate the epidemiology and reasons of occupational burns and thereby to emphasize preventive measures. Between January 2017 and December 2018, the data of major occupational burn injury patients admitted to our burn center were evaluated in this cross-sectional retrospective study. During the study period 342 patients older than 16 years were admitted to the burn center. Among them 80 patients with occupational burns (23.4%) were identified. The mean age of the patients was 34.73 ± 12.3 years. Seventy-eight patients (97.5%) were male. Electrical burns and flame burns were the two leading type of occupational burns. The most common occupation of our patients was construction work. Dangerous behavior, carelessness, lack of protective equipment, and failure to follow instructions were causes of injury. Only 14 patients (17.5%) experienced unavoidable accident. Thirty-seven patients (46.3%) worked on temporary basis. Occupational experience was under 5 years in majority of the cases (62.5%). For the occupational burns the percentage of burned TBSA was 17.08 ± 14.5 (1-60) and the length of hospital stay was 23.94 ± 21.9 days (2-106). There were no significant differences between occupational and nonoccupational burn injuries considering TBSA, total length of hospital stay, and complications (P > .05). Occupational burn injuries are common in less experienced and younger workers. Therefore, recognition of the problem and maintaining awareness is important. In order to prevent occupational accidents and burns, occupational health and safety rules must be obeyed.