Journal of burn care & research : official publication of the American Burn Association
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Hospital-acquired (HA) methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of HA infections and a significant concern for burn centers. The use of 2% chlorhexidine-impregnated wipes and nasal mupirocin significantly decreases the rate of HA-MRSA in adult intensive care units. The aim of this study was to examine the impact of universal decolonization on the rate of MRSA conversion in an American Burn Association verified adult and pediatric burn center. ⋯ The incidence rate of MRSA was significantly decreased after the implementation of the decolonization protocol (11.8 vs 1.0 per 1000 patient days, P < .001). Secondary to the loss of the skin barrier and suppressed immune systems, burn patients are at greater risk for invasive infection leading to severe complications and death. The prevalence of HA-MRSA at our institution's burn center was significantly decreased after the implementation of a universal decolonization protocol.
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The acute care of burn patients is critical and can be a daunting experience for emergency personnel because of the scarcity of burn injuries. Telemedicine that incorporates a visual component can provide immediate expertise in the treatment and management of these injuries. The authors sought to evaluate the addition of video telemedicine to our current telephone burn transfer program. ⋯ This study reports the successful implementation of video-enhanced telemedicine pilot project in a rural state. Video-enhanced telemedicine using a store and forward process improved burn size estimation and facilitated management changes. Although not quantitatively assessed, the low cost of the system coupled with the changes in transportation and disposition strongly suggests a decrease in healthcare costs associated with the addition of video to a telephone-only transfer program.
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The authors conducted a prospective study of fractional CO2 laser treatment of mature burn scars, comparing objective and subjective scar measurements evaluating at least one treatment and one control scar on the same patient pre- and post treatments. After institutional review board approval, burn survivors with mature blatant burn scars were invited to enter the study. A series of three fractional CO2 laser treatments was performed in an office setting, using topical anesthetic cream, at 40 to 90 mJ, 100 to 150 spots per cm(2). ⋯ Fractional CO2 laser treatment is a promising entity in the treatment of burn scars. Our study results show significant differences in objective measurements between the treated scars and the untreated control scars over the same time period. In scar treatment studies, the patient/observer and Vancouver scar scales may not be sensitive enough to detect outcome differences.
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Burn conversion is a contributor to morbidity that currently has no quantitative measurement system. Active dynamic thermography (ADT) has recently been characterized for the early assessment of burn wounds and resolves the three-dimensional structure of materials by heat transfer analysis. As conversion is a product of physiological changes in three-dimensional structure, with subsequent modification of heat transfer properties, the authors hypothesize that ADT can specifically identify the process of burn conversion and serve as an important tool for burn care. ⋯ LDI identifies by hour 4 wounds that will not (P < .05). This study has demonstrated that ADT can directly identify burn wound conversion, while LDI can identify nonconverting wounds. Further advancement of ADT technology has the potential to guide real-time interventional techniques.
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Hypertrophic scar after burn injury is a significant problem. Previous studies have examined the roles for decorin, interleukin-1β, and transforming growth factor-β1 in hypertrophic scar formation locally, but few have considered their systemic influence. The authors conducted a pilot study to examine whether serum levels of these molecules could predict hypertrophic scar formation. ⋯ Decorin up-regulated the expression of toll-like receptor 4 and C-X-C receptor 4 in peripheral blood mononuclear cells, and interleukin-1β up-regulated fibroblast production of C-X-C ligand 12. Transforming growth factor-β1 up-regulated, and interleukin-1β down-regulated, the production of profibrotic cytokines, collagen, and myofibroblast differentiation. The model predicting hypertrophic scar formation is supported by clinical results and limited in vitro experiments.