Hot Water Burns Research Articles

HİZMET İŞLETMELERİNDE MALIYET ANALİZİ: SİVAS NUMUNE HASTANESİ YANIK ÜNİTESİNDE YATAN HASTALARIN MALİYET ANALİZİ

Amaç. Sivas Numune Hastanesi yanık ünitesinde 1 Mayıs 2012-15 Haziran 2013 tarihleri arasında yatarak tedavi edilen 68 hastadan toplanan veriler incelenmiş; hasta başına düşen ortalama maliyetler hesaplanmış ve analiz edilmiştir. Yöntem. İnceleme kapsamında yaş, yanık derecesi, yanık yüzdesi, yanık çeşidi, yatış günü verleri ve faturaları değerlendirilmiştir. İstatistiksel olarak hastaların yanık çeşidine göre oranları tespit edilmiş ve ayrı ayrı maliyetleri hesaplanmıştır. Bulgular. Hastaların %80,9’u sıcak su yanığına, %7,4’ü alev patlamasına, %4,4’ü süt yanığına, %4,4’ü buhar yanığına, %2,9’u elektrik yanığına maruz kaldıkları saptanmıştır. Sonuç. Yanık maliyetlerinin; yanık derecesine, yanık yüzdesine ve yatış gün sayısına bağımlı olduğu, yaş ve yanık çeşidinden bağımsız olduğu görülmüştür. Maliyeti artıran en önemli etkenin yatış gün sayısı olduğu belirlenmiş; 68 hastanın ortalama maliyetinin 1193,65 TL ve bir hastanın bir günlük yatış maliyetinin ortalama olarak 110,12 TL olduğu sonucuna ulaşılmıştır.

HİZMET İŞLETMELERİNDE MALIYET ANALİZİ: SİVAS NUMUNE HASTANESİ YANIK ÜNİTESİNDE YATAN HASTALARIN MALİYET ANALİZİ

Aim. The aim of this study is to investigate retrospectively the average cost per patient between the time 1May 2012-15 June 2013 in 68 patients who were hospitalized in the Burn Section of Numune State Hospital. Methods. This investigation includes age, degree of burn, burn percentage, burn type, hospitalization days and bills. Rates were determined according to the burn type of patients and costs were determined according to these types. Results. 80.9% of patients had hot water burn, 7.4% were burned due to burst flames, 4.4% had milk burns, 4.4% had steam burns and 2.9% were identified to have electrical burns. Average costs of burn injury inpatients was reported as TL values. Conclusion. The degree of burn injury, burn ratio and number of days during hospitalization were found to be dependent while age and type of burn injury were found to be independent variable that affect burn costs. The most important paramater that increased cost was number of days of hospitalization. Total cost of 68 patients was 1193,65 TL and average daily cost of a patient was found to be 110,12TL.

Multiple sclerosis (MS) and neurodegeneration: cause and pathogenesis in relation to electromagnetic fields (EMF)

Multiple sclerosis (MS) is prevalent in higher latitude areas where geomagnetic storms often occur. The earliest pathological finding is myelin destruction. Myelin is a high capacitance electrolytic capacitor that can store a large amount of charge and energy. Since storms possess high-energy electromagnetic fields (EMF), the capacitor will be overcharged, which may break down the dielectric. As a result, a short circuit occurs and electrolytes heat up and/or the capacitor may burst. Also, EMFs have the potential to induce hotspots in the center of the brain. The increased temperature of the cerebrospinal fluid will cause hot water burns in surrounding areas. Thus, two distinct lesions exist in MS, electric shock and hot water burns. In addition, the overcharged capacitor will produce repetitive or continuous action potentials, causing excess Ca2+ influxes and subsequent excitotoxicity. This leads to mitochondrial dysfunction, including an energy deficit, oxidative stress and apoptosis. Moreover, EMFs activate microglia via activation of voltage-gated ion channels. These MS related neurodegenerative and inflammatory processes could have causes and pathogeneses in common with Alzheimer’s, Parkinson’s, and amyotrophic lateral sclerosis, which are often reported in MS patients. I hypothesize thus that MS and certain common neurodegenerative diseases are caused by high energy EMF.

Early childhood severe scalds in a developing country: A 3-year retrospective study.

The burns intensive care unit (BICU) staff observed an increasing number of pediatric scald burn admissions as a result of increase injuries associated with the scald burns. A retrospective study was conducted to identify scalds demographics, etiologies, and mortality risk factors. This descriptive study comprised a total of 166 patients aged 0-5 years, who were admitted to the BICU of the Reconstructive Plastic Surgery and Burns Unit (RPSBU) through the Accident and Emergency (A and E) Centre of the Komfo Anokye Teaching Hospital (KATH)from May 1st 2009 to April 30th 2012. Source of information was the BICU Computerized Database System. Data extracted included demographics as well as treatment methods and outcomes. The study population was 166; 92 (55.4%) males and 74 (44.6%) females. Scalds admissions were 141 (84.9%); 13 (9.2%) of them died, 83 (58.9%) discharged, and 45 (31.9%) transferred-out to another burn ward and pediatric surgery ward in the hospital. Scald patients’ demographics included 78 males (55.3%) and 63 females (44.7%); mean age was 2.18 years. Mortality risk factors identified were age <3 years (P = 0.044); scalds from hot water (P = 0.033), total burns surface area >30% (P = 0.017), and multiple body parts affected (P = 0.049). The current study showed age, hot water, and Total Burns Surface Area (TBSA) as risk factors of early childhood scalds. Education on scalds prevention targeting mothers/caregivers is needed to create awareness of the frequency, severity, and danger associated with pediatric scalds.

The demographics of modern burn care: should most burns be cared for by non-burn surgeons?

Background Minor burns represent .96% to 1.5% of emergency department visits, yet burn center referral is common. Analysis of the Grady Memorial Hospital Burn Center was conducted to examine the feasibility and savings if burns were managed locally with consultation as needed. Methods Data on 776 consecutive admissions to Grady Memorial Hospital Burn Center between November 2005 and July 2007 were prospectively reviewed. National and international cohorts were compared. Results Patients' mean age was 31 years, 69.8% were male, and 87% were insured. Thirty-nine percent were transfers. Seventy-six percent of transfers (51% of air transfers) and 70% of all admissions were for ≤10% total body surface area burns. Helicopter transport cost $12,500 and averaged 48 miles. Eighty percent of burns were hot water (scald), grease, or flame burns, and 31% required skin grafting. Conclusions Most burns require assessment, debridement, and dressing changes. Grafting is rarely necessary. Patients are transferred because of a lack of training, and patients suffer economic burden and treatment delay. Savings could be realized were patients treated locally with select burn center referral. Video consultation and mentoring can help with triage and care of minor burns. Major burns require burn center referral. International practice reinforces these results.

Epidemiology and bacterial colonization of burn injuries in Blantyre

Forty-nine patients from the Burns Unit at the QECH had swabs taken from various sites in order to determine the bacterial profile and antibiotic susceptibilities in burn wounds colonized by bacteria. The mean age was 16 years (range 1-70 years); 27 (55 %) of the study population were female and 22 (45%) were male. Twenty-four (49%) patients were epileptic. Open fire (41%) was the most common cause of burn injuries among epileptics while hot water burns (29%) were commonest among non-epileptics. Burn injury and percentage total burn surface area (% TBSA) injuries decreased with age, and the upper and lower limbs, trunk, head and neck were the most commonly affected sites. Staphylococcus aureus was the commonest isolate (23%), followed by Proteus mirabilis (22.7%), Streptococci spp (15.9%), Pseudomonas aeruginosa (4.5%) and 3.4% for Escherichia coli, Salmonella and Klebsiella spp. There was a significant trend of bacterial growth with increasing % TBSA (p<0.001). Bacterial growth was significantly more common in more recent burns of less than 20 days compared to burns of longer duration (OR 4.1 [95% CI 1.58-10.99]). Broad-spectrum antibiotics are required as first-line therapy for burns-related sepsis but there is need for surveillance of antibiotic susceptibility to help determine appropriate therapy.

Cutaneous mercury deposits after henna dye application in the arm

Conflicts of interest: none declared. Sir, Henna is used to prepare hair and body dyes. It is obtained from dried leaves which are powdered and mixed with oil or water.1 Application of temporary henna tattoos is popular in holiday resorts of the Mediterranean area among young people. However, this application may be accompanied by topical or systematic complications. Allergic contact dermatitis resulting from henna tattoo mixtures has been already reported, but there have been no reports concerning the effects of heavy metals, such as mercury, on granuloma formation and cutaneous abscess after henna tattoo application. Herein we describe a case of cutaneous mercury deposit after the application of henna dye containing red pigment and we discuss its diagnosis and proper management. A 13‐year‐old boy presented to us with a painful cutaneous granuloma and abscess on the lateral aspect of his swollen arm (Fig. 1). From history‐taking the parent revealed an incident of hot water burn in this particular region of the arm. Initial physical examination showed a second‐degree burn with signs of inflammation. He was given oral antibiotics and painkillers. Care of the wound was done with occlusive dressings. The patient was discharged after a single day of hospitalization, to be re‐examined in a week. Upon re‐examination we concluded that the signs of inflammation had subsided but the cutaneous granulomas were still present.

Scalding in Turkish children: Comparison of burns caused by hot water and hot milk

Introduction Our aim in this study was to compare the clinical differences and etiologic risk factors for hot water and hot milk scald burns in Turkish children. Methods The retrospective study examined the cases of 140 children aged 0.1–7 years who had scald burns treated in three burn units of a Turkish hospital network between March 2000 and December 2004. The patients were categorized in two groups: hot water burns or hot milk burns. Results Ninety-five (67.9%) patients had hot water burns and 45 (47.1%) had hot milk burns. The proportion of patients with hot milk burns who lived in rural areas was significantly higher than the corresponding proportion for the hot water cases (75.6% versus 52.6%, respectively; p < 0.01). In 20 (44%) of the hot milk cases, the burn was caused by milk being boiled in large pots outdoors for cheese production. The other 25 hot milk cases were caused by milk being boiled in the kitchen. The mean (±S.D.) percentage total body surface area burned in the hot milk cases was higher than that in the hot water cases (33.6 ± 2.24% versus 21.42 ± 1.43%, respectively; p < 0.001), and the corresponding mean percentages of TBSA with full-thickness burns were 9.2 ± 2.52% versus 3.13 ± 0.83%, respectively; ( p = 0.083). The mean percentages of TBSA with second-degree burns showed the same trend (29.0 ± 12.39% versus 18.8 ± 1.47%, respectively; p < 0.001) higher percentage of the children with hot milk burns required antibiotics (78% versus 52.8%, respectively; p < 0.006). Seven (7.4%) of the hot water burn patients and 15 (33.3%) of the hot milk burn patients died during the study period ( p = 0.025; overall mortality rate 15.7%). Conclusion Children scalded with hot milk tend to have more extensive burns, and thus have higher mortality, than those scalded with hot water. To create effective programs for preventing scald injuries in Turkey and elsewhere, it is essential to consider ethnic and cultural issues based on these characteristics. Simple precautions should be explained and methods of using liquids such as hot milk should be researched in different geographic locations in order to formulate good prevention strategies.

Gender roles and economics of exploitation, processing and marketing of bivalves and impacts on forest resources in the Sanaga Delta region of Douala-Edea Wildlife Reserve, Cameroon

Socio-economic surveys were carried out in the Malimba and Mouanko communities in the Sanaga delta region of the Douala-Edea Wildlife Reserve, Cameroon, on the exploitation, processing and marketing of bivalves, with emphasis on gender aspects and impacts on the surrounding forest resources. Sixty people from 16 villages were sampled using a structured questionnaire with field observations documented during the peak fishing period (November 2000–June 2001). Results indicated a strong gender differentiation in the activity, with males dominating bivalve harvesting and shell processing and women dominating the processing for meat. Monthly bivalve meat production of 32.9 tons (197.4 tons per year) generated revenues of 65.4 million FCFA (74.9 million per year). Monthly shell production was put at 1380 tons (8040 tons per year) generating a monthly revenue of 74 million FCFA (444 million per year). Problems faced during exploitation, processing and marketing stages include physical, health and socio-economic: use of very depreciable rudimentary tools, shell injuries, fire and hot water burns, insect pests; blindness, deafness; inadequate storage facilities, transport and remoteness of the area. Bivalve processing activities using wood contributed to a total annual harvest of 50 986 m3 from the surrounding forest. Sustainable conservation measures geared towards poverty alleviation are proposed.

The Split Skin Graft Donor Site: Can Pretreatment with Vitamin a Cream Help?

Background A skin graft donor site that heals rapidly with less cosmetic sequelae is of particular benefit to children with burns. Vitamin A cream has been shown to speed up healing after controlled ‘burns’ (dermabrasion and CO2 laser) if it is applied six weeks before treatment. Objective To assess whether pretreatment with vitamin A cream increases the rate of healing of split skin graft donor sites in children with burns. Methods Prospective study of children with hot water burns of 8% to 30% that required split thickness skin grafting. Vitamin A cream was applied bidaily to one thigh and/or buttock of each child for five to seven days before skin grafting. At surgery, equal thickness grafts were harvested from both thighs and/or buttocks. Biopsies were taken from each thigh and/or buttock and were sent for histological analysis. The rate of donor site healing was monitored clinically and with serial photographs. Results No difference in the rate of healing was noted between the treated and untreated sides by either histological or clinical criteria. Conclusions Vitamin A cream applied bidaily for a period of five to seven days did not affect the healing rate of the split skin graft donor sites in children with burns.

The continuing risk of domestic hot water scalds to the elderly

Elderly people are particularly at risk of accidents in the home and with an ageing population, they constitute a large proportion of scald victims. We have seen several elderly patients every year in our own unit who had sustained domestic hot water burns. We decided to ascertain the temperature of water in the private homes of elderly people and in residential care homes in our community. Twenty-five private homes and 14 residential care homes were visited and peak water temperatures were measured in the kitchens and bathrooms. Only one private home and one residential home had water below 45°C. It is recommended that water should be delivered at less than 43°C. We conclude that water is dangerously hot. However, if water is stored at a temperature of less than 60°C there is a risk of infection with Legionella pneumophila. Existing regulations governing the use of ‘fail safe’ thermostatic mixing devices must be enforced and extended to cover domestic hot water systems.

Burns sustained by hot bath and shower water

An 8-year retrospective review of patients admitted to Stoke Mandeville Hospital (Aylesbury, UK) because of burns sustained by hot bath and shower water was undertaken. Fifty-seven patients of all ages were identified and stratified into paediatric (<16 years) and adult groups. Nine patients died. The main characteristics of the burns, causes and outcomes of treatment were analysed for each group. Children were predominantly under three years of age (83%), sustaining most frequently only superficial burns (41%) with areas of less than 10 % total body surface area (72%). Parents' supervision was inadequate in 85% of cases. Eighty-three percent of the adults were over the age of 60. Two thirds had some form of psycho-motor disorder that predisposed to an accident which should have been anticipated. In comparison to children, adults suffered more extensive and deeper burns that resulted in a mortality of 44% (8/18). In both groups, the lower parts of the body were most frequently involved. The observed decline in the number of admissions for the period of investigation is encouraging. It supports an ultimate need for further development and actual implementation of preventative measures for hot water burns in the homes of people who are at greatest risk.

Cooling the burn wound: evaluation of different modalites

A study was undertaken to investigate the cooling and healing effect of different modalities: Melaleuca Alternifolia Hydrogel (Levtrade International (Pty) Ltd.) was compared with tap water as a coolant following application onto a fresh deep partial thickness hot water burn in a porcine model. Four identical circular scalds were created on the backs of 10 pigs. One wound was not treated and served as a control. The other 3 wounds were either cooled with tap water (15°C) or had Melaleuca Hydrogel dressing applied immediately, or after a 30 min delay. Intradermal temperatures were monitored in all wounds: preburn, during the burn and at regular intervals for 1 h. The wounds were biopsied for histological assessment. These samples were repeated at 24 h and 3 weeks. The mean decrease in final temperature at 1 h was in comparison to the preburn temperature; control +0.44°C (i.e. a temperature increase); water −7.82°C; Melaleuca Hydrogel −3.87°C; Melaleuca Hydrogel after 30 min delay −2.67°C. Clinical and histological assessment at 21 days indicated more rapid healing in both the Melaleuca Hydrogel and water-cooled burns compared with the untreated controls. Effective cooling of the burn wound and an increased rate of wound healing was achieved by both repeated tap water compresses and by immediate or delayed application of Melaleuca Hydrogel. Cooling is an effective means to reduce tissue damage and increase wound healing.

The use of diverting colostomies in paediatric peri-anal burns

Over a 3 yr period we performed colostomies in 13 paediatric perineal burn patients out of a total of 1544 patients admitted to our Burns Unit during that period. The mean total body surface area (TBSA) burn was 34% (14–65%); ten patients sustained fire burns and the remaining three hot water burns. We performed prophylactic colostomies in seven children, therapeutic colostomies (to counteract deep wound infection and septicaemia with gut-derived organisms) in five patients and one colostomy in a cerebral palsy child with a left hemiparesis. A sigmoid end-colostomy with Hartmann's closure of the distal segment was the preferred method of choice. In all children but one (died from multi-organ failure 13 days after admission) there was a marked improvement in the clinical appearance of the burn wounds and subsequent graft-take and healing. There was a change in the bacterial profile away from predominantly gut-derived Gram negative organisms to either Pseudomonas aeruginosa or no pathological organisms grown. Complications were few — two children suffered prolapse of their colostomy requiring manual reduction. We advocate diverting colostomies in a highly select group of paediatric burn patients in whom continual faecal soiling is threatening to both graft and life.

Paediatric burns in Iceland.: Hospital admissions 1982–1995, a populations based study

Epidemiological data of 290 children admitted to the Paediatric Department, University Hospital of Iceland, over a 14 year period, 1982–1995, are presented. The sex ratio boys/girls was 1.6. 72.8% were children four years and younger. Hot fluids was the most common cause of burn injuries, mostly caused by geothermal hot water. Only one child suffered from electricity burn injuries and none from corrosives. Most of the accidents occurred at home (81.4%). A decreasing number of children suffering from electricity and corrosive burn injuries reflects heightened awareness and improved safety in the home. We found a significant increase in the incidence of hot fluid burn injuries in Icelandic children compared to previous studies. This calls for preventive measures with regard to geothermal and other hot water burns in Icelandic children.

Inhalation burns in children.

Survival from serious burns in children has improved substantially in recent years. Mortality is predominantly determined by the total body surface area burned and the often unrecognised inhalation injury. A retrospective review of 4,451 consecutive children with thermal injuries over a 10-year period was undertaken to determine the incidence, clinical presentation, and pathology of inhalation injury and its contribution to morbidity and mortality. Inhalation burns were diagnosed clinically and confirmed endoscopically and post-mortem in 97 (2.2%) children; 77 sustained fire burns (mean age 4 years) and 20 hot-water burns (mean age 18 months). The Moylan classification stratified them into upper-airway burns in 59 children, major-airway burns in 29, and parenchymal burns in 44. Major-airway burns were always seen in conjunction with either upper-airway or parenchymal injury. Stridor and acute progressive respiratory distress were the two main symptoms, the onset of which was occasionally delayed for up to 72 h. Endoscopy was most helpful in confirming the diagnosis and determining airway management. Endotracheal intubation was needed in more than 50% of children, usually for less than 5 days, and was converted to tracheostomy in only 6. Persistent laryngeal and tracheal damage was identified in 4. Secondary pneumonia occurred in 41.5% of children with fire burns and 55% with hot-water burns. Extensive surface burns, parenchymal injury, and secondary pneumonia all contributed to the significant mortality. Post-mortem findings corroborated clinical and endoscopic evidence. This study suggests that inhalation burns were often not recognised, could present late, and usually had significant consequences. Early clinical diagnosis, supported by endoscopic findings and appropriate management, is essential if the high morbidity and mortality amongst these children is to be improved.

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...

Hot water burns in Cape Town

Scalds are common in South Africa and accounted for 21.6 per cent of the admissions to the Burns Unit of the University of Cape Town. Two hundred and forty adult patients (160 males, 80 females) with a mean age of 34.2 years were admitted for treatment of scalds between 1985 and June 1992. One hundred and thirteen sustained their scalds accidentally while 127 patients were assaulted with hot water. Epilepsy accounted for 11 per cent of the accidental burns. The head and neck was involved in 16.8 per cent of accidental burns and in 84.9 per cent of assaults. A quarter of the scalds to the trunk and limbs were caused by assault compared with 75 per cent caused by accidents. Beta haemolytic streptococcus was the second commonest organism isolated from the burn wound (57 patients). In 19 per cent of these patients a weekly course of penicillin and erythromycin did not eradicate the streptococcus and clindamycin was required. Accidental scalds usually affect the lower body and limbs whereas assault with hot water commonly involves the head and neck. Streptococcus is a common organism in the Burns Unit and is becoming more difficult to eradicate.

Assault inflicted by hot water

Assault inflicted by hot water is uncommon although such injuries have been reported from many parts of the world. The patient characteristics, burn distribution and outcome in 127 patients who had been intentionally assaulted with hot water during a 7 1 2 -year period are reported. More than half of the males were assaulted by their wives. The female was often assaulted by her spouse or another family member. Most patients came from lower socioeconomic groups. The average burn surface area was 13.7 per cent (range 1–45 per cent). The upper part of the body was much more frequently burned than the pelvic and lower limb areas (12 per cent). Males (94) were assaulted more commonly than females (33). Eighty-four patients suffered partial skin thickness burns requiring debridement and skin grafting. The average hospital stay was 17 days (range 1–61 days). Upper body hot water burns in adults should raise the possibility of assault in the minds of attending medical personnel, especially where predisposing factors exist (alcohol abuse, lower socioeconomic strata, poor education). Most patients sustain partial skin thickness burns and will require debridement and grafting. Psychosocial factors require investigation and professional intervention.

Help Needed on Hot Water Burns

To the Editor.— Tap water scald burns present a serious, yet highly preventable, injury to children. They can be most easily prevented by reduction of home water heater temperature to safe levels. In order to protect a maximum number of children, efforts have been made to convince the US Consumer Product Safety Commission (CPSC) to modify water heater industry policy. In February 1981, the US Consumer Product Safety Commission rejected a petition requesting a maximum setting of 130°F on new water heaters for home use.