Further Inpatient Care
A primary focus during hospitalization is to prevent nosocomial transmission of multidrug-resistant pathogens, especially in patients with a greater percentage of 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).
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 is expected with infected material or open wounds. Masks and caps should be implemented based on the presence of multidrug-resistant bacteria. The use of individual-patient equipment should be considered.
Further Outpatient Care
Patients will require prolonged occupational and physical therapy support based on the site of burn.
Transfer
Aggressive infection-control procedures should be undertaken when transferring patients between facilities because of the risk of transferring multidrug-resistant bacteria.
Deterrence/Prevention
The prevention of burn wound infection is a team approach that includes the support of surgeons, nurses, infection-control providers, and infectious disease physicians. Emphasis on early wound care, infection-control practices, and long-term rehabilitative care is necessary to improve the morbidity and mortality associated with burns.
Early removal of full-thickness burned tissue, as well as early definitive wound closure and strict enforcement of infection-control procedures, is necessary to mitigate poor outcomes.
Complications
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.
Prognosis
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.
Patient Education
For excellent patient education resources, visit eMedicine's Burns Center. Also, see eMedicine's patient education article Thermal (Heat or Fire) Burns.
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