Burn Wound Infections Follow-up
- Author: Jairo A Fonseca, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD more...
Further Outpatient Care
Patients require prolonged occupational and physical therapy support based on the site of the burn.
Further Inpatient Care
A primary goal during hospitalization is to prevent nosocomial transmission of multidrug-resistant pathogens, especially in patients with a greater percentage of total body surface area (TBSA) burn (approximately 30%) or who are known to be colonized with multidrug-resistant bacteria such as MRSA, vancomycin-resistant Enterococcus species, or gram-negative bacteria known to develop resistance (eg, Pseudomonas, Klebsiella, Acinetobacter species).[5, 10]
Hand hygiene should be aggressively implemented. Standard precautions should be used in the care of all patients with burn injuries. Patients should be managed in single rooms, if possible, with use of contact precautions. Gowns and gloves should be used when contact with infected material or open wounds is expected. Masks and caps should be implemented based on the presence of multidrug-resistant bacteria. The use of individual-patient equipment should be considered.
For catheter insertion, locations distal from the wound are necessary since catheters inserted near or through burn wounds are more frequently associated with infection development and earlier bacterial contamination with higher numbers of colony-forming units than catheters inserted distant from the wound. If a central venous catheter is required, femoral insertion sites are associated with higher infection rates.
Routine surveillance cultures may be used in conjunction with isolation precautions for all or those patients with multidrug-resistant bacterial colonization or previous infection. Surveillance cultures, isolation, and hand hygiene, used in conjunction with regular feedback and education and environment control measures, have been shown to control the transmission of resistant pathogens.
Aggressive infection-control procedures should be undertaken when transferring patients between facilities because of the risk of transferring multidrug-resistant bacteria.
Burn wound infections are often the source of bacteria responsible for other systemic infections including bloodstream infections and pneumonia. This can lead to multisystem organ failure and death.
Sepsis can contribute to multisystem organ failure and death.
Early wound excision is associated with bleeding complications that require transfusions. Given the evidence that increased blood transfusion is associated with higher infection rates in the general trauma population, further data is needed to evaluate the overall utility of early excision especially as the overall data supporting this technique is limited although it is considered standard of care in most burn facilities.
The overall prognosis depends on numerous factors, including the patient’s age, percentage of TBSA burned, comorbidities, initial management strategies, and the support necessary for long-term rehabilitative care.
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