Impacts of intelligent monitoring technology installation and additional modalities on hand hygiene compliance in a burn center: A quasi-experimental longitudinal trial.

BACKGROUND: The increasing development of intelligent technologies for hand hygiene (HH) compliance audit has the potential to create an alternative to direct observation (DO), which is still considered the gold standard but has disadvantages such as lack of standardized monitoring practices, Hawthorne effect, insufficient sample size, and time/resource consumption. We aimed to share our preliminary results on the impacts of intelligent monitoring technology installation (IMTI) and additional modalities on healthcare workers' (HCWs') HH compliance in a Burn Center, according to the "5 Moments of HH" concept defined by the World Health Organization (WHO). METHODS: A quasi-experimental longitudinal trial was conducted over eleven months.The first phase of the three-stage study evaluated basic HH compliances obtained by DO. The system-defined HH performances, which IMTI recorded, were assessed in the second phase. Finally, the effect of IMTI and additional modalities was determined in the third stage. RESULTS: 15202 HH events were performed by 41 HCWs, and a total of 20095 HH opportunities were observed. Four hundred fifty-five opportunities were in the preinstallation phase, and 19640 were during the total post-installation period. IMTIdefined performance rates in both Phase 2 (71.2%) and Phase 3 (80.5%) were generally considerably higher than HH compliances obtained from DO (58.5%). Nurses, physical therapy /anesthesia technicians, and housekeeping personnel showed significant increases, which was insignificant in physicians in phase 2. Meanwhile, a sustained increase was observed regarding IMTI and additional modalities of HH compliance of all HCWs in Phase 3. CONCLUSION: IMTI has significantly increased HH performance rates. Furthermore, combining the IMTI with additional modalities as components of a multimodal strategy recommended by WHO appears to affect the sustainability of the increasing trend of HCWs' HH compliance.

Intramolecular through-space charge transfer between benzofuran and ynone groups on a naphthalene spacer.

We have developed a new scaffold that exhibits an efficient intramolecular through-space charge transfer (CT). In this design, electron-rich benzofuran and electron-deficient ynone groups are placed strategically in proximity via a naphthalene spacer. Charge transfer is supported by distinct CT bands in the visible region (>500 nm) in their UV-vis absorption and emission spectra.

Comparison of Work- and Nonwork-Related Lower Extremity Burn Injuries: A Retrospective Analysis.

Lower extremity burn injuries are among the most affected anatomical regions in hospitalized burn patients. Our objective was to compare burn patients with work-related isolated lower extremity burn injuries (w-ILEBI) and patients with nonwork-related isolated lower extremity burn injuries (nw-ILEBI). Sixty-four (15.7%) of 407 patients (16-92 years) were in the w-ILEBI cohort. The most extensive burn wounds were among patients in the fire-flame group with a median total body surface area percent (%TBSA) of 27.0 (interquartile range = 11.0%-45.0%). While 50 (76.9%) patients in the electrical group had full-thickness burns, 99 (60%) of the cases in the scald group had superficial partial-thickness burns. Blood and wound sample cultures were positive in 42 (29.4%) patients in the fire-flame group. Approximately one-third of patients in the fire-flame/electrical group required escharotomy/fasciotomy procedures, only one (0.6%) case in the scald group, and none in the chemical/contact groups. Thirty-three (51%) of the patients in the electrical group underwent skin grafting, but 14 (21.5%) required amputations. The highest mortality was detected in 27 (18.9%) patients in the fire-flame group. This study revealed several differences in clinical characteristics of isolated lower extremity burn injuries (ILEBI): burn mechanism and depth, total body surface area percent (%TBSA), infection, surgery requirements, laterality, and mortality. Within the scope of occupational health and safety measures, protective clothing and increased workplace and safety training for employers/employees should be implemented.

Epidemiological and clinical characteristics and outcomes of inpatient burn injuries in older adults: Factors associated with mortality.

BACKGROUND: There is a lack of epidemiological research on defining the epidemiological profile of burn injuries in older adults in different regions of Turkey. This study was designed to document the prevalent epidemiological pattern of burn injuries and factors that affect mortality in older adults admitted for treatment to the inpatient unit of Adana City Training and Research Hospital (ACTRH). METHODS: Demographic data, burn mechanism, presentation, percentage of total body surface area (TBSA) burn, abbreviated burn severity index (ABSI) and revised Baux scores, comorbidities, and treatment modalities burn patients aged 60 years and over admitted to our burn center January 1, 2016, and December 31, 2019, were evaluated retrospectively in this study. RESULTS: The medical records of 1754 inpatient burns over 4 years were retrospectively reviewed. A total of 104 (5.5%) hospitalized adult burn patients aged 60 years old or over and treated more than 24 h were included in the study. There were 38 males and 66 females with a male-to-female ratio of 1.00: 2.05 in survivors and 1.25: 1.00 in non-survivors. The mean age was 70.5±8.5 (60.0-92.0) for survivors and 72.7±8.4 (62.0-90.0) years for non-survivors. The mean (%) TBSA burned was 11.4±9.9% for survivors and 37.8±30.0% for non-survivors. Most of the burn injuries occurred at indoor locations (81%), caused by hot water scalds, representing more than one-third of all burns, especially in the kitchen and bathroom. Considering the age (p=0.329), the etiology (p=0.984) and place of burns (p=0.071), burned anatomical regions (p=0.817), and the surgical procedure (yes/no) (p=0.798), no statistical difference was observed between survivors and non-survivors. CONCLUSION: The more extended %TBSA burn, the inhalation injury, and deep burns were found to be significantly the most effective factors in mortality. Revised Baux (R Baux) and ABSI scores had a high value of predicting mortality.

Patterns and Outcomes of High-Voltage vs Low-Voltage Pediatric Electrical Injuries: An 8-Year Retrospective Analysis of a Tertiary-Level Burn Center.

Although electrical injuries (EIs) are rare traumas in the pediatric age group, they are considered one of the most devastating injuries. We aimed to evaluate the patterns and outcomes of pediatric high-voltage injuries (HVIs) vs low-voltage injuries (LVIs), admitted to the burn center within the efforts of determining evidence-based data for contributing to burn prevention strategies. A retrospective study was conducted on children with EIs hospitalized in the Burn Center of Adana City Training and Research Hospital for 8 years (2013-2020). Data including the patients' clinical and demographic characteristics, the percentage of total body surface area with burns (%TBSA), length of hospital stay, exposure place, electrical current type, and treatment results were collected and analyzed. EIs were detected in 57 (2.5%) of 2243 acute pediatric burn injury admissions. EIs were most frequently observed in the form of HVIs, among children within the age range of 13 to 18 years, mostly in residential outdoor environments, where the high-power lines still passing close to the home roofs and balconies, resulting from contact with them. Besides, to a lesser extent in LVIs, in the home environment among children younger than 5 years, which was caused by connection with substandard electrical cords/poor-quality electrical devices and inserting an object into the electric sockets. Concerning the mean of %TBSA, HVIs suffered more extensive burns than LVIs. The most frequently affected anatomical regions among HVIs and LVIs were the upper limb, followed by the lower limb. While superficial partial- and deep partial-thickness burns were significantly more common among the LVIs, full-thickness burns were more prevalent among the HVIs. The amputation rate was 12% of which only one of them was major amputation (forearm above the elbow joint). HVIs had more elevated creatine kinase (CK) and CK-myocardial band (CK-MB) levels than LVIs but were not correlated with electrocardiography findings. Only one death (caused by HVI) was observed, with a mortality rate of 1.8%. Pediatric EIs are less common than scald or fire flame-related burns in this age group but can cause significant morbidity and even mortality, especially in severe burns. It is possible to prevent possible morbidity and mortality by strengthening compliance with safety precautions, especially with parental education and raising social awareness. In this context, taking necessary precautions for passing high-voltage power lines under the ground, the standardization of electrical cables by the relevant legal regulations, the use of socket covers in homes, promoting the widespread use of residual current relays, and arrangements to be taken against the use of illegal electricity are among measures for the prevention strategy.

Most Prominent Factors Contributing to Burn Injury-Related Amputations: An Analysis of a Referral Burn Center.

Amputations are uncommon surgical procedures in patients with severe burn injuries. However, these patients often face extreme physical and psychological challenges that result in social stigmatization and inadequate rehabilitation facilities. A retrospective cohort study was designed for the patients admitted to the Burn Center of Adana City Training and Research Hospital (ACTRH). During the study period, 2007 patients aged 0.5 to 92 years were hospitalized at the burn center from January 2016 to June 2020. The incidence of amputation observed among inpatient burn injuries regardless of the etiology was 1.9%, and 87.2% were male. The univariate and multivariate logistic regression analyses were performed to detect the most prominent factors contributing to burn-related amputations. Considering the leading factors of amputations in patients with severe burns, the cause of burns appears to be one of the main factors in past research, and electrical burns were prominent in this context. Also, "the fire-flame-related burns," "full-thickness burns," "the presence of infection," "male gender," "patients within the 18 to 64 age group," and "the burns involved 10% to < 50% of total body surface area (TBSA)" were found to be the most prominent factors of amputations among patients having severe burns. Although they are rare, amputations related to burns commonly cause a decrease in quality of life. Therefore, besides increasing occupational health and safety methods for these risk groups, especially for adults of working age; also, it is essential to increase the importance and awareness of the precautions to be taken in daily life.

A Survey of YouTube Videos as a Source of Useful/Unuseful Information in the Field of the Prevention and Management of Burn Injuries: A Cross-sectional Analysis of the English Language Content.

The study was designed on whether YouTube videos are useful as an information resource in the field of burn injury prevention and management. Current literature on the educational content and quality of burn-related first-aid videos on YouTube was reported as inadequate and inaccurate. However, the quality of YouTube videos on various medical and clinical topics has been the subject of many previous studies, and there has been increasing evidence that the content ratio of usefulness was higher than that of nonuseful. While hours and even minutes in burn injuries are as precious as gold in terms of outcomes, it would be a significant loss not to use the most popular and easily accessible free social media platform of our time as a tool that can contribute to the prevention of burns and raise awareness. Analysis was conducted with the remaining 96 videos from 240 videos obtained from YouTube, according to possible search terms and exclusion of videos according to predetermined criteria. The Global Quality Score (GQS) and modified DISCERN (m.DISCERN) tools were used to assess the quality and reliability of the videos. Viewer engagement metrics and video properties were also investigated according to the usefulness criteria (eg, video length, duration on YouTube, topic contents, source uploads, reliability, and quality). Finally, it was revealed that nearly 80% of the YouTube videos contained information in the field of the prevention and management of burn injuries deemed useful in this study, comparable to the other medical disciplines' reports in the literature.

The Descriptive Epidemiology and Outcomes of Hospitalized Burn Patients in Southern Turkey: Age-Specific Mortality Patterns.

The current descriptive analysis was designed to document the common epidemiologic characteristics and outcomes of burn injuries, and age-specific mortality patterns covering all age groups admitted for treatment to the Burn Center of Adana City Training and Research Hospital. Medical records were retrospectively analyzed. The patients were stratified into two age groups as pediatric and adults, and then into 10 sub-age groups. Among the 946 patients of the study population, there were 24 mortalities with a mortality rate of 2.5%. Patients within the age range of 70 to 79 years had the highest mortality rate of 33.3%; followed by 60 to 69, 80+, 18 to 29, 10 to 17, and <5 sub-age groups, whose mortality rates were 13.0%, 7.8%, 7.2%, 2.4%, and 0.5%, respectively. In terms of multivariate regression analysis of factors predicting mortality among burn patients in all age groups, fire-flame related burns, age ≥18 years, TBSA burned ≥20% (TBSA ≥20%), the existence of inhalation injury, deep partially/full-thickness burns were found to be significant prognostic factors of mortality. The strongest association was seen in TBSA ≥60% segment (P < .0001), which had 25.9 times more death risk. As expected, a similar trend was detected when the age groups stratified into age groups, and the strongest association was in the 60+ sub-age group (P < .0001), whose had 5.84 times more likely death; followed by 29 to 59 and 18 to 29 sub-age groups, with the odds ratios of 2.12 (95% confidence interval = 1.25-3.61) and 2.08 (95% confidence interval = 1.90-4.05), respectively. Oppose to these findings; the 0 to 17 sub-age group was not found to have a statistically significant effect in predicting mortality.

Electrical burns and complications: Data of a tertiary burn center intensive care unit.

BACKGROUND: To review the records of electrical burn patients hospitalized in our burn intensive care unit (ICU) and to report the complications together with our treatment results. METHODS: Demographic data, burn mechanism, presentation, percentage of burn total body surface area (TBSA), abbreviated burn severity index (ABSI) scores, complications and treatment approaches of electrical burn patients admitted to our burn ICU between September 2017 and August 2018 were evaluated retrospectively in this study. RESULTS: Electrical burn injury patients consisted of 17.9% of the patients who were hospitalized in burn ICU (n=139). All patients were male, and the median age was 27.0 years. Twenty-three patients (92%) were burned with high voltage electricity. The median percentage of burn TBSA score was 20.0. Eight patients had an accompanying head, a vertebra or extremity injuries. Sixteen patients (64%) were injured at work. Sixteen patients (64%) recovered with complications. ICU stay and total hospital stay were significantly higher in the group that healed with complications (p=0.005 and p=0.001, respectively). However, no significant differences were detected in burn TBSA and ABSI scores. TBSA and ABSI scores were correlated with ICU and total hospital stay. CONCLUSION: The proportion of our electrical burn patients is higher than reported in the literature. Burn TBSA and ABSI scores seem unrelated to prognosis. As the majority of patients are burned with high-voltage electricity at work, these injuries can be reduced by following occupational safety principles. Because of the high rate of complications in electrical burns, an experienced health team in well-equipped centers should treat patients in accordance with updated guidelines.

The Use of Dermal Substitute in Deep Burns of Functional/Mobile Anatomic Areas at Acute Phase After Early Excision and Subsequent Skin Autografting: Dermal Substitute Prevents Functional Limitations.

We aimed to evaluate the results of dermal substitute implantation after early excision in the acute phase of major burn cases within the scope of efforts to reduce contractions and scar formation in functional anatomic areas (face, neck, axilla, elbow, popliteal). Twelve patients with major burn who were treated in the burn center between September 2017 and September 2018 were included in the study. In these patients, Nevelia® dermal substitute was implanted into 24 functional areas with deep partial or full-thickness burns after surgical debridement of the wound. Autologous split-thickness skin graft was applied to these areas after 14 to 21 days. The patients were followed for 4 to 14 months (mean 6 months). Postoperative scar formation was assessed by the Vancouver Scar Scale at the end of the follow-up period. A simple qualitative staging system was used for aesthetic and functional evaluation. The time from burn injury to dermal substitute implantation was 3 to 21 days. Skin graft take was complete in 22 of 24 regions and partial in one of them, while graft loss developed in one region. In the implantation sites, the Vancouver Scar Scale ranged from 1 to 7. The aesthetic and functional evaluation showed excellent/good results in 21 of 24 anatomic regions, moderate results in 2 regions, and poor results in 1 region. The use of dermal substitute in deep burns of functional/mobile anatomic areas at the acute phase after early excision and subsequent skin autografting has opened a new alternative area in the burn surgery arena to prevent contractures and functional limitations.

Complications of intestinal milking: experimental model.

BACKGROUND: Intestinal milking is a frequently used method in abdominal surgery for various purposes; although it is frequently used for eliminating distension, moving faeces, bezoar or other foreign objects proximal or distal, there are no experimental or prospective studies in the surgical literature with respect to complications of the method. The purpose of the present study was to investigate complications of the milking process in an experimental model. METHODS: Forty-four outbred, 8-month old Wistar albino male rats with weights ranging between 195 and 225 g were used. Four rats were used for preliminary study. The other 40 rats were divided into two equal groups. In the study group (n = 20), a plastic sphere, 3 mm in diameter was sent to the stomach via oro-gastric tubes. This sphere was then moved into the cecum by milking. In the control group rats (n = 20) the small intestines were manipulated at 1-cm intervals but milking was not performed. RESULTS: In the study group six rats (30%) developed grade 1, 11 rats (55%) developed grade 2, and three rats (15%) developed grade 3 peritoneal adhesion. In the control group, 18 rats (90%) had no adhesions and only two rats (10%) developed grade 1 adhesion (chi(2) = 34, P < 0.0001). In the study group, four rats (20%) had small bowel obstruction, whereas no rats in the control group developed small bowel obstruction (Fisher's P > 0.05). Peritoneal smear culture was positive in 11 rats (55%) in the study group, whereas it was positive in two rats (10%) in the control group (Fisher's P < 0.01). CONCLUSIONS: Intestinal milking is a process that can cause severe peritoneal adhesions and peritoneal contamination, which may lead to small bowel obstruction. Avoiding milking to the extent possible in eliminating distension intraluminal material that may cause obstruction, and preferring alternative methods is important for reducing postoperative morbidity.