Burn Ward Research Articles

Burn Ward.

Burn Ward.

Modifying burn care in a low- and middle-income countries (LMIC) to meet global best practice: A burn unit or burn isolation ward?

The overwhelming burden of burns in low-income (LIC) and low-middle-income (LMIC) countries has been well-documented. Though best global practice is for major burns to be treated in burn units, the prohibitive cost makes it difficult. In this article we attempt to present the improvement in outcome recorded over a period of 3 years as we transitioned from nursing our burns patients in the general surgical wards (Group A), then a separate cubicle within the wards (Group B) and then an isolated burn ward (Group C). Other practices such as physiotherapy, traditional wound dressings, and limb splinting remained the same.Data of patients who met criteria for burn unit admission during these periods were analysed and compared. The groups were matched across age, depth of burn, total body surface area burned (TBSA) and length of hospital stay (LOHS). There was an improvement in the lethal area 50% (LA50) at 31.1 %, and in mean LOHS of 18 ± 3.8 days in group C.Most LICs and LMICs do not have functional health insurance schemes for burns patients and overall resources allocated for healthcare cannot support a state-of-the-art burn unit. Our report attempts to encourage such countries to adapt global practice to their economic reality. Minimal changes like an isolated burn ward, separate shower room for wound dressings, strict hygiene practices, and limiting visitor traffic may go a long way to improve burn patient outcome.

Timepoint for return to occupations post-burn injury using the Canadian Occupational Performance Measure (COPM).

The Canadian Occupational Performance Measure (COPM) was implemented at a state-wide burns service to ensure compliance with current best evidence as outlined by the Australian and New Zealand Burns Association 'burn trauma rehabilitation: allied health practice guidelines'- Chapter 7 Measuring Post-Burn Recovery, as a standard outcome measure for individuals with an admission time greater than 24 h. The primary aim of this study is to determine if individuals have a minimal important change in performance and satisfaction with activities that were identified as problematic on the COPM prior to their acute discharge. Previous research confirmed the feasibility of using the COPM in the acute burn ward and recommended the most appropriate timepoint for re-measurement be confirmed, which is the secondary objective of this study. The benefits of confirming this timepoint include ensuring efficient use of clinicians' time without compromising the accuracy of the assessment and ensuring effective translation of the guidelines' recommendation. A prospective longitudinal study was undertaken, where all individuals who previously completed a COPM prior to acute discharge were sought to complete a re-assessment while accessing outpatient services. Time frames for re-assessment were open. Only individuals who were actively receiving occupational therapy outpatient services were included. COPM assessments were completed in person where possible, particularly for participants who required an interpreter, with phone and video calls also used when needed. A total of 37 participants were included, with the timeframe between initial and post-COPM assessment ranging from 2 to 643 days. Outcomes plateaued at approximately 12 months (365 days) post-initial measurement (prior to discharge from acute ward). The most common occupational performance goals that participants identified were returning to work, sport, and driving. 86.5% of participants increased their satisfaction with these activities. The results of this study demonstrate improvements across the domains of performance and satisfaction occur for individuals with burns at approximately 3 months and 12 months post-injury. Based on this study, it is suggested that when using the COPM assessment in a tertiary burn setting, re-measurement be completed no earlier than 3months and later than 12 months from burn injury, or upon discharge from the service. The findings from this study will be translated into clinical practice at this facility.

Tigecycline is the Most Effective against Multi-Drug Resistant Klebsiella pneumoniae Recovered from Burn Wound Infections in Two Hospitals in Al-Kut City, Iraq

Klebsiella pneumoniae is among the most frequent microorganisms isolated from infections of burn wounds. This cross-sectional study aimed to investigate the distribution of multi-drug resistant (MDR) K. pneumoniae in two burn hospitals and the antibiotic resistance profile in different burn regions of the same patient. It was performed in two hospitals (Al-Zahraa and Al-Karama) in Al-Kut, Iraq, between January and May 2022. Totally, 100 burn swabs were collected from 40 patients of both genders suffering from burn wound infections, with ages ranging between 3 and 50 years. Klebsiella pneumoniae were isolated and identified using conventional methods followed by VITEK®2 system and confirmed via polymerase chain reaction targeting the gapA gene. Then, the antimicrobial susceptibility pattern was studied by the VITEK®2 system. Of the 100 burn wound swabs, 20 isolates were K. pneumoniae. Fifty five percent (11 out of 20) of K. pneumoniae isolated in the current study were MDR and 35% of the isolates had the extended spectrum beta-lactamase (ESBL) which is the main antibiotic resistance mechanism. Furthermore, the bacteria isolated from different burned areas of the same patient showed variable pattern of antibiotic susceptibility. To conclude, K. pneumoniae contaminating the burn wards in the Iraqi hospitals are mostly MDR, against which tigecycline is the most effective antibiotic.

Pseudomonas Aeruginosa Prevalence, Antibiotic Resistance and Antimicrobial use in Burn Wards from Nagpur City of Maharashtra

Pseudomonas Aeruginosa Prevalence, Antibiotic Resistance and Antimicrobial use in Burn Wards from Nagpur City of Maharashtra

The Perceived Informational Needs of Family Caregivers of Children Hospitalized in a Burn Department: A Cross-sectional Study.

Children are most vulnerable to burn injuries, and their families are their most important source of support. Therefore, it is necessary to identify the information needs of such parents and support them to help children adapt to the new situation, recover to pre-accident conditions, and reintegrate into school and society. This study aimed to investigate the perceived information needs of family caregivers of children admitted to the burn wards of hospitals. This cross-sectional study was conducted on 200 family caregivers of children admitted to the burn ward of a hospital in Tabriz, Iran. Participants were selected through convenience sampling, and the required data were collected by using questionnaires on socio-demographic information, information needs, information resources, and information acquisition methods. The obtained data were analyzed statistically using descriptive statistics (mean, standard deviation, frequency, and percentage) and inferential statistics (Mann-Whitney, Kruskal-Wallis, and Spearman correlation tests). Results indicated that the greatest informational need among family caregivers was related to the child's condition. The treatment team was identified as the most important source of information for them. It was found that information should be provided in a comprehensive and understandable manner, while maintaining honesty and human dignity. The study findings contribute to our understanding of the specific information needs of family caregivers in managing the medical care of children with burns. These findings can serve as a basis for interventions and support services aimed at meeting the needs of these families and improving the quality of care for children with burns.

Epidemiological and cost analysis of burned patients in Iran

IntroductionConsidering the financial support provided by insurance and the government for burn patients in Iran, and recognizing the substantial economic impact associated with their treatment, there is a pressing need to delve into the epidemiology of these patients and analyze the related costs. This study aims to explore the epidemiological aspects and hospitalization costs of burn patients specifically within the burn ward of Imam Reza 68-bed Hospital in Mashhad, a regional center of referral in the eastern part of the country. MethodsData had extracted from the electronic data collection system, which is used on a daily basis in the hospital. We included patients with a primary or secondary diagnosis of burns, code T20.0-T32.9 and T95 according to the International Classification of Diseases ICD-10. Ultimately, 1151 patients were included in the study. We analyzed 1151 burn cases in terms of patients’ age at the time of the event, gender, type of burn (Chemical, scalds, flame, electrical and contact burns), anatomical location of the burn (head and neck, upper limb, lower limb, multiple regions and part unspecified), burn etiology, burn degree (I, II, III), total burn surface area (%TBSA), Inpatient ward, expenditure ($), burn mortality rate and length of hospitalization. The age group was divided into seven groups by the 10 years intervals. Statistical analysis of the data was performed using SPSS-16 and Excel software. Results1151 patients were included in the study. High-risk groups are pediatric up to nine (0–9) years. According to age, we found that most cases were children, respectively, 25% (291) cases. Men accounted for 743 cases (65%), women for 408 (35%). Major causes of severe burn injury were flame burns (49%) and scalds (43%). Unspecified was the most common burn location (40%), followed by the multiple regions (23%) and upper limb (11%). In cases of head and neck burns, the financial burden on the patient is elevated compared to other types of burns due to increased expenses for medications, disposable medical instruments, and hoteling. The main items for the burned patients are hoteling (38% of total costs), surgeon (24%), medicine (16%), and medical consumables (6%). The per capita expenditure was $9,365 ± $8,100 in pediatrics and $11,179 ± $10,180 in adults Conclusions: Most cases of death were related to burn in multiple areas of the body and then trunk burn (30% and 19%, respectively) and no death was observed in patients with hand and wrist burn. Burns can be incredibly severe and life-threatening, especially when they affect multiple areas of the body, such as the trunk and any burn injury is still a serious matter. It's important to prioritize fire safety and take precautions to prevent such accidents from happening.

Characterization of class 1 integrons in metallo-β-lactamase-producing Acinetobacter baumannii isolates from hospital environment

Background and ObjectiveThe emergence and widespread dissemination of antibiotic resistance in A. baumannii, has become a globally challenge. The increasing hospital outbreaks by multi-drug resistant (MDR) A. baumannii strains, shows the necessity of continuous monitoring to find sources of resistant strains in hospitals. This study aimed to identify the presence of class 1 integrons and metallo-β-lactamase (MBL) related genes in A. baumannii isolates from hospital environment.MethodsIn order to identify A. baumannii isolates, a total of 297 environmental samples were collected from burn wards and intensive care units (ICUs) of two university hospitals. Resistance to common antibiotics was studied by disk diffusion method and microbroth dilution assay was used to determine the minimum inhibitory concentrations (MICs) of imipenem, colistin and tigecycline. The A. baumannii isolates were studied by polymerase chain reaction (PCR) for the presence of class 1 integrons (intI1, intl CS) and metallo-β-lactamases (MBLs) (blaIMP, blaVIM, blaNDM) genes.ResultsA. baumannii was identified in 68/297 (22.9%) of hospital environment. All A. baumannii strains were multidrug-resistant (MDR), but none of them were resistant to colistin, tigecycline and ampicillin-sulbactam. All (100%) and 38 (95.0%) of A. baumannii isolates from ICUs and burn wards were imipenem resistant respectively. Class 1 integrons was identified in 30/40 (75.0%) and 23/28 (82.1%) isolates from burn wards and ICUs respectively. Two different types of gene cassettes were identified, which included: arr-2, ereC, aadA1, cmlA5 and arr2, cmlA5. MBL genes including blaVIM and blaIMP were detected in 26/28 (92.8%), 27/28(96.4%) and 39/40 (97.5%) and 31/40 (77.5%) of the isolates from the ICUs and the burn wards respectively. None of the isolates contained the blaNDM−1 gene.ConclusionThe findings of the present study showed that the isolation rate of MBL producing carbapenem-resistant A. baumannii (CRAB) was relatively high in the environmental surface of burn wards and ICUs, which can be considered as a potential source of outbreaks in hospitalized patients.

Healthcare provider perspective on barriers and facilitators in the care of pediatric injury patients at a tertiary hospital in Northern Tanzania: A qualitative study.

Pediatric injuries are a leading cause of morbidity and mortality in low- and middle-income countries (LMICs). The recovery of injured children in LMICs is often impeded by barriers in accessing and receiving timely and quality care at healthcare facilities. The purpose of this study was to identify the barriers and the facilitators in pediatric injury care at Kilimanjaro Christian Medical Center (KCMC), a tertiary zonal referral hospital in Northern Tanzania. In this study, focus group discussions (FGDs) were conducted by trained interviewers who were fluent in English and Swahili in order to examine the barriers and facilitators in pediatric injury care. Five FGDs were completed from February 2021 to July 2021. Participants (n = 30) were healthcare providers from the emergency department, burn ward, surgical ward, and pediatric ward. De-identified transcripts were analyzed with team-based, applied thematic analysis using qualitative memo writing and consensus discussions. Our study found barriers that impeded pediatric injury care were: lack of pediatric-specific injury training and care guidelines, lack of appropriate pediatric-specific equipment, staffing shortages, lack of specialist care, and complexity of cases due to pre-hospital delays in patients presenting for care due to cultural and financial barriers. Facilitators that improved pediatric injury care were: team cooperation and commitment, strong priority and triage processes, benefits of a tertiary care facility, and flexibility of healthcare providers to provide specialized care if needed. The data highlights barriers and facilitators that could inform interventions to improve the care of pediatric injury patients in Northern Tanzania such as: increasing specialized provider training in pediatric injury management, the development of pediatric injury care guidelines, and improving access to pediatric-specific technologies and equipment.

Evaluating of the Synergistic Effect of three Essential Oils on the Virulence Factors (resistance gene) of Pseudomonas aeruginosa and Serratia fonticola Isolated from Wounds

Depending on the high resistance to antibiotics, five isolates of Pseudomonas aeruginosa and 7 isolates of Serratia fonticola were selected out of 150 bacterial isolates from burn wards in Baghdad hospitals, which were later identified by VITEK2. A susceptibility test was done by using 15 antibiotics. The results showed that all the selected isolates were resistant to antibiotics: AMP, CTX, CAZ, GEN, PIP, TIC and TMP especially, while they were sensitive to IPE. The essential oils of Aloysia citrodora (Family: Verbenaceae), Rosmarinus officinalis (Family: Lamiaceae) and Thymus vulgaris (Family: Lamiaceae) were extracted by the Clevenger. The synergistic effect of essential oils of these plants on bacterial growth were studied by determining the MIC of essential oils for P. aeruginosa and S. fonticola. The MIC concentration of P. aeruginosa was: 2500 ppm of A. citrodora, 2500 ppm of R. officinalis, 2500 ppm of T. vulgaris, whilst the synergistic effect of each two plants was:1250 ppm of A. citrodora with 2500 ppm of R. officinalis, 1250 ppm of A. citrodora with 312.5 ppm of T. vulgaris, 1250 ppm of R. officinalis with 156.25 ppm of T. vulgaris, whereas the synergistic effect of three plants was: 156.25 ppm of A. citrodora with 156.25 ppm of R. officinalis and 39.0625 ppm T. vulgaris. While the MIC concentration of S. fonticola was: 1250 ppm of A. citrodora, 5000 ppm of R. officinalis, 1250 ppm of T. vulgaris, whilst the synergistic effect of each two plants was: 1250 ppm of A. citrodora with 2500 ppm of R. officinalis, 1250 ppm of A. citrodora with 312.5 ppm of T. vulgaris, 1250 ppm of R. officinalis with 156.25 ppm of T. vulgaris, whereas the synergistic effect of three plants was: 312.5 ppm of A. citrodora with 312.5 ppm of R. officinalis and 78.125 ppm T. vulgaris. The results of bacterial gene expression showed that three isolates of P. aeruginosa had a mexB gene expression that ranged between 2.5 - 0.4 (concentration 1) and 2.8 to 0.6 (concentration 2). It increased in two isolates and decreased in one isolate. The melting point ranged between 90.91 - 91.280C compared with 89.89 to 90.330C for fbp gene. Whereas S. fonticola did not have blaKPc gene, instead it had blaTEM gene with the gene expression ranging between 2.4 - 0.1 (concentration 1) and 4.5 - 0.2 (concentration 2). The gene expression increased in two isolates and decreased in five isolates. The melting point ranged between 83.63 - 84.200C compared with 75.82 - 85.560C for gyrB gene.

A Study Investigating Factors Related to Self-Immolation and Its Association with Depression, Anxiety, and Stress in Women of Reproductive Ages

Background: Self-immolation is one of the most common methods of suicide among Iranian women. This study was designed and conducted to investigate factors related to self-immolation and its association with depression, anxiety, and stress in women of reproductive age.
 Methods: The present descriptive-analytical study was performed on self-immolated women admitted to the burn ward of Imam Khomeini Hospital in Urmia during the years 2021-2020 the nineteen women of reproductive ages were included in the study through convenience and census. Data collection tools included a demographic questionnaire and DASS-21.
 Results: The average age of the participants in this project was 29.57 ± 7.79 years. About half of the women lived in rural areas and lived in the house of their father-in-law and lived with him. And the wife's family stated. Most of them were married, housewives and Kurdish speakers had low incomes and economic status and undergraduate education, and most of them had set themselves on fire with oil. 89.5% of the participants had severe depression, 94.5% had severe anxiety, and 52.6% had severe stress.
 Conclusion: This study showed that the rate of depression, anxiety, and stress is high in women who have attempted suicide by self-immolation. It is suggested that special measures be taken to reform the culture of the northwestern region of the country to perhaps reduce the burden of the problems of women in this region.

The Relationship Between Safe Nursing Care and Professional Commitment of Nurses in Iranian Educational-Therapeutic Hospitals

Background: Safe nursing care and professional commitment are known as two important components influencing the nursing service quality. Objectives: The present study aimed to assess the relationship between safe nursing care and nurses’ professional commitment. Methods: In the present cross-sectional correlational research, 263 nurses were selected from the intensive care unit/cardiac care unit (ICU/CCU), internal, surgery, pediatrics, gynecology and obstetrics, oncology, burn, orthopedics, infectious, and neurology wards of educational-therapeutic hospitals affiliated with Qazvin University of Medical Sciences by quota sampling method between May 2022 and September 2022. Data collection was performed using the nurses’ professional commitment scale (NPCS) and the assessment of safe nursing care (ASNC) questionnaire. Nurses were selected using a convenience sampling method. The collected data were analyzed using descriptive and inferential statistical tests (t-test, Pearson’s correlation, and one-way analysis of variance (ANOVA)) by SPSS software version 16. Results: The mean scores of nurses’ professional commitment and safe nursing care were 86.16 ± 4.92 and 134.57 ± 16.15, respectively. Pearson’s correlation test showed a significant relationship between nurses’ professional commitment and safe nursing care (r = 0.345, P ≤ 0.001). Also, the test results indicated that the level of nurses’ professional commitment varied among individuals with different employment types (P = 0.008). Conclusions: According to this study, safe nursing care and nurses’ professional commitment are two important components influencing each other. Therefore, these results have important implications for policymakers and healthcare systems involved in promoting the level of safe nursing care and nurses’ professional commitment.

Evaluating the Performance of Inpatient Wards in Hospitals Affiliated with Birjand University of Medical Sciences Using the Pabon-Lasso Model in the Years before and during the COVID-19 Pandemic

Background: Evaluating the performance of hospitals will increase effectiveness, efficiency, and quality of services provided and improves responding to the customer. Performance indicators are the most widely used tools for measuring the performance of hospitals. The prevalence of Covid-19 pandemic has affected health care systems at various levels with significant implications for health, the economy, and social structures. Therefore, the present study evaluates the performance of inpatient wards of hospitals affiliated with South Khorasan University of Medical Sciences in the years before and during the COVID-19 pandemic.
 Methods: The current study was cross-sectional, which was conducted during the years before (2018-2019) and during the outbreak of COVID-19 (2020-2021). The research population included all inpatient departments of hospitals affiliated with Birjand University of Medical Sciences (28 departments). The performance of services was analyzed using data collection form, and through the Pabon Lasso model, the efficiency of the hospital was analyzed. Excel 2018 was used to draw Paben Lasso diagram, describe the data, and check the process of change. Service performance and change process before and during the COVID-19 pandemic were examined using SPSS22 software and Paired sample t-test statistical test (The significance level was determined at 0.05).
 Results: The results of this study showed that in the years before and during the COVID-19 pandemic, the functional ratios of bed occupancy percentage decreased by 29.20 %, the average patient stay increased by 6.90 %, and the annual bed turnover rate decreased by 32.80%. The results of paired sample t-test with a significance level of 0.05 showed that there was a significant relationship regarding the internal wards and CCU (Coronary Care Unit) between 3 functional indicators: bed occupancy percentage, bed turnover rate and average patient stay; there was no significant relationship in the burn ward. After examining the wards of kidney and urinary tract surgery, ear, nose and throat surgery, orthopedics, psychiatry, pediatrics, infectious diseases, general surgery, open heart ICU (Intensive Care Unit), neurosurgery, and cardiovascular surgery, 2 functional indicators of bed occupancy percentage and bed turnover rate, in the ICU ward, the functional index of the percentage of bed occupancy, and in the neonatal wards, the NICU (Neonetal Intensive Care Unit), the average length of patient stay showed a significant relationship. After examining the efficiency of the wards, the number of efficient districts changed from 32.14 to 28.57 %, and the number of inefficient districts changed from 25 to 28.57 %. Moreover, positive changes in the efficiency status of the open heart and neonatal ICU departments and negative changes in the efficiency status of the pediatric, internal, psychiatric, and infectious wards were observed in the target period.
 Conclusion: With the arrival of COVID-19 pandemic, service performance and efficiency in hospitals affiliated with South Khorasan province decreased due to limited services to patients. During the years under study, on average, less than one third (30.36%) of hospital wards in the region were efficient, and had good performance; therefore, continuous periodic evaluation is recommended for policy makers to exploit the available resources using the Pabon Lasso model or other models.

Negyvenéves a Debreceni Bőrklinikán működő Égési Osztály

For decades the burn patients have been treated at dermatological institutions worldwide, due to the similarities of the burns to certain blistering dermatological conditions. Another explanation was the routine of these clinics in the conservative treatment of wounds and general care of patients with extensive skin defects. Later on, together with more knowledge about the pathomechanism of burns and as the operative treatment became dominant, complex burn care was provided by specialized burn departments. Thanks to these developments, most burn care institutions nowadays are either autonomous centers or departments closely associated with traumatology, intensive care, surgical, pediatric surgical, or plastic surgery clinics. In Debrecen, the second profile is dermatologic surgery, which is now a unique combination, so the burn service is provided by the Department of Dermatology. Since its inauguration in 1983, the department introduced an active, operational burns treatment strategy. In the past forty years it pioneered several ground breaking therapeutic approaches, such as fluidization therapy, negative pressure wound therapy (NPWT), biotechnological wound coverage with keratinocyte suspension and sheets, dermal substitution with Alloderm®, Integra®, etc. Thanks to the continuous improvement of the instrumentation of the burn ward and the specific intensive care unit, it became possible to successfully treat patients with extensive deep burn wounds as well as dermatological crisis situations requiring intensive support. The department has remarkable international connections and scientific publication activities. Despite unfavorable tendencies of the most recent years, reducing the work force of both doctors and related professionals, the burn unit in Debrecen is keen on providing continuous, up to date, high quality professional service to burn patients of our region.

Multidrug-Resistant Pathogens in Burn Wound, Prevention, Diagnosis, and Therapeutic Approaches (Conventional Antimicrobials and Nanoparticles).

Multidrug-resistant pathogens are one of the common causes of death in burn patients and have a high risk of nosocomial infections, especially pneumonia, urinary tract infections, and cellulitis. The role of prolonged hospitalization and empirical antibiotics administration in developing multidrug-resistant pathogens is undeniable. In the early days of admitting burn patients, Gram-positive bacteria were the dominant isolates with a more sensitive antibiotic pattern. However, the emergence of Gram-negative bacteria that are more resistant later occurs. Trustworthy guideline administration in burn wards is one of the strategies to prevent multidrug-resistant pathogens. Also, a multidisciplinary therapeutic approach is an effective way to avoid antibiotic resistance that involves infectious disease specialists, pharmacists, and burn surgeons. However, the emerging resistance to conventional antimicrobial approaches (such as systemic antibiotic exposure, traditional wound dressing, and topical antibiotic ointments) among burn patients has challenged the treatment of multidrug-resistant infections, and using nanoparticles is a suitable alternative. In this review article, we will discuss different aspects of multidrug-resistant pathogens in burn wounds, emphasizing the full role of these pathogens in burn wounds and discussing the application of nanotechnology in dealing with them. Also, some advances in various types of nanomaterials, including metallic nanoparticles, liposomes, hydrogels, carbon quantum dots, and solid lipid nanoparticles in burn wound healing, will be explained.

Responding to burns - is our practice adequate?

Madam, Around 90% of burn related injuries are seen in low- and middle-income countries. Misfortune of such incidents lies in the fact that most of these are either preventable in the first place or can be efficiently managed before the casualty reaches the healthcare centre. According to a study1 conducted in Burns Ward of Civil Hospital Karachi, around 1,979 patients with burn-related injuries were admitted in just two-year period. Out of which, 715 patients (36.12%) expired. This mortality rate was higher in females (39.40%) and in people older than 60 (47.90%). A massive chunk of these deaths was accidental (95.80%), imposing the need to address the root cause of the issue. Another study2 showed that around 76% of students had never attended any formal training related to burns first aid management which is quite alarming. This again implies the extreme necessity to train and enable the masses to face burn related accidents. Another real dread comes with the prevalence of myths in the community that lead to the worsening burn wounds at home. According to a study3 conducted in POF hospital in Wah Cantt, a statistically significant (81.28%, p<0.05) number of people lacked the understanding of burns first-aid. A vast fraction did not take immediate action upon facing a burn wound, making awareness sessions an exigency for such epidemiology. Another similar study4 interviewed parents and showcased that around 86.8% of parents didn’t irrigate the burn wound with tap water, which is considered a standard intervention for burn injury. Instead, a significant ratio (30%, p<0.05) of parents used traditional remedies, among which toothpaste application (16.70%) tops the list. FRIP (First Response Initiative of Pakistan) is a non-governmental organization founded in 2010 aimed to educate the masses about the pre-hospital management of traumatic and non-traumatic injuries. One such aspect of its curriculum is burn management. Over more than ten years, it has instilled a standard method of burn wound care based on AHA’s (American Heart Association) guidelines among the masses and has taught ways to prevent it too. The effectiveness of such workshops is evidenced in a relevant study5 which reveals that a statistically significant difference (p<0.05) existed after similar sessions conducted as illustrated in Figure 1. These figures prove the importance of first aid workshops and the crucial role FRIP plays in solving pre-hospital burn management problems.

Silver resistance in Pseudomonas aeruginosa and Acinetobacter baumannii isolated from burn patients

Introduction: Burn infections are a serious obstacle to the patient’s recovery. Infection is estimated to account for 75% of burn patient mortality. Widespread and often indiscriminate administration of antibiotics and lack of basic infection control methods are major factors in the emergence of drug-resistant bacteria. Due to the growing and serious threat of antibiotic resistance, interest in silver compounds has grown in modern medicine. Objectives: The aim of this descriptive study was to evaluate the frequency of sil genes and its phenotypic expression in Pseudomonas aeruginosa and Acinetobacter baumannii isolates isolated from the burn ward of Imam Khomeini hospital in Urmia. Patients and Methods: P. aeruginosa (n=16) and A. baumannii (n=32) isolates were collected from burn wound samples in an 8-month period from August to March 2017 from the burn ward of the hospital. The minimum inhibitory concentration of silver nitrate on the clinical isolates was determined using microdilution method. The presence of silP, silE and silS silver resistance genes was investigated by polymerase chain reaction (PCR). Results: The results of minimum inhibitory concentration (MIC) test showed that 62.5% (n = 10) of P. aeruginosa isolates and 56.25% (n = 18) of A. baumannii isolates showed MIC above 512 mg/ml. Polymerase chain reaction results revealed that only one P. aeruginosa isolate had silE gene and among A. baumannii isolates, 20 isolates had silE gene and six isolates had silS gene. None of the isolates showed positive results for the silP gene. Conclusion: Based on the results, A. baumannii was the most common microorganism of burn wounds in the burn ward of our hospital in Urmia. This study showed a high degree of phenotypic resistance to silver in A. baumannii and P. aeruginosa isolates which silE and silS genes were also observed in some isolates.

89 Second-Degree versus Third-Degree Burn Differences in Length of Stay

Abstract Introduction Length of stay (LOS) is a crucial element to patient care plans, hospital profit, and a patient’s well-being. However, predicting LOS is difficult as burn injuries often have complications. The expectation for LOS in the burn ward is generally one day per percent total body surface area (TBSA) burned. This prediction approximates the average but rarely represents true patient LOS. Healing times for second and third-degree burns differ, yet most studies only evaluate TBSA rather than 2nd and 3rd degree burns separately. We hypothesized that third-degree burns would have a longer LOS than same sized second-degree burns. Methods We obtained a list of all patients diagnosed with Second/Third-degree and verified the inclusion of patients meeting the study criteria from July 01, 2011, to July 01, 2021. Afterward, data was manually extracted from electronic health records and separated from patients with inhalation injury. We placed the aggregate findings in a 3D scatter plot to develop a predictive LOS formula. Results The initial data set (n=678) decreased due to missing burn documentation and exclusion of the inhalation injury group yielding the final data set (n=388). For every one percent second-degree burn increase, the LOS (in days) increases by 0.587 + 0.057 (p= 3.07E-22). For every third-degree burn percent increase, LOS increases by 1.328 + 0.086 (p=1.4E-42). The intercept for the 3D scatter plot was set to 0 as a patient without burns or inhalation injury should have a LOS of 0. The r-squared value is 0.58 which shows a medium level of correlation. Our current equation – LOS = 0.587(2nd degree-burn) +1.328(3rd degree-burn). Conclusions The one day per percent TBSA rule does not accurately predict LOS. Third-degree burn percentage may double the length of stay when compared to second-degree burns. More closely following 2nd v. 3rd degree burn and other comorbidities will give patients a more accurate estimate of their LOS. Applicability of Research to Practice Insurance, physicians, and patients are all affected by LOS. Insurance companies require accurate depictions of LOS to ensure sufficient funding for their patients’ hospital stay. Physicians use LOS to assess course of healing and if other problems are hindering recovery. Furthermore, hospital stay changes a patient’s daily life, work, education, and family. Better predictions for LOS may allow patients to fully grasp what to expect with their recovery.

Comparative effect of PNF VS early Dynamic stretching in pain, range of motion and functional status in shoulder joint

Background: Burn of shoulder and axillary region are common affecting patient’s range of motion and his/her performance in his daily life. Because post burn if treatment is not given, contracture will ultimately form. Aim: To determine the comparative effectiveness of PNF (hold relax) VS early Dynamic stretching exercises for improving pain, range of motion and functional status in the shoulder joint and quality of functional recovery in burn patients. Methodology: A single blinded Randomized clinical trial was conducted at Mayo Hospital, Burn ward. Total 74 patients (Male and Female) were included in the study on the basis of inclusion and exclusion criteria. Participants were randomly allocated in two groups, 32 in each group by odd even method. Group 1 received PNF (hold-relax) protocol while group 2 received Dynamic stretching protocol, both the groups received the treatment along with conventional therapy on alternate days for 4 weeks. Pre and post treatment assessment VAS, Q-DASH score and ranges of motion were done. Data was analyzed using SPSS 23 version. Paired sample T-test and independent sample T test was used to assess within and between group analysis with having confidence interval CI 95% and p value 0.05. The purpose of paired T-test and independent t-test was to determine the difference within and between the groups in all clinical parameters (Q-DASH score, VAS score and ROM) during both pre and post treatment. Results: According to the findings, VAS, Q-DASH scoring and ranges of affected burn shoulder joint were significantly improved in both groups i.e., treated with PNF and Dynamic stretching protocol. However, on group comparison; statistically significant improvement in VAS, Q-DASH scoring and ranges of shoulder were observed in patients treated with PNF as compared to Dynamic stretching with p-value <0.05. Practical implication: The study provides the opportunity to physiotherapist to get aware of the role of PNF and dynamic stretching in preventing and treating post burn patients. It provides the statistical effectiveness of techniques in increasing the recovery rate of patients by using defined treatment protocol. Conclusion: This study proved that PNF and Early Dynamic Stretching both are effective in improving pain, range of motions and functional status among burn patients. However; PNF (hold relax) was more beneficial for improving functional status and treating pain and range of motion in shoulder joint of burn patients with p-value <0.05. Keywords: Axillary burns, Contractures, Early Dynamic Stretching exercises, Functional recovery, Range of motion(ROM).

The Bacterial Contamination in the Burn Unit of Al- Hussain Teaching Hospital at Al-Samawa City, Iraq

Background: The main causes of a burn patient’s mortality are microbial infection which is related to burn unit contamination, which represents a significant health problem in the burn ward. Objectives: The aim of this study was to determine the types and microbial contamination degree in eleven different burn wards at AL-Hussain Teaching Hospital in Al-Muthanna Province-Iraq. Materials and Methods: This survey study included 770 samples (burn unit swabs) from June 2019 to march 2021 distributed into 70 swabs for each one of the different sources with missing system 3 for each (Floor of the Burn Ward, Locker of the Burn Ward, Bed of the Burn Ward, Floor in Bathroom of the Burn Ward, Chart of the Burn Ward, Door in Bathroom of the Burn Ward, Shower in Bathroom of the Burn Ward, Wall of the Burn Ward, Wall In Bathroom of the Burn Ward, Gauze of the Burn Ward, and Surgical Instruments of the Burn Ward). Results: The data of samples cultivation, 284(39%) samples yielded bacterial growth and 453(61%) samples showed no bacterial growth. The highest rate of positive growth was seen in samples of Floor of the Burn Ward 5 (78%) while the lowest incidence of positive growth was 1(1%) in samples of Surgical Instruments of the Burn Ward. Gram-positive bacteria were the predominant 173(61%) as compared with gram negative bacteria 111(39%). Conclusion: On the basis of data results we conclude that burn ward especially Floor harbor bacteria. Although some bacteria were normal flora, potentially pathogenic bacterial rates diverse between places.