Efficacy of Infection Control Measures in Managing Outbreaks of Multidrug-Resistant Organisms in Burn Units

Development of an investigation form for hemodialysis infection outbreak: Identifying sources in the early stage

BACKGROUND

There are many infectious factors causing the outbreak of hemodialysis infection, which may easily lead to the delay of investigation and treatment. This study aimed to develop an investigation form for hemodialysis infection outbreak (HIO), and to identify sources of outbreak in early stage.

METHODS

After an exhaustive literature review, we used the Delphi method to determine the indicators and relative risk scores of the assessment tools through 2 rounds of specialist consultation and overall consideration of the opinions and suggestions of 18 specialists.

RESULTS

A total of 87 studies of HIOs were eligible for inclusion. The mean authority coefficient (Cr) was 0.89. Kendall's W coefficient of the specialist consultation was 0.359 after 2 rounds of consultation (P < .005), suggesting that the specialists had similar opinions. Based on 4 primary items and 13 secondary items of the source of HIO, and tripartite distribution characteristics of infected patients, we constructed the investigation form.

CONCLUSIONS

The investigation form may be implemented during the initial phase of an outbreak investigation, it is a prerequisite for taking effective control measures, avoiding HIO occurrence. However, the efficacy of the investigation form needs to be further evaluated.

Patterns of multidrug resistant organism acquisition in an adult specialist burns service: a retrospective review

Background

Multidrug resistant organisms (MDROs) occur more commonly in burns patients than in other hospital patients and are an increasingly frequent cause of burn-related mortality. We examined the incidence, trends and risk factors for MDRO acquisition in a specialist burns service housed in an open general surgical ward, and general intensive care unit.

Methods

We performed a retrospective study of adult patients admitted with an acute burn injury to our specialist statewide tertiary burns service between July 2014 and October 2020. We linked patient demographics, injury, treatment, and outcome details from our prospective burns service registry to microbiology and antimicrobial prescribing data. The outcome of interest was first MDRO detection, stratified into the following groups of interest: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), two groups of Pseudomonas (carbapenem resistant, and piperacillin-tazobactam or cefepime resistant), carbapenem-resistant Acinetobacter species, Stenotrophomonas maltophilia, carbapenem-resistant Enterobacteriaceae (CRE), and extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-PE). We used a Cox proportional hazards model to evaluate the association between antibiotic exposure and MDRO acquisition.

Results

There were 2,036 acute admissions, of which 230 (11.3%) had at least one MDRO isolated from clinical specimens, most frequently wound swabs. While acquisition rates of individual MDRO groups varied over the study period, acquisition rate of any MDRO was reasonably stable over time. Carbapenem-resistant Pseudomonas was acquired at the highest rate over the study period (3.5/1000 patient days). The 12.8% (29/226) of MDROs isolated within 48 h were predominantly MRSA and Stenotrophomonas. Median (IQR) time from admission to MDRO detection was 10.9 (5.6–20.5) days, ranging from 9.8 (2.7–24.2) for MRSA to 23.6 (15.7–36.0) for carbapenem-resistant P. aeruginosa. Patients with MDROs were older, had more extensive burns, longer length of stay, and were more likely to have operative burn management. We were unable to detect a relationship between antibiotic exposure and emergence of MDROs.

Conclusions

MDROs are a common and consistent presence in our burns unit. The pattern of acquisition suggests various causes, including introduction from the community and nosocomial spread. More regular surveillance of incidence and targeted interventions may decrease their prevalence, and limit the development of invasive infection.

Effect of Combining Immersion Therapy with Shengji Ointment on Wound Healing Rate and Adverse Reaction Rate in Patients with Second-Degree Burn

Objective

To explore the effect of combining immersion therapy with Shengji ointment on wound healing rate and adverse reaction rate (ARR) in patients with second-degree burn.

Methods

The data of 80 patients with second-degree burn treated in our hospital from February 2019 to February 2020 were retrospectively analyzed by the means of retrospective study, and the patients were equally divided into the treatment group and the control group according to their admission order, with 40 cases each. Immersion therapy was performed to all patients (7 d); after that, patients in the control group received routine medication (7 d), and those in the treatment group were treated with Shengji ointment until the wounds were healed, so as to compare their wound healing condition, ARRs, levels of inflammatory factors, and infection incidence.

Results

Compared with the control group after treatment, the treatment group presented significantly shorter wound healing time (12.14 ± 1.26 vs. 15.98 ± 1.20, P < 0.001), better wound healing rate and quality (P < 0.05), and lower levels of inflammatory factors (P < 0.001); no significant between-group difference in ARRs was shown (P > 0.05); 34 patients in the treatment group (85.0%) and 26 patients in the control group (65.0%) had no infections, so the incidence rate of infections was significantly lower in the treatment group than in the control group (P < 0.05).

Conclusion

Combining immersion therapy with Shengji ointment can reduce the levels of inflammatory factors in patients with second-degree burn, lower the incidence rate of infections, provide the conditions for wound healing, and increase the wound healing rate, which shall be promoted and applied in practice.