Entire Multidisciplinary Team Research Articles

Multi-disciplinary mass burn casualty simulation exercise

Disaster simulation exercises are important to test service processes, capabilities, and deficiencies and disaster response planning should encompass the entire multidisciplinary team over an extended period. Our service simulated a modest eight burn casualty scenario to test our service capabilities over a 10-week period across medical, nursing, and allied health professions. Requirements due to the mass burns casualty cohort were predicted in terms of theatre requirements, allied health treatment hours required, and nursing hours requirements. Prospective business-as-usual service provision data was also collected over the 10-week study period in respect to theatre utilisation, allied health workload, nursing hours and burns ward bed census. This data was then superimposed on predicted mass burn casualty requirements to gauge total workload demands over the study period. Results showed an expected significant initial spike in theatre requirements in the first week post mass casualty with ongoing deficiencies in theatre allocation occurring throughout the 10-week study period. Allied health staff were working at or near capacity in a business-as-usual setting with major spikes in workload demand occurring due to the mass burn casualty cohort. Total workload demands clearly exceeded current staff capacity for most of the allied health professions over the 10-week period. Bed census exceeded funded nursing bed capacity for all but seven days of the study period. Predicted combined nursing hours required exceeded funded capacity for all but two days. This simulation clearly demonstrated the high and immediate increase in workload demands across all professions over a prolonged 10-week period and that high business-as-usual demand can greatly affect staff capacity to cope with a mass casualty surge in admissions. It was able to provide evidence, and awareness, for leadership and management on the need for resources and resource re-allocation in a mass burn casualty scenario. It also informed a review of our current triggers for activating our SA Health Multiple Burns Plan.

Head Nurse Leadership: Facilitators and Barriers to Adherence to Infection Prevention and Control Programs-A Qualitative Study Protocol.

The effective management of Healthcare-Associated Infections (HAIs) relies on the implementation of good practice across the entire multidisciplinary team. The organizational context and the role of head nurses influence the team's performance and behavior. Understanding how decision-making processes influence healthcare professionals' behavior in the management of HAIs could help identify alternative interventions for reducing the risk of infection in healthcare organizations. This study aims to explore how the behaviors promoted and actions implemented by the head nurse can influence healthcare professionals' adherence to Infection Prevention and Control (IPC) programs. A multi-center qualitative study will be conducted using a Grounded Theory approach. Observations will be conducted, followed by individual interviews and/or focus groups. A constructive and representative sample of healthcare professionals who care directly for patients will be enrolled in the study. The COnsolidated criteria for REporting Qualitative research (COREQ) checklist will be followed to ensure the quality of this study protocol. A multistep inductive process will be used to analyze the data. The study results will provide an understanding of how nurses perceive the influence of leadership and how they modify their behaviors and activities toward patients according to IPC programs. The study will identify barriers and facilitators to IPC compliance and suggest strategies to minimize negative patient outcomes, such as the development of an HAI.

Compiling a Set of Actionable Quality Indicators for Medical Practitioners in Dutch Nursing Homes: A Delphi Study

Most quality indicators (QIs) currently used in nursing homes reflect the care delivered by the entire multidisciplinary team and are not specific for medical practitioners. International experts have proposed a set of QIs that specifically reflect the quality of medical care in nursing homes. The objective of the Delphi study described here was to compile a set of actionable QIs tailored for medical practitioners working within Dutch nursing homes. This was achieved through the evaluation of 15 existing national QIs and 35 international QIs by a panel of medical practitioners, comprising medical specialists, nurse practitioners, and physician assistants, who are working in Dutch nursing homes. Panelists rated each QI on (1) level of direct control by medical practitioners and (2) its relevance to the quality of medical care. QIs progressing to subsequent rounds required panel agreement on both direct control (≥70% ≥3 points on a 4-point scale) and relevance (≥70% ≥8 on a 10-point scale). In the last round, each panelist selected the 5 most relevant QIs and arranged them in order of importance. These top 5 rankings were converted into points for an overall final ranking. There was consensus on 42 QIs being under the control of medical practitioners, and 21 of these QIs were considered relevant for quality of care. Most of the 21 QIs originated from the international QI set. This finding supports the transferability of the internationally developed QIs to the Dutch nursing home context and provides opportunities to compare the quality of medical care in nursing homes across countries. In the final ranking, the QI related to new medication prescriptions received the highest rating, followed by 3 QIs related to advance care planning. Future research should focus on evaluating the feasibility of measuring the selected QIs and assessing their measurement properties before implementing them in professional learning and quality improvement initiatives for medical practitioners in nursing homes.

THE IMPORTANCE OF THE PARTICIPATION OF THE DENTAL SURGEON IN BREASTFEEDING: a narrative review of the literature

Breastfeeding is essential for newborns and is unfortunately neglected by countless mothers, especially those who have their first children. In many cases, weaning occurs early due to a series of popular opinions that must be combated by a team multidisciplinary. Among these, dental surgeons play a very important role since these professionals work in one of the areas that can suffer serious consequences due to the act of early weaning. The objective of this research was to carry out a literature review on the importance of the dentist in promoting breastfeeding as well as benefits and advantages. Especially: identify the advantages and benefits of breastfeeding; Describe the dentist's participation in breastfeeding; describe the importance of promoting breastfeeding. A descriptive narrative literature review was carried out using as a bibliographic basis scientific articles available in the online databases BVSalud, PUBMed, Lilacs Scielo and Google Scholar, published between 2005 and 2023 and available in Portuguese and English. It is concluded that breastfeeding is extremely important for adequate development of the baby's stomatognathic system and this very important process must be encouraged by both the dentist and the entire multidisciplinary team that accompanies the woman pre- and postpartum.

Hospital Pharmacist experience in the Intensive Care Unit: Plan COVID

The Intensive Care Unit (ICU) of the University Hospital of Fuenlabrada was forced to critically increase its capacity in the COVID-19 pandemic. The objective of this work is to describe the activities promoted by the pharmacist in the care of the critically ill patient in this context.A new organizational structure was designed, analyzing the tasks necessary to make the processes profitable. Two pharmacists joined the critical patient care to help the pharmacist who was already integrated in the ICU team.The development of the operational structure was carried out on three levels.The healthcare activity highlights the daily participation of pharmacists in the two clinical sessions in which the ICU teams evaluated all cases and made decisions. This in turn facilitated the pharmaceutical validation that was carried out in the critical units themselves. In addition, one of the pharmacists created the Immuno-COVID Committee, in which they participated together with different specialists for therapeutic decision-making in the most complex cases.On the other hand, the availability of human and material resources allowed the implantation of centralized elaboration in the Pharmacy Service of many intravenous mixtures, including antibiotics elastomers Pumps for continuous infusion, and non-sterile elaborations.In logistics management, in addition to the acquisition of COVID-19 therapies, the reconciliation with nursing activity stands out. The physical presence of the pharmacist favored the detection of needs, the availability in time of medications in the unit, including sterile and non-sterile preparations, and coordination with the central pharmacy.In knowledge management, the participation of the pharmacist in the working group for the development of the hospital management protocol COVID-19 stands out.The daily presence in the unit and the joint work with the entire multidisciplinary team demonstrate the value that the pharmacist can bring. In addition to efficient resource management, support for clinical decision-making and improvement actions, it provides the climate of inter-professional trust necessary to respond to the complexity of the critical patient and promote joint projects.

The Lucerne Toolbox 2 to optimise axillary management for early breast cancer: a multidisciplinary expert consensus.

Clinical axillary lymph node management in early breast cancer has evolved from being merely an aspect of surgical management and now includes the entire multidisciplinary team. The second edition of the "Lucerne Toolbox", a multidisciplinary consortium of European cancer societies and patient representatives, addresses the challenges of clinical axillary lymph node management, from diagnosis to local therapy of the axilla. Five working packages were developed, following the patients' journey and addressing specific clinical scenarios. Panellists voted on 72 statements, reaching consensus (agreement of 75% or more) in 52.8%, majority (51%-74% agreement) in 43.1%, and no decision in 4.2%. Based on the votes, targeted imaging and standardized pathology of lymph nodes should be a prerequisite to planning local and systemic therapy, axillary lymph node dissection can be replaced by sentinel lymph node biopsy (±targeted approaches) in a majority of scenarios; and positive patient outcomes should be driven by both low recurrence risks and low rates of lymphoedema.

DA ABORDAGEM MULTIDISCIPLINAR À ATUAÇÃO DO PSICÓLOGO NO PROCESSO DE TRANSPLANTE E DOAÇÃO DE ÓRGÃOS: UM OLHAR SOBRE OS ASPECTOS PSICOEMOCIONAIS

Transplantation is a treatment modality, which may be the only alternative for some patients. There is a careful assessment, by a multidisciplinary team, so that the patient gets in line to receive an organ donation from a living or dead donor. This article aims to discuss the possibilities of interventions and contributions in the multiprofessional approach, weaving a look at the psychological aspects, to patients and donors, inserted in the transplantation and organ donation process, using a literature review. We sought to present the specifics of psychic issues according to the organ to betransplanted by the patient, such as the confrontation of the donor and recipient of a living donor, fantasies, anxieties and fears permeating the decision and reception. The importance of the performance of the entire multidisciplinary team was highlighted, with the psychologist as an essential part in the approach during the entire process and in the post-transplantation process, being a facilitator, organizer and evaluator, effectively contributing to the understanding, elaboration, adherence and support against the lived moment, both for the patient and the donor, favoring adherence and minimizing negative repercussions throughout the organ transplant process.

Vaginal Delivery in a Primipara with Glanzmann Thrombasthenia

Vaginal Delivery in a Primipara with Glanzmann Thrombasthenia

Impact of bariatric surgery on oral health: a systematic review and meta-analysis.

To evaluate the impact of bariatric surgery (BS) on the oral health status of obese individuals. The search was performed on the Cochrane Library, Embase, Latin American and Caribbean Literature on Health Sciences (LILACS), LIVIVO, PubMed/Medline, Scopus, and Web of Science databases. Grey literature was also consulted through Google Scholar, OpenGrey, ProQuest, and MedRxiv. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal tool. Pre- and post-surgical moments were compared through random effects meta-analysis. The GRADE (Grading of Recommendations, Assessment, Development and Evaluations) assessment tool was used to judge the certainty of evidence. After searching the databases, 908 references were retrieved, with 30 articles selected for synthesis. When comparing the pre- and postoperative moments, there was no difference in the index of decayed, missing, or filled teeth. Furthermore, salivary flow and probing depth presented a slight increase. Post-surgery patients showed an increase (%) in tooth wear at the dentin level [MD = -6.23; IC95% = -8.45--4.01; I2 = 0%]. Patients undergoing BS show no difference when considering the rate of caries or missing teeth and little to no effect was observed on salivary flow rates and periodontal probing depth. On the other hand, greater attention should be given to dentin wear in post-surgical patients of BS. Patients undergoing BS should receive careful monitoring regarding oral health by doctors, dentists, and the entire multidisciplinary team involved before and after the surgical procedure.

The Team Is Not Okay: Violence in Emergency Departments Across Disciplines in a Health System.

Healthcare workers, particularly those in the emergency department (ED), experience high rates of injuries caused by workplace violence (WPV). Our goal was to establish the incidence of WPV among multidisciplinary ED staff within a regional health system and assess its impact on staff victims. We conducted a survey study of all multidisciplinary ED staff at 18 Midwestern EDs encompassing a larger health system between November 18-December 31, 2020. We solicited the incidence of verbal abuse and physical assault experienced and witnessed by respondents over the prior six months, as well as its impact on staff. We included responses from 814 staff (24.5% response rate) for final analysis with 585 (71.9%) indicating some form of violence experienced in the preceding six months. A total of 582 (71.5%) respondents indicated experiencing verbal abuse, and 251 (30.8%) indicated experiencing some form of physical assault. All disciplines experienced some type of verbal abuse and nearly all experienced some type of physical assault. One hundred thirty-five (21.9%) respondents indicated that being the victim of WPV has affected their ability to perform their job, and nearly half (47.6%) indicated it has changed the way they interact with or perceive patients. Additionally, 132 (21.3%) indicated experiencing symptoms of post-traumatic stress, and 18.5% reported they have considered leaving their position due to an incident. Emergency department staff suffer violence at a high rate, and there is no discipline that is spared. As health systems seek to prioritize staff safety in violence-prone areas such as the ED, it is imperative to recognize that the entire multidisciplinary team is impacted and requires targeted efforts for improvement in safety.

Ways and means to comfort people at the end of life: how is the nurse a privileged player in this process?

Comfort is a necessity throughout life, and it is a key element in the practice of nursing care for the patient at the end of life. A particular human need and a state related to the experience and culture of the person at the end of life constitute the target of attention and nursing intervention, being a very relevant indicator of the quality of health care. This article is part of a doctoral study in the field of comfort in a palliative care unit, and these are some of the partial results that emerged. To understand the ways and means of comfort perceived by the person at the end-of-life hospitalized in a palliative care unit, their family, and health staff as well as the value of the nurse in this process. Qualitative study using an ethnographic approach. We conducted semistructured interviews with 18 patients at the end of life and their matched significant family members (18) and 21 health professionals. We also conducted participant observation of care situations. The ways and means of providing comfort are centered on strategies developed by the entire multidisciplinary team. During this whole process, one of the categories that emerged from the ethnography was the nurse as a privileged player, representing an absolutely essential role in all phases. The results revealed that nurses play a very important role in end-of-life comfort, which is based on a predisposition for end-of-life care (active listening, empathy, congruence, and biographical narrative) and focused attention (global care, attention to detail, family support, and opposition to therapeutic obstinacy). The different ways and means of providing comfort aim to increase care, relieve, and invest in potential different forms of comfort and nurses are recognized by all those involved in this process as someone essential to providing comfort care.

Bariatrické restrikční výkony a výživa

In the case of restrictive procedures, more than elsewhere, consistent preparation of the patient is crucial. A nutritional therapist participates in this and tries to pass on partial knowledge not only about nutrition, to such an extent that the patient is subsequently able to continue the reduction himself. The entire multidisciplinary team participates in the education making an effort to maximize the probability of the success of the restrictive procedure and thereby increase the patient’s quality of life. Approaches differ within the individuality of patients and within the type of restrictive procedure. Sufficient motivation and cooperation fundamentally influence the entire process that the person goes through. Keywords restrictive procedures, bariatric surgery, enteral nutrition, nutritional intervention

Canadian perspectives in multiple myeloma on the use of steroids in clinical practice based on patient and healthcare provider interviews.

Corticosteroid (steroid) medications are associated with challenging adverse effects that can negatively impact patient quality of life. However, owing to a long legacy of effective use in treatment protocols, they remain a cornerstone of multiple myeloma (MM) care. We conducted a roundtable with Canadian healthcare providers (HCPs) with diverse healthcare backgrounds and involvement in MM care as well as with patients with MM. Our goal was to develop clear guidance for steroid management aimed at improving patient quality of life, taking into account patient perspective and experiences with managing the disease. Our recommendations, which are based on the insights acquired from this discussion, can be categorized to the following areas: steroid prescribing, dosing, and modifications; managing adverse effects; and patient-HCP communication. These recommendations can be used by the entire multi-disciplinary hematology team to improve patient quality of life while being treated with steroid medication for multiple myeloma.

P1.01: Optimizing Lung Function During Donor Management Through A Multidisciplinary Approach

Introduction: In current healthcare, a multi-disciplinary approach is taken in critical care to ensure all specialties can offer their training and expertise in the care of every patient. In organ donation, and specifically donor management, having a team of Procurement Transplant Coordinators (PTCs) that is comprised similarly ensures that optimal results can be achieved through a varied knowledge base. Traditionally, this has been heavily weighted with Registered Nurses with critical care experience. We propose that including Registered Respiratory Therapists (RRTs) as PTCs can broaden the base of expertise of the team and maximize successful lung transplantation. Additionally, the incorporation of different modes and modalities of ventilation with a physiological approach to lung recruitment has successfully proven an increase in lung optimization. Method: To fully understand the positive impact of RRTs in lung recruitment, we looked at the upward trend of the Horowitz index for Lung Function (P/F ratio) with a subject United States based Organ Procurement Organization and how it correlated with an increasing number of PTCs that are licensed and registered Respiratory Therapists. Four RRTs were onboarded to the donor management team during 2020 and 2021. Comparing the results from previous years, data showed a related increase in lung recruitment and optimization per year with RRTs working as PTCs. Results: Evidence demonstrated a correlation of the increase in lung procurement and transplantation numbers mirroring an increase in RRTs in the role of PTCs. Improvements to P/F ratios were compared at the beginning of the case to the final P/F ratio prior to OR. From January 1, 2018-December 31, 2019 there were 89 donors who were brought to the operating room for lung procurement with the intent of transplant. The median and mean improvement to P/F ratios were +0.83 and +0.83, respectively. From January 1, 2020- December 31, 2021 there were 75 donors who were brought to the operating room for lung procurement with the intent of transplant. The median and mean improvement to P/F ratios were +1.04 and +1.32, respectively. This proved a 25.3% increase for the median PF ratio and a 59% increase to the mean PF ratio. Conclusion: Our research supports that PTCs who are licensed and experienced Respiratory Therapists being proficient in lung physiology, recruitment, and ventilation strategies contribute to an increase in lung optimization. With having specific organ expertise, RRTs have proven to be a vital asset while sharing knowledge with the entire multi-disciplinary team.

Infections and Smartphone Use in Nursing Practice: A Systematic Review.

AIM:Nurses use their smartphones during the work shift. The objective of this review is to investigate the presence of bacteria on mobile phones and the procedures to disinfect or decontaminate the smartphone and decrease the infection rate.Method:This systematic review was carried out through a search on the main scientific databases by following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The research was conducted by considering articles published in the last ten years.Results:Of 502 initial articles, 489 were excluded and 12 articles were considered relevant. Twelve articles were included in the review. The analysis of the studies showed a high contamination of pathogenic microorganisms on the device’s surfaces, most of which appear to be antibiotic resistant. The use of smartphones during clinical practice increases the risk of contracting nosocomial infections. The presence of bacteria on mobile phones and their use favors the cross-transmission of microorganisms.Conclusıon:Onset prevention is a primary goal for the entire multidisciplinary team. There are no protocols concerning smartphones disinfection during clinical practice, but their implementation would reduce the incidence by improving nursing care.

Introducing an MDT Morning Huddle on an Adult Inpatient Unit During the COVID-19 Pandemic

AimsThis quality improvement project aimed to introduce a staff communication tool, ‘the morning huddle’, to Goddington ward (Green Parks House, Oxleas NHS Foundation Trust). The huddle's purpose was to share key information between members of the ward's multidisciplinary team (MDT) regarding patient risk, diagnosis, mental state and treatment progress.MethodsThe project team worked with the Oxleas Quality Improvement (QI) team to create a structured huddle with agreed goals that commenced at 9am each morning. The team sought views from ward staff on the existing communication process before implementing the huddle via a series of weekly questionnaires. The morning huddle was introduced on 26th May 2020 and all members of the team were invited (including the ward consultant, junior doctors, ward manager, nursing staff, healthcare assistants, psychologists, occupational therapist, and ward administrator).Following multiple PDSA (Plan, Do, Study, Act) cycles, the team further refined the morning huddle into a meeting with a set template that included COVID-19 test results, psychiatric risk concerns, medication adherence, and barriers to discharge. The project team also timed the huddle, aiming for it to last a maximum of 30 minutes. A questionnaire was distributed to ward staff weekly after the huddle was implemented to ascertain their views on the process. Data collection for the project ended on 2nd August 2020.ResultsThe project's main outcomes were based on two questions from the weekly staff questionnaire:1. “How effective did staff members find the morning huddle in addressing their concerns about patients and promoting safety of patients and staff?”This improved over the course of the project, starting with 20% of staff finding the huddle “good” or “very good” in its effectiveness to 77% finding it “good” or “very good” in the final questionnaire.2. “How effectively do staff feel that their concerns about patients are addressed by the rest of the team?”This also improved, starting with 40% of staff selecting “well” or “very well” to 100% in the final questionnaire.ConclusionGoddington ward introduced a huddle that was valued by the entire MDT. The huddle improved how well staff felt their concerns about patients were addressed and a noticeable improvement in team morale was observed. While the project succeeded in implementing a huddle that staff appreciated, patient outcomes also need to be considered in future

Use of contraceptive methods by users of a family health strategy of Rondonópolis - MT

Knowing the contraceptive strategies used by women in a given population allows for better planning of guidance actions and distribution of methods by health teams. The purpose of this study was to analyze the use of contraceptive methods by users of a Family Health Strategy (FHS) in Rondonópolis, MT. This is a prospective, cross-sectional and quantitative study. FHS André Maggi users, aged between 18 and 49 years, were included. The sampling was by convenience, being included women who attended the health unit during the data collection period, from February 1st to May 13th, 2021. Data were collected through a structured questionnaire containing information on sociodemographic aspects, clinical trials and use of contraceptives. 110 women participated in the study, with a mean age of 29.1 years. A frequency of 78.38% (n=88) women use contraceptive methods, with a predominance of oral contraceptives (54.55%), injectable contraceptives (13.64%) and male condoms (12.50%). The indication of contraceptive methods was mostly performed by Doctors (47.72%) and Nurses (20.45%). A total of 83 (75.45%) women received guidance on contraception. The users of the FHS studied showed a high prevalence of use of contraceptive methods. It is necessary that the entire multidisciplinary team of the FHS is involved in the use of strategies that seek to promote family planning, taking into account the characteristics of women in the area covered by the unit.

Describing Nonfatal Intimate Partner Strangulation Presentation and Evaluation in a Community-Based Hospital: Partnerships Between the Emergency Department and In-House Advocates.

To describe characteristics of strangulation, and associated medical care, documentation, and injuries of women after nonfatal intimate partner strangulation (NF-IPS) who present for care to a community-based emergency department (ED) with an associated intimate partner violence (IPV) advocacy program between 2008 and 2016. A retrospective review of 345 female ED patients' medical records who sought care at a community hospital ED following a physical assault including strangulation by an intimate partner was conducted. Demographics, characteristics related to reported signs and symptoms, injuries, and subsequent imaging, diagnoses, and discharge information were abstracted. Commonly reported symptoms were neck pain (67.2%) and headache (45.8%), with fewer patients reporting more severe symptoms such as loss of consciousness (22.6%), dysphagia (25.0%), or dysphonia (26.7%). Rates of patients disclosing strangulation to the entire multidisciplinary team and dedicated neck imaging appeared to improve between 2008 and 2014. Among the 45 patients with noted head and neck findings, 2 patients were found to have an internal carotid artery dissection, 2 patients were found to have strokes, and 1 patient was found to have an intracranial hemorrhage. Survivors of NF-IPS may present to community-based hospitals, and existing imaging guidelines can support clinicians in identifying serious internal injury such as carotid artery dissection and stroke. Further research is needed to better discern symptoms previously attributed to psychological trauma from poststrangulation brain injury. This study contributes to the growing literature on NF-IPS with data specific to community-based ED visits.

Implementing the First Outpatient Parenteral Antimicrobial Therapy (OPAT) Program to Utilize Disposable Elastomeric Pumps in the Gulf Region: Results From a Tertiary Teaching Hospital in the Kingdom of Saudi Arabia.

ObjectivesTo describe the implementation process, safety, and efficacy outcomes, as well as cost-effectiveness, of the first outpatient parenteral antimicrobial therapy (OPAT) program to utilize disposable elastomeric pumps in the Kingdom of Saudi Arabia and the entire Gulf region.MethodsThis OPAT program was initiated in May 2018 and was administered through a multidisciplinary team that included the home medicine department, pharmacy department, nursing department, and the infectious diseases service. The device used was the Intermate® (Baxter, Deerfield, Illinois) elastomeric pump. After consultation with an infectious diseases physician, eligible patients were discharged home to complete the remainder of their antimicrobial treatment, which was self-administered via the elastomeric devices.ResultsFrom May 2018 to December 2019, 47 patients received 55 courses of OPAT via the new program. A total of 2,869 pumps were used during that period to provide 927 days of antimicrobial therapy in the home setting. Most patients completed the program successfully with no reported significant OPAT-related complications such as catheter-related infections. Four patients were re-admitted for relapse of infections and one patient was re-admitted for colistin-induced nephrotoxicity. No mortality was reported for any patient during OPAT treatment and 30 days after program completion.ConclusionsThe implementation of this novel OPAT program was safe, effective, and offered significant cost-savings to our institution. The entire process was very dynamic and was centered around proper patient selection and education as well as excellent communication between patients and the entire multidisciplinary team involved in the program. We hope that these results will encourage other institutions in the region to implement similar OPAT programs to alleviate the existing bed crisis due to the ongoing COVID-19 pandemic.

Diagnosis and Management of Invasive Fungal Wound Infections in Burn Patients

Invasive fungal wound infection (FWI) after burn injury, while uncommon, is associated with significant morbidity and mortality. There are numerous risk factors for FWI, including large burn size and incomplete excision of burn wounds. FWI can be challenging to diagnose. Close attention to changes in the physical examination and, in particular, to the appearance of burn wounds leads the burn team to be suspicious of FWI. Once FWI is suspected, histopathological evaluation of an incisional biopsy provides definitive diagnosis, while tissue culture enables identification of the causative organism to the species level and facilitates targeted antifungal therapy. Management of FWI focuses largely on aggressive surgical intervention, in addition to adjunctive systemic and topical antifungals and nonpharmacologic therapies. Treatment of FWI involves a multifaceted approach, which requires expertise from the entire multidisciplinary burn team.