Improving Nutritional Support of Burn Service Patients by Increasing the Number of Days When 100% of Prescribed Formula Is Given.

The authors sought to increase the number of days when burn service patients receive 100% of prescribed enteral nutrition. The authors first performed a retrospective review of 37 patients (group 1) receiving enteral nutrition. The authors then created and implemented a nurse-directed feeding algorithm, placing patients into three age groups addressing maximum hourly infusion rates, high residual limits, initiating feeding, refeeding residuals, and replacing formula. The authors then performed a prospective review of 37 patients (group 2) fed utilizing the new algorithm. The amount of prescribed, infused, discarded, and missed feeds were recorded, as well as admitting diagnosis, age, gender, length of stay, ventilator days, infections, and mortality. All patients in group 1 (n = 37) received 100% of feeds 59.9% of prescribed days vs 76.5% in group 2 (n = 37; P = .003). Burn patients in group 1 (n = 26) received 100% of feeds 61.6% of prescribed days vs 85.4% in group 2 (n = 21; P < .001). The mean amount of hours tube feeds were held for surgery, procedures, clogged or dislodged tubes, in both historical control and the group using the restorative algorithm were the same. While there was a significant difference in burn size between groups (6.24 vs 18.39%, P = .01), there were no statistically significant differences in length of stay, ventilator days, or mortality. Implementation of a nurse-directed feeding algorithm improved delivery of enteral nutrition for all burn service patients, increasing the number of days when 100% of prescribed enteral nutrition is given.

Multiple-Drug Resistance in Burn Patients: A Retrospective Study on the Impact of Antibiotic Resistance on Survival and Length of Stay.

Despite improvements in early treatment, survival following burn injury remains challenged by sepsis and multiple organ dysfunction syndrome (MODS). Additionally, susceptibility to infections and growing antibiotic resistance places burn patients at increased risk for infections with multiple-drug resistant organisms (MDROs). We therefore aimed to evaluate the impact of MDRO infections on survival and hospital length of stay, as well as examine the role of these organisms in the development of complications, such as acute kidney injury, sepsis, and MODS. To study this, we included all burn patients with infections, admitted between January 1, 2012, and December 31, 2013. Patients were divided into two groups: patients with infections caused by MDROs and patients with infections caused by susceptible organisms. Data were collected on all available cultures, as well as demographic, injury, and treatment-related variables from the medical record. The number of operative procedures (median: 2 vs 1, P < .0001), ventilator days (21 vs 0 days, P < .0001), total antibiotic days (21 vs 7days, P < .0001), and length of hospitalization (39 vs 14 days, P < .0001) were significantly different in the MDRO group vs the nonresistant group. While MDRO infection was not associated with patient mortality, univariable logistic regression analyses demonstrated >20% TBSA (odds ratio [OR] = 4.30, 95% confidence interval [CI]: 1.14-16.29, P = .03), acute kidney injury (OR = 10.93, 95% CI: 2.74-43.57, P = .001), sepsis (OR = 19.20, 95% CI: 3.79-97.27, P < .001), and MODS (OR = 85.49, 95% CI: 12.97-563.28, P < .0001) significantly increased the odds of patient mortality. These findings suggest that infections with MDROs are associated with a greater number of surgical procedures, longer duration of mechanical ventilation, more antibiotic days, and longer hospitalization.

A multicenter study of preventable contact burns from glass fronted gas fireplaces.

Glass fronted gas fireplaces (GFGFs) have exterior surfaces that can reach extremely high temperatures. Burn injuries from contact with the glass front can be severe with long-term sequelae. The Consumer Product Safety Commission reported that these injuries are uncommon, whereas single-center studies indicate a much higher frequency. The purpose of this multi-institutional study was to determine the magnitude and severity of GFGF injuries in North America. Seventeen burn centers elected to participate in this retrospective chart review. Chart review identified 402 children ≤10 years of age who sustained contact burns from contact with GFGF, who were seen or admitted to the study hospitals from January 2006 to December 2010. Demographic, burn, treatment, and financial data were collected. The mean age of the study group was 16.8 ± 13.3 months. The majority suffered burns to their hands (396, 98.5%), with burns to the face being the second, much less common site (14, 3.5%). Two hundred and sixty-nine required rehabilitation therapy (66.9%). The number of GFGF injuries reported was 20 times greater than the approximately 30 injuries estimated by the Consumer Product Safety Commission's 10-year review. For the affected children, these injuries are painful, often costly and occasionally can lead to long-term sequelae. Given that less than a quarter of burn centers contributed data, the injury numbers reported herein support a need for broader safety guidelines for gas fireplaces in order to have a significant impact on future injuries.