Examining the Rates of Anxiety, Depression, and Burnout Among Providers at a Regional Burn Center.

Burnout, defined by feelings of inefficacy, cynicism, and emotional exhaustion, affects the performance and well-being of health care providers. Burn care exposes providers to factors known to cause or worsen burnout, but no research has presented prevalence rates of burnout in this population. We estimate the rates of anxiety, depression, and burnout among nonphysician providers in a regional burn center and compare those rates to a reference population of critical care nurses. In our sample of 22 providers, 64% screened positive for anxiety; 32% for depression; 82% for emotional exhaustion; 18% for personal achievement burnout; and 54% for depersonalization. When compared with a national sample of critical care nurses, burn center providers demonstrated a significantly higher rate of anxiety (risk difference [RD]: 0.453, 95% confidence interval [CI] [0.244, 0.622]), a significantly higher rate of emotional exhaustion (RD: 0.207, 95% CI [0.001, 0.323]), and a significantly lower rate of personal achievement burnout (RD: -0.325, 95% CI [-0.442, -0.119]). These findings constitute the first evidence that many burn care providers meet criteria for burnout and that burnout in burn care providers may qualitatively differ from burnout in other critical care providers. Future research should identify burn care-specific predictors of burnout and determine the feasibility and efficacy of interventions to prevent and reduce burnout in burn care providers.

A polymicrobial fungal outbreak in a regional burn center after Hurricane Sandy.

OBJECTIVE: To describe a polymicrobial fungal outbreak after Hurricane Sandy. DESIGN: An observational concurrent outbreak investigation and retrospective descriptive review. SETTING: A regional burn intensive care unit that serves the greater Baltimore area, admitting 350-450 burn patients annually. PATIENTS: Patients with burn injuries and significant dermatologic diseases such as toxic epidermal necrolysis who were admitted to the burn intensive care unit. METHODS: An outbreak investigation and a retrospective review of all patients with non-candida fungal isolates from 2009-2016 were performed. RESULTS: A polymicrobial fungal outbreak in burn patients was temporally associated with Hurricane Sandy and associated with air and water permeations in the hospital facility. The outbreak abated after changes to facility design. CONCLUSIONS: Our results suggest a possible association between severe weather events like hurricanes and nosocomial fungal outbreaks. This report adds to the emerging literature on the effect of severe weather on healthcare-associated infections.

Use of Implementation Science for a Sustained Reduction of Central-Line-Associated Bloodstream Infections in a High-Volume, Regional Burn Unit.

OBJECTIVE We describe the use of implementation science at the unit level and organizational level to guide an intervention to reduce central-line-associated bloodstream infections (CLABSIs) in a high-volume, regional, burn intensive care unit (BICU). DESIGN A single center observational quasi-experimental study. SETTING A regional BICU in Maryland serving 300-400 burn patients annually. INTERVENTIONS In 2011, an organizational-level and unit-level intervention was implemented to reduce the rates of CLABSI in a high-risk patient population in the BICU. At the organization level, leaders declared a goal of zero infections, created an infrastructure to support improvement efforts by creating a coordinating team, and engaged bedside staff. Performance data were transparently shared. At the unit level, the Comprehensive Unit-based Safety Program (CUSP)/ Translating Research Into Practice (TRIP) model was used. A series of interventions were implemented: development of new blood culture procurement criteria, implementation of chlorhexidine bathing and chlorhexidine dressings, use of alcohol impregnated caps, routine performance of root-cause analysis with executive engagement, and routine central venous catheter changes. RESULTS The use of an implementation science framework to guide multiple interventions resulted in the reduction of CLABSI rates from 15.5 per 1,000 central-line days to zero with a sustained rate of zero CLABSIs over 3 years (rate difference, 15.5; 95% confidence interval, 8.54-22.48). CONCLUSIONS CLABSIs in high-risk units may be preventable with the a use a structured organizational and unit-level paradigm. Infect Control Hosp Epidemiol 2017;38:1306-1311.

Cody.

Advances in burn management over the past 2 decades have resulted in improved survival and reduced morbidity. The treatment of a single patient following a 90% total body surface area injury illustrates the intensity of labour and coordinated hospital care required for such catastrophically injured patients. Data were extracted from the medical records and from personal recollections of the individual members of the multidisciplinary team as well as from the patient. The clinical course and management of complications are described chronologically as a series of overlapping phases from admission to discharge.