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Dear Readers: Patients hospitalized with burn wounds face special challenges. Host, environmental, and organism factors increase burn patient risk of developing infection and may prolong the course of infection, once acquired. For example, host immune, circulatory, and respiratory systems are often compromised. Most admitted burn patients have third-degree or full-thickness burns, requiring granulation and/or grafting for acceptable repair. The zone of necrosis surrounding the burned tissue may continue to expand for up to 48 hours after injury, enlarging and deepening the path for pathogen invasion. Hospital environments may contain resistant strains of pathogenic organisms. Recent research summarized below provides insight into addressing these challenges, shortening hospital stays, and reducing the likelihood of hospital-acquired infections in patients with burn wounds.
The Evidence for Burn Wound Excision
Reference: Ong YS, Samuel M, Song C. Meta-analysis of early excision of burns. Burns. 2006;32(2):145–150.
Rationale: Treatment with early excision and grafting is reported to have improved burn wound patient outcomes significantly since its inception. It is time for a close look at what aspects of efficacy early excision and grafting improve and the safety issues clinicians face in performing these procedures.
Objective: The objective of this study was to compare effects of early excision and grafting versus conservative treatment on a variety of outcomes for burn patients to clarify efficacy and safety of early excision and grafting.
Methods: The authors conducted a meta-analysis of randomized controlled trials (RCTs) found in MEDLINE, EMBASE, and Cochrane database searches from 1966–2004 comparing early excision and grafting to conservative management of burn patients. Six of the identified 15 RCTs met the inclusion criteria. Outcomes measured included mortality, operating hours, complications of surgery, burn wound healing time, duration of sepsis, length of hospital stay, blood transfusion requirements, and long-term morbidity including joint contractures and hypertrophic scarring.
Results: Early excision was associated with lower mortality in patients without inhalation injury and shorter hospital stays for all burn patients. Patients treated with early excision also had more blood transfusions than those receiving traditional care. The evidence was insufficient to draw clear conclusions regarding effects on healing time, duration of sepsis, or skin graft take.
Conclusion: Early excision reduces mortality in burn patients without inhalation injury and shortens hospital stay for all burn patients. The only significant drawback is that early excision results in greater blood loss than is experienced during traditional burn care.
Reducing Hospital-Acquired Infections in Burn Patients
Reference: Wibbenmeyer L, Danks R, Faucher L, et al. Prospective analysis of nosocomial infection rates, antibiotic use, and patterns of resistance in a burn population. J Burn Care Res. 2006;27(2):152–160.
Rationale: Infection remains a major cause of morbidity and mortality in burn patients despite major advances in burn care. There is a need to identify and alleviate causes of hospital-acquired infection in patients hospitalized with burns.
Objective: The objectives of this study were to determine accurate infection rates in hospitalized burn patients, including those caused by resistant organisms, and identify risk factors for infection and interventions to decrease antimicrobial drug use.
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