Hospital Burn Unit Research Articles

The changing face of burn care: The Adelaide Children's Hospital Burn Unit: 1960–1996

There have been considerable changes in burn care since the inception of the Adelaide Children's Hospital Burn Unit in 1960, resulting in a marked improvement in both morbidity and mortality. A burn of 30% T.B.S.A. is no longer considered life threatening, whilst a burn of 80% T.B.S.A. is now not only expected to survive, but to have a satisfactory functional and cosmetic outcome. An outline of these changes, as reflected in a review of 37 years of care, is discussed with particular reference to the improvements in scar management.

Burn Unit Ensures Expert, Specialized Staffing

At Children's Hospital Burn Unit, nurse managers developed a decentralized staffing plan to provide specialized nursing care and avoid using agency, per diem, and float personnel.

Health status after recovery from burn injury

Outcome studies after burn injury have become increasingly important as overall mortality from injury has decreased. The present study, concerning physical and psychosocial aspects, is the second part of our larger survey of outcome after burn. The basis of our study instrument was the Abbreviated Burn Specific Health Scale. A postal survey was conducted among 315 patients aged 15–65 years, treated at Töölö Hospital Burns Unit between 11 November 1988 and 31 December 1994. The study series analysed consisted of 124 patients, whose mean total body surface area (TBSA) burned was 13.0%, mean full-thickness (FT) burns 6.2%, mean age 37 years and mean time of hospital treatment 16 days. Statistical analyses were performed with non-parametric tests and a probability level of 0.05 as the limit of statistical significance. Physical function was affected by the severity of the burn and by hand burns. Body image was influenced by FT burns but not by hand or facial injuries. Sexual life was affected by FT burns larger than 20%. Patients older than 25 years, those with TBSA greater than 30%, FT greater than 20% or time of hospitalization over one month were concerned about their general health. The effect of burns on patients' physical and psychosocial life was, however, slight, even with respect to severe injuries.

Aeromonas hydrophila in burn patients

Burn wound infection with Aeromonas hydrophila appears to be very uncommon. This study reports on nine cases of A. hydrophila in burn patients treated over a 21 month period at the New Somerset Hospital Burn Unit. The average age of the patients was 31 years (range 24–60 years) and the average TBSA was 33% (range 16–51%). All patients had positive wound cultures for A. hydrophila, obtained on admission or shortly thereafter. One patient also had a positive blood culture. Two patients with small partial thickness burns did not receive antibiotic therapy, and made an uneventful recovery with topical therapy alone. The other seven patients developed clinical signs of septicaemia and required parenteral antibiotics, in addition to topical therapy. One patient died of ARDS, but the other eight recovered and were discharged. No patient had evidence of myonecrosis. Small, superficial burns which culture A. hydrophila can be treated by topical therapy alone. Large and/or deep burns, require antibiotic therapy and debridement of all necrotic tissue, particularly when myonecrosis is present. The antibiotics of choice are the aminoglycosides or the quinolones.

Imipenem Resistance in Aerobic Gram-Negative Bacteria

A prospective study was undertaken to observe the emergence of resistance to imipenem, if any, among aerobic Gram-negative bacteria. A total of 736 isolates were tested during 1994-95 and less than 1% of them were resistant to imipenem, whereas the next year ('95-'96) the rate increased to 11 of the 903 isolates tested. The resistant isolates during ‘94-'95 were all Stenotrophomonas maltophilia whereas the spectrum of resistant bacterial species increased in ‘95-'96 to include Pseudomonas aeruginosa, Burkholderia cepacia, Acinetobacter calcoaceticus, Enterobacter cloacae, Proteus mirabilis and Morganella morganii with a tendency to an increase in the minimum inhibitory concentration (MIC) in the later part of the year. A majority (72%) of the resistant isolates were from patients with burns, and burn wounds were most frequently infected with such organisms. These data suggest that over a period of time aerobic Gram-negative bacteria may develop resistance to imipenem and the pool of such bacteria increases with extensive use of the drug. Non-fermentative aerobic bacteria tend to develop resistance faster with widespread dissemination than Enterobacteriaceae. Hospital Burn Units are a potential source of development of such resistance.

Self-inflicted burns

Self-inflicted burns are a regular source of admissions to burns units world wide. This study examines the characteristics and outcomes of those who deliberately burn themselves. The medical records of all patients admitled to the Royal Brisbane Hospital Burns Unit and identified as having suffered a self-inflicted burn between 1990 and 1995 were reviewed. The records of patients who doused themselves with flammable liquid between 1984 and 1995 were examined as a separate group. Of 1072 admissions there were 44 cases (4.1 per cent) of deliberately self-inflicted burns. Average age was 30 yr with an average total burn surface area (TBSA) of 30 per cent (range 1–98 per cent). Schizophrenia, depression and personality disorder were diagnosed in 71 per cent. Alcohol intoxication was common in the rest. Suicide attempters were almost all male and the majority (60 per cent) were diagnosed with a major psychiatric illness. Self-mutilators suffered much less serious burns and none died. Self-inflicted burns accounted for 24 per cent of burns admitted to the intensive care unit. Self-immolation with flammable liquid resulted in severe burns with a 45 per cent mortality. A number of differences was demonstrated between those patients who had attempted suicide and those who had deliberately burnt themselves without suicidal attempt. Self-immolators constitute a considerable proportion of major burns admitted to this unit.

Return to employment after burn

The increase in the survival rate of burned patients has stressed the need to study their rehabilitation. The purpose of our study was to characterize the factors influencing such patients' return to work. We conducted a mail survey among 316 patients aged 15–65 years, treated at Töölö Hospital Burns Unit between 11 November 1988 and 31 December 1994. Of 175 participants, 130 (74 per cent) were men and 45 (26 per cent) women. The mean TBSA was 14.0 per cent, mean FT 6.4 per cent and the mean time of hospital treatment (TOT) 17.5 days. Statistical significance was calculated by Mann-Whitney U test, Kruskall-Wallis one-way analysis of variance and Chi-square test as appropriate, with a probability level of 0.05. In the study, 54 per cent of patients whose burn area was 1–10 per cent, returned to work within 2 months. No difference was found between patients who had hand burns and those who had burn injuries in other parts of the body. Patients who did not return to work were significantly older (mean age 45 years) than those who did (mean ages varying from 33 to 36 years; P < 0.05). Total body surface area burned (TBSA), FT, TOT, age and employment status at the time of injury were the factors predicting the resumption of working ability after burn injury.

Reduction in paediatric burn admissions over 25 years, 1970-94

Objective–To describe trends in burn admissions to a large paediatric burn centre, between 1970 and 1994.Methods–Hospital records of the Royal Children's Hospital burns unit were audited for the years 1970-94...

High-resolution genotyping elucidates the epidemiology of group A streptococcus outbreaks.

Streptococcus pyogenes strains were genotyped by a combination of molecular methods for high- resolution epidemiologic studies of disease outbreaks. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) analysis of the emm gene is reported. Alone or in conjunction with other molecular techniques (16S ribotyping, pulsed-field gel electrophoresis, and detection of exotoxin genes), PCR-RFLP could differentiate outbreak-related strains from contemporaneous background strains of the same M serotype. Three outbreaks were studied: pharyngitis in a boarding school (serotype M5), cross-infection in a hospital burn unit (serotype M76), and severe invasive disease in two elderly care homes (serotype R28). It was possible, for example, to identify within serotype R28 a clone with particular potential for invasive disease. In all cases, the four molecular methods yielded complementary results that were hierarchically related. Strains could be assigned to the outbreak or the background in a precise, reproducible, and rapid manner.

Impact of Pharmacy Efforts to Promote the Optimal Use of Ranitidine in a University Teaching Hospital

Objective: To determine whether the development, implementation, and outcome of a hospital-wide, pharmacy-initiated, educational and intervention program impacted ranitidine prescribing patterns specific to institution guidelines. Methods: The development of a standardized ranitidine medication utilization guideline (R-MUG) form was established by the departments of pharmacy and gastroenterology in conjunction with the pharmacy and therapeutics committee at the University of California, Irvine. Using this standardized R-MUG form, all hospitalized patients (excluding pediatric, mental health, and labor and delivery) receiving ranitidine during their hospitalization were identified and evaluated for appropriate ranitidine use patterns. A baseline evaluation phase that included 240 patients was conducted, and diagnosis, dosage, and dosage form were recorded. This was followed by an educational program and subsequently a posteducational pharmacist intervention phase involving 210 patients, in which data were collected over a 3-week period. From these data, projected ranitidine cost savings were calculated. Results were used to determine the impact the educational process had on modifying ranitidine prescribing patterns. Results: Initially, ranitidine was prescribed according to the guidelines in 74% of the patients. After educational inservice sessions this number rose to 96% (p &lt; 0.001). The 3-week intervention phase saved approximately $930 compared with the baseline period by limiting the amount of ranitidine used. The optimal choice of ranitidine dosage form increased significantly from baseline (87%) to the posteducational data collection period (94%) (p &lt; 0.01). Targeted intervention of high-need areas of the hospital (surgical and burn intensive care units) resulted in a significant decrease (p &lt; 0.001) in the percentage of inappropriate dosing with continuous ranitidine infusion, but not with intravenous piggyback or syrup. Conclusions: This program was an effective method of educating healthcare professionals regarding ranitidine prescribing, improving the pattern of use of ranitidine, and decreasing costs to the institution. It may serve as a model for addressing other medication usage concerns.

Pattern of burn injury in hang-glider pilots

High-voltage electrical injury has been well documented in a number of situations, such as the occupational hazard of linesmen and construction workers, and in the context of overhead railway power lines. Two cases of hang-glider pilots contacting 11 000-volt powerlines have recently been treated in the Royal Brisbane Hospital Burns Unit. They demonstrate an interesting pattern of injury, not described in current burns literature, involving both hand and lower abdominal burns. Both patients sustained full-thickness patches of burn injury, with underlying muscle damage and peripheral neurological injury. This distribution of injury seems to be closely related to the design of the hang glider.

Art Therapy on a Hospital Burn Unit: A Step towards Healing and Recovery

AbstractThis article describes how art therapy can benefit patients who are hospitalized due to severe burns. Burn patients typically suffer psychological as well as physical trauma due to their burn experience. This author outlines the psychological phases, identifies how burn patients typically experiences their healing process, and discusses how art therapy can assist the patient at each stage of the recovery process. Two case studies illustrate the use of art therapy with pediatric burn patients to express their trauma and cope with their burn experience.

Hot tar burns: twenty-seven hospitalized cases.

Between July 1, 1984, and December 31, 1991, 27 consecutive patients required admission to the Grady Memorial Hospital Burn Unit for care of hot tar burns. This group represented 1.4% of all admissions to this burn unit. Injuries occurred at the workplace and occurred mostly during the summer. They most commonly involved the patient slipping while carrying a bucket of hot tar. Ninety-six percent were male. The mean age was 33.7 years. Mean burn size was 13.1% total body surface area. Burn topography centered on the upper extremities and hands. Forty-one percent required a surgical procedure for their burn. Mean hospitalization time for survivors was 16.6 days. The survival rate was 92.6%. Both of the patients who died had large burns and/or preexisting medical problems. Hot tar burns occur under predictable circumstances, appear to be preventable, and have accounted for only a small fraction of all admissions to this burn unit.

Burn injuries in the elderly

This study has shown that elderly males were more likely to be admitted to the Royal Brisbane Hospital Burns Unit than females. No high-risk period of the day, week or year could be identified for this group. Flame burns and scalds were most common as was the association with cooking and bathing activities. Predisposing factors were found to be common in the elderly burn population. Prevention programmes need to be directed to the home with safer cooking facilities and lower temperature or temperature outlet controls to lessen bathing scalds, as these patients found it difficult to escape a hot bath. Mortality rates were related to the percentage total body surface area burned and inhalation injury, and were well predicted by the Burn Severity Index. Complications were mainly pneumonias and venous thrombosis and reflect the need in this age group of maintaining active mobility and a quick resolution of the burn injury. Good nutrition, often lacking in this age group, must be maintained, along with meticulous wound care if infection is to be prevented. Early wound coverage is vital to prevent sepsis. Our approach is towards an early skin grafting programme while the patient is fit. This is aggressive, with as much skin coverage as possible, before the patient's condition deteriorates. Every effort is made to maintain the patient's health as near normal as possible. However, if deterioration occurs, then the patient is supported and grafting delayed until the patient is again fit for surgery. When this study was undertaken, it was hoped that an answer to the controversial subject of early versus late surgery could be answered. Unfortunately, the data varied so much due to the unstable condition of many of the patients, that no valid conclusion could be reached in this regard.

Tasks of Bereavement for Burn Center Staffs

Considerable research and theoretic work is reviewed to identify the major tasks of the grieving process. These tasks are diffusing the emotional energy of loss, reknitting the social fabric, and forming a new relationship with the deceased. A narrative approach to understanding human experiences is outlined, and specific application is given to the grieving process. Through the use of a narrative report of the death of twins in a hospital burn unit, the tasks of grieving are applied to professionals who work with patients with burns. Finally, practical suggestions for help with the tasks of grieving in a burn center are offered.

Automobile carburetor- and radiator-related burns.

Seventy-nine persons who had sustained automobile engine carburetor- and radiator-related burns were admitted to Grady Memorial Hospital Burn Unit between June 1, 1984 and September 30, 1990. Forty patients with carburetor-priming flame burns had a mean age of 31.5 years, a mean burn size of 13.4% total body surface area, and a mean length of stay of 13.8 days. There were 37 male patients. Four patients had an inhalation injury. Twenty-two surgical procedures were performed on 13 patients. One patient was an innocent bystander, and one patient died. The clothing of 16 patients had ignited, which resulted in larger, deeper burns and in one death. Burns predominantly involved the right sides of the face, head, and torso; the right upper extremity; and the right hand. Thirty-nine patients had scald burns that were associated with uncapping a radiator. These patients had a mean age of 29.6 years, a mean burn size of 8.9% total body surface area, and a mean length of stay of 6.4 days. There were 36 male patients and three innocent bystanders. One autografting procedure was performed, and there were no deaths in this group of patients. The burn-prone person is the young adult male. The circumstances that result in such dangerous behavior are predictable, and resultant burn injuries are preventable.

The burn unit experience at Grady Memorial Hospital: 844 cases.

Between February 20, 1987 and July 13, 1990, 844 patients were admitted to the Grady Memorial Hospital Burn Unit. Mean age was 25.5 years, mean burn size 16.5% total body surface area, mean survivor hospital length of stay 15.9 days, and an overall survival 90.5%. Seventy-three percent were male. One half of the burns were less than 10% total body surface area. Almost half (48.5%) of the patients had flame burns, which accounted for 88.8% of the 80 deaths. The peak burn incidence occurred in infants and children as a result of scalds. If those with toxic epidermal necrolysis (n = 5), those without skin injury (n = 13), and those who were allowed to die (n = 16) are excluded, survival was 92.2%. Survival in 62 patients with inhalation injury (55.23%) was significantly less than that in 474 patients without inhalation injury (98.10%) (p less than 0.0001). The three variables--age, burn size, and inhalation injury--each influenced survival significantly but appeared to be dependent on each other; all three tended to increase or decrease together. Logistic regression equations to predict survival were developed.

Burns caused by automobile radiators: a continuing problem.

In spite of the fact that injury warning labels have been placed on radiator caps for the last 15 years, automobile radiator scald burns continue to be a burn prevention problem. The temperature of radiator fluid may be as high as 100 degrees F to 250 degrees F in a properly functioning car and higher in an overheated vehicle. From 1974 to 1990, 100 patients with burns that were caused by automobile radiators have been admitted to the Parkland Memorial Hospital Burn Unit (1.5% of acute admissions). Eighty-two percent of the injuries occurred in the summer months, and 93% of the patients were male. Mean age was 31 +/- 17 years (range, 8 months to 79 years), and mean burn size was 11.3% total body surface area (TBSA) (range, 1% to 32%) with a mean full-thickness burn size of 0.6% TBSA. Length of stay was 7 +/- 7.4 days (range, 1 to 38 days). Burns to the face, neck, and trunk necessitated most admissions. Although there were no deaths, five patients required intensive care for airway monitoring; mean length of stay was 6 days. One patient required endotracheal intubation for a total of 11 days. Ten patients required one or more skin grafting procedures, and three patients required burn resuscitation. Four patients sustained minor ocular injuries. A subgroup of patients demands special review: 10 children younger than 10 years of age (mean age, 4.1 years) of which 70% were boys. Mean burn size was 15.5% TBSA; mean full-thickness burn size was 2.4% (four times larger than the mean burn size for the adult population).(ABSTRACT TRUNCATED AT 250 WORDS)

Cement burns and their treatment

Twenty patients with cement burns presenting to Stoke Mandeville Hospital Burns Unit between 1981 and 1989 are described. They represent 1.8 per cent of the total adult patients treated at this unit. Fifteen (75 per cent) had surgery for full thickness skin burns. A questionnaire sent to all the accident and emergency officers employed within the catchment area of the Burns Unit at Stoke Mandeville Hospital showed important gaps in their knowledge of the subject. It is suggested that further publicity be given to this uncommon but potentially serious injury.

Effects of Auricular Acupuncture-Like Transcutaneous Electric Nerve Stimulation on Pain Levels Following Wound Care in Patients with Burns: A Pilot Study

This study was designed to test the hypothesis that auricular acupuncture-like transcutaneous electrical nerve stimulation would significantly reduce the pain experienced by patients with burns immediately after wound debridement, other wound care, and dressing changes. Subjects were 11 inpatients at the University of Alabama Hospital Burn Unit. A two-period crossover design was used, and each patient received one experimental treatment consisting of bilateral acupuncture-like transcutaneous electrical nerve stimulation to six ear points and one control treatment consisting of a placebo pill. The Visual Analogue Scale was used as a measure of pain and was completed immediately before and after treatments and at 15, 30, and 60 minutes after treatment. A two-factor repeated measures ANOVA indicated significant effects of measurement time (p less than 0.001) and treatment by time (p = 0.002). Post hoc analysis revealed significant differences (p less than 0.05) between experimental and control conditions at all times after treatment but not at pretreatment baseline. These results indicate that auricular acupuncture-like transcutaneous electrical nerve stimulation may be an effective pain management technique in patients with burns.