A pilot study of the use of biocide-impregnated gauze as an adjunct to wound care in a burn population.

The aim of this study was to evaluate the use of a polyhexamethylene biguanide biocide-impregnated gauze (Kerlix™ AMD gauze dressing, Covidien d/b/a Tyco Healthcare Group LP) as an adjuvant to routine burn care and its impact on the incidence of hospital-associated infections in burn population. One hundred eight burn patients admitted to the Burn Treatment Center were prospectively enrolled from August 2008 to June 2009 and matched 1:2 with historic controls who were admitted from March 2006 to July 2008. Clinical care remained otherwise unchanged; however, several hospital initiatives (the national surgical improvement project, the surgical care improvement project, and a central venous line bundle) were initiated before and during the study. There were significantly less infections in the study population (18.52% of case patients vs 28.70% of control patients had infections, P = .047). Although there was a decrease in each infection subtype analyzed, a statistically significant reduction was only reached for pneumonias (1.85% in cases vs 5.86 in controls, P = .042). Implementation of polyhexamethylene biguanide biocide-impregnated gauze was temporally correlated with a significant decrease in healthcare-associated infections in burn population. As there was no corresponding decrease in wound infections, the impact of the gauze on healthcare-associated infections, if any, cannot be conclusively determined by this study. A larger prospective study powered to detect a decrease in wound-related infections is warranted.

Risk factors for acquiring vancomycin-resistant Enterococcus and methicillin-resistant Staphylococcus aureus on a burn surgery step-down unit.

The incidence of hospital-associated infections secondary to methicillin-resistant Staphylococcus aureus (MRSA) and those caused by vancomycin-resistant enterococci (VRE) continue to increase, despite the publication of evidence-based guidelines on infection control. We sought to determine modifiable risks factors for acquisition of MRSA or VRE or both on a burn trauma unit (BTU). We performed a retrospective single-center-matched control study. Our study group comprised 94 patients who acquired MRSA or VRE or both while on the BTU from January 1, 2001 to December 31, 2005. The case-patients were matched 1:1 to control-patients based on the time the cases were exposed to the BTU before they became colonized or infected. Logistic regression was used to analyze the relationship of demographic, procedure, and antimicrobial exposure variables to acquisition of MRSA or VRE. Acquisition of MRSA or VRE was related to patient factors, antimicrobial exposure, and device use. Younger age and prior vancomycin treatment while on the BTU were independently associated with MRSA acquisition. The presence of a Foley catheter was related to VRE acquisition. Sixteen study patients (17.0%) who became colonized on the BTU subsequently acquired 17 infections: six patients had MRSA bloodstream infections, nine had MRSA burn wound infections, and two had VRE urinary tract infections. Younger age, exposure to vancomycin, or Foley catheters were associated with increased risk of acquiring MRSA or VRE. Protocols or algorithms that help physicians remember to assess the necessity of antimicrobial agents and devices may help limit the duration of exposure to these risk factors, which may enhance infection prevention efforts. Future studies need to explore the effect of these variables on cross-transmission and their impact predominately in a burn unit.

Effectiveness of universal screening for vancomycin-resistant enterococcus and methicillin-resistant Staphylococcus aureus on admission to a burn-trauma step-down unit.

Vancomycin-resistant enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) are significant healthcare-associated pathogens. We sought to identify factors that could be used to predict which patients carry or are infected with VRE or MRSA on admission so that we could obtain cultures selectively from high-risk patients on our burn-trauma unit. We conducted a case-control study of patients admitted to our burn-trauma unit from September 2000 to March 2005 who were colonized or infected with either VRE or MRSA (cases) and patients who were not colonized or infected with one of these organisms (controls). We used logistic regression to construct a model that we subsequently validated based on data collected prospectively from patients admitted from September 2006 to August 2007. In the case-control study, colonization or infection with MRSA or VRE on admission were independently associated with the total days of antimicrobial treatment, age, prior hospitalization, prior operations, and admitting diagnosis (admission for a burn injury was protective). In the cohort study, a prior hospitalization with a length of stay>or=7 days and operations within the past 6 months were significantly associated with colonization or infection on admission. The latter model was 59.3% sensitive. If, we used this model to identify which patients should be cultured on admission, we would have missed 24 (39.3%) of the colonized or infected patients. These patients would not have been placed in isolation (434 missed isolation days, 71.0%) and may have been the source of transmission to other patients. Our model lacked the sensitivity to identify patients colonized or infected with VRE or MRSA. We recommend that units, which care for patients who are at high risk of hospital-acquired infection and having prevalence and transmission rates of VRE or MRSA similar to those in our study, screen all patients for these organisms on admission to the unit.

Population-based assessment of burn injury in southern Iowa: identification of children and young-adult at-risk groups and behaviors.

Although nonfatal burn injuries vastly outnumber fatal injuries, their epidemiology is not well defined. We sought to determine the epidemiology of nonfatal burn injuries in a largely rural region of a midwestern state to target intervention efforts at populations and injury mechanisms at risk. Data were retrospectively collected on a population-based sample of medically treated burn injuries in 10 counties in southern Iowa from 1997 to 1999 using International Classification of Diseases, 9th Revision, Clinical Modification codes (ICD-9-CM, Ncode 940-949) to identify burn-related emergency room visits from computerized lists. A total of 1430 emergency room visits were identified, with 1382 records available for review. Injuries were grouped into etiology subcategories to better delineate common mechanisms and determine methods of prevention. Scald and hot-object contact and flame-related injuries were the leading causes of burn injury. Scald and contact injuries were subdivided into three major sets of scenarios, scald and contact injuries related to household food preparation and consumption, work-related scald and contact injuries. and injuries resulting from contact with nonfood and nonbeverage-related household objects. Children ages 0 to 4 had the highest population-based scald and hot-object contact injury rate of all age groups, with an average annual incidence rate of 35.9 per 10,000. Injuries in this age group were most commonly related to household objects (34.7%) followed by food preparation (25.3%). Children and young adults ages 5 to 24 were also the most likely to be injured by flame and fire-related causes secondary to open fires. Nonfatal burn injuries typically afflict children and young adults in definable patterns, suggesting intervention strategies. Future studies need to better delineate the contributing factors associated with these injuries to refine the intervention strategies.