Burns : journal of the International Society for Burn Injuries
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Meta Analysis
MRSA colonization and acquisition in the burn unit: A systematic review and meta-analysis.
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most commonly encountered bacteria in the burn unit. In order to investigate the magnitude of this challenge, we assessed the prevalence of MRSA colonization on admission and the incidence of MRSA acquisition within burn units. ⋯ Our study yielded that among burn victims, MRSA colonization prevalence on admission is not negligible and the risk of becoming MRSA colonized during hospitalization is higher when no decolonization protocols are implemented. Flame burns, admission to ICU, and inhalation injury were found to be associated with MRSA acquisition.
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Methicillin-resistant Staphylococcus aureus (MRSA) is a key pathogen in burn patients. Several factors put them at increased risk of MRSA infection: partial loss of the skin barrier, the immune-compromising effects of burns, prolonged hospital stays, and invasive procedures. This study aims to find the relation between MRSA screening swab cultures taken within 48 h of admission, weekly surveillance cultures, and MRSA infection secondary to colonization. ⋯ Nosocomial MRSA colonization rates are high, and patients incurring infections experience a greater than average LOS in hospital and complications. Over 60% of patients who had a positive swab culture at surveillance developed an infection, whereas, no patient with a negative MRSA swab status developed an infection. Hence, pragmatic prevention strategies have to be implemented.
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Review Biography Historical Article
Dakin's Solution: "One of the most important and far-reaching contributions to the armamentarium of the surgeons".
Henry Drysdale Dakin is a notable person in the history of surgery, wound care, military medicine and infectious disease control. Dakin is an exemplar scientist who in the midst of war forged an international collaboration with scientists in multiple fields to create and universalize an antiseptic utopia, which saved thousands lives during World War I, remarkably diminished functional disabilities from wounds and continues to be a "far-reaching armamentarium" of the surgeons and wound care specialists around the globe. Dakin investigated over 200 different antiseptic substances to finally conclude that a 0.5% buffered sodium hypochlorite solution satisfies his criteria for an ideal antiseptic. ⋯ Nevertheless, Dakin contributed more to science than just his solution. In this article, Dakin's life story, his unique scientific career and his contributions to surgical literature are explored. The article also illustrates how a wartime necessity resulted in a medical discovery that is still in use to date.
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Comparative Study Observational Study
Prospective observational study comparing burn surgeons' estimations of wound healing after skin grafting to photo-assisted methods.
Appropriate graft healing after split-thickness skin graft and early recognition of complications (graft loss) are critical to burn patient management. Larger mesh ratio expansions and Meek micrografting may pose a greater challenge in estimating the percentage of wound healing. This study looks at the reliability of photograph assessments and the concordance of bedside evaluation to photograph assessments of wound healing after skin grafting. ⋯ Bedside wound healing assessments show variability; photograph documentation of sequential wound progression could supplement active clinical management or studies for more reliable assessments.
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The aim of this study is to compare doctors' knowledge regarding analgesia in paediatric burns patients in a setting where analgesia protocols are provided but not reinforced to a setting where the same protocols are used but with constant re-enforcement from burns surgeons. ⋯ We have identified a discrepancy in knowledge between staff in an academic burn centre and those in peripheral referral hospitals. This discrepancy translates into differences in quality of burn analgesia which patients receive. Ongoing efforts must be directed towards changing the culture of district institution and strengthening attempts to standardize care across the region.