Impact of burn unit routine on outcome: A 5-year experience

Abstract

Background: The burn unit, like any high dependency, unit is awash with multi-antibiotic resistant microbes, and the clinician is in a constant battle to prevent such infections from becoming established. After the elimination of hypovolemic shock as a cause of death, infections constitute the leading cause of morbidity and mortality in burn patients. Aims and Objectives: This study aimed to determine the incidence of infection in our burn unit and to demonstrate how our burn unit routine leads to a low incidence of infection in our setting. Materials and Methods: This is a retrospective review of the records of patients attended to between 2009 and 2013 in the burn unit of Federal Teaching Hospital, Gombe, Nigeria. Details of the treatment and follow-up data were obtained from patients′ case files using a predesigned pro forma. All patients were within 24 h of burn and had wounds cleaned under general anesthesia before admission to the unit. In addition, all patients with major burns received infusion of glucose, potassium, and insulin (GKI). Antibiotics use was strictly regulated and was guided by known antimicrobial and sensitivity patterns. Results: Thirty-three patients were admitted within the study period, of whom 27 patients had complete information and were analyzed. The mean age of the burn patients was 11 ± 16.7 (SD) years. There were 16 (59.3%) males and 11 (40.7%) females. Scalding and flame burns accounted for 20 (74.1%) and seven (25.9%) patients, respectively. Only four (14.8%) patients developed wound infection on admission (three were in the age range of 11 years and below, while one was 57 years old) and one patient had gastrointestinal tract (GIT) infection. One patient died from suspected thromboembolism within 24 h of burn, and 14 (51.8%) and 12 (44.4%) patients were discharged with and without residual burn wounds, respectively. The average burn surface area was 18.9%. The average length of stay (LOS) was 18.65 days and the average LOS per patient per percentage burn surface was 0.98 days. On follow-up at 2 weeks after discharge, four (14.8%) patients had delayed wound healing and seven (25.9%) patients developed hypertrophic scars. Conclusion: Our findings indicate a low incidence of infection related complications and it appears that our burn unit routine may play a significant role.