Burn Wound Infections by Nermin Samir rashwan Burns

Burn Wound Infections by Nermin Samir rashwan

Burns Devastating Patients: require specialized care

Extent Of Burn Injury Rule of nines.

Degrees Of Burns First Second Third

Complications In Burn Patients Wound infection→ sepsis→ deaths Other complications: ● Urinary tract infections ● Ventilator-associated pneumonia ● Central venous catheter-associated bloodstream infections

Aim Of The Work Review possible etiologies and risk factors Plan infection control strategies

Burn Wound Infections

Sources of infection Endogenous: Skin GIT Respiratory flora. Exogenous

Causative Organisms Group Gram-positive organisms Species Staphylococcus aureus Methicillin-resistant S. aureus Coagulase-negative staphylococci Enterococcus spp. Vancomycin-resistant enterococci Gram-negative organisms Pseudomonas aeruginosa Escherichia coli Fungi Candida spp. Aspergillus spp. Klebsiella pneumonia Serratia marcscens Enterobacter spp. Proteus spp. Acinetobacter spp. Bacteroides spp. Fusarium spp. Alternaria spp. Rhizopus spp. Mucor spp. Viruses Herpes simplex virus Cytomegalovirus Varicella-zoster virus

Predisposing factors Burn wound: ● Size ● Cause ● Management: ■ excision ■ antibiotics ■ resuscitation Patient: ●age ●nutrition ●medical condition Improper application of infection control

Immune Response To Burns Immunosuppression Host defense: ● Innate ● Adaptive

Innate Immune Response Loss of barrier function of GIT epithelium. ↓ Macrophage, NK → ↓ IFN-γ ↓ Phagocytic capacity Complement: ● ↓↓ → ↑↑↑ ● Alternative

Adaptive Immune Response T lymphocytes ↓ CD 4+/CD 8+ ↓

Inflammatory Response Proinflammatory: ● IL-1β ● TNF-α ●IFN-γ Anti-inflammatory: ● IL-4 ● IL-10

Diagnosis Clinically Laboratory: ●Haematological ●Microbiological

Microbiological Diagnosis Samples: ● Frequency: ■ Regular ■ Multiple ● Types: ■ Superficial: ▪ Swabs ▪ Contact plates ▪ Capillarity gauze ■ Tissue biopsy (Superficial Or Biopsy ? )

Colonization Vs Infection Gram staining: ● Purulence ● Predominant bacteria Semiquantitative or quantitative cultures Histological analysis

Antimicrobial Susceptibility Testing Penetration of devascularized burn eschar (Invitro Vs Invivo) Planktonic Vs Biofilm forming bacteria Topical antibiotics: No standard for antibiotic susceptibility testing

Treatment Transport Patient care Topical antimicrobial therapy: ● Selection ● Benefit: ↓ Microbial load Prophylactic systemic antibiotic: ● Doubtful ● Complications

Patient’s care

Treatment (cont. ) GIT care: ● Why? ↑ Intestinal permeability ● Selective bowel decontamination ● Early enteral feeding Prevention of tetanus: ● Human tetanus Ig routine ● Tetanus toxoid Early excision and burn wound closure

Recent Treatment Approaches Tissue-engineered skin substitutes: Antibacterial properties→ ↑ by cytokines Flt 3 L treatment: Th 1 cytokine response Human Histone 1. 2→ antimicrobial activity

Infection control plan Specific Unified Written guidelines Specifications of individual rooms ● Laminar airflow ● Access-restricted ● Positive pressure ventilation ● HEPA filters ● Negative pressure anteroom

Infection Control (cont. ) Basics Of Hand hygiene PPE HCWs: ● restriction !

Environmental measures Cleaning methods Equipments Spills of blood Sodium hypochlorite product Pest Control Soiled textiles Mattresses and Pillows. Solid waste. Dishware and eating utensils.

Contact precautions Prevent transmission of infectious agents Single room ● Not available→ multi-rooms Hydrotherapy tanks→ Showering

Contact Precautions (cont. ) Visitors: ● Source of HAIs ● Gowns and gloves ● Restricted→ 2/patient

Recommendations Proper antibiotic use (topical-prophylactic-systemic) Unified written infection control policy specified to the burn units, updated Further studies: ● SDD ● Closed wound ● Showering hydrotherapy

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