Abstract
BACKGROUND Patients with burn wounds are at increased risk for HABWI due to loss of the protective skin barrier and depression of immune system function. Infection prevention practices help to mitigate HABWI risk in this population. The aim was to determine the frequency, causative organisms and risk factors for HABWI, and to assess compliance with standard infection prevention practices in a burn unit at an Egyptian university hospital. METHODS This was a prospective cohort study of 83 patients admitted to the burn unit for at least 48?hours from October 2015 to March 2016. HABWI were identified by clinical signs and symptoms, and culture results. Risk factors for HABWI, including gender, residence, smoking, drug abuse, type of care, Diabetes Mellitus, presence of a septic focus, burn wound depth, and total body surface area of burn were assessed. Infection prevention practices were observed during clinical care. RESULTS The incidence of HABWI was 63.9%, the most common causative organism was Klebsiella (47.5%). Rural residence (69.9%), diabetic patients (86.7%), current septic focus (84.2%), use of hydrotherapy (100%), large burn wounds (>30% body surface area) and deep wounds (90.3%) were associated with HABWI. Hand hygiene compliance (44%), and personal protective equipment (PPE) compliance (50%) were sub-optimal. CONCLUSIONS The study revealed a high frequency of HABWI among patients with large or deep burn wounds. Some opportunities for improvement include improving hand hygiene, adherence to contact precautions, and assuring appropriate disinfection of hydrotherapy equipment. Clinically, managing comorbidities such as diabetes may be important to decreasing HABWI risk. Our study highlights the importance of educating healthcare workers about infection prevention and cleaning and disinfection of equipment, controlling comorbid conditions and monitoring adherence to these processes.
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