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Third Degree Burn Infection in the ICU

Treatment of severe burns is still one of the challenging issues for physicians and necessitates the collaboration of a multidisciplinary team due to the magnitude of the injury. Many patients with serious burns require ICU admission for their management in order to minimize morbidity and mortality. Despite the modern advances in the treatment of burns, still the mortality rate is high in patients with extensive burns with infection being a major cause of death. (Thompson, Herndon, Abston and Rutan, 1987) found that early excision of dead tissue (burn eschar) decrease the incidence of invasive burn infection and sepsis, improves the patient’s outcome and decreases the duration of hospital admission.

Burned patients are also at higher risk of developing infection and sepsis from catheters and central lines. A central line is a long, thin, soft plastic tube that is introduced through a small cut in the skin into a large vein to administer fluids, blood products, nutrients and medications over an extended period of time. It is often placed in patients who require care in the intensive care unit to provide nutrition, medication and fluids. Infection can be one of the complications associated with the use of a central venous line which can be caused by bacteria and/or fungi. Other complications may include bleeding, pain, blockage, kinking or shifting of the line, air embolism and lung collapse.

As the central venous line is introduced through an opening in the skin, bacteria can grow in this line making the patient more susceptible for blood born infection. Infections associated with a central venous line can be very serious as the bacteria causing these infections can multiply and spread quickly to the entire blood stream causing septicemia which can be fatal.

A Consumer Reports analysis of newly released data revealed that central line infections account for 15 percent of all hospital infections but are responsible for at least 30 percent of the 99000 annual hospital-infection-related deaths according to the best estimates available. Hospitals that are following simple hygienic steps have virtually eliminated those infections but many others are failing to act. Research shows that putting the catheter in the subclavian vein is best for infection control.

According to an article in the New England Journal of Medicine in December 2006, there was a 66 percent reduction in central-line associated blood stream infections after 67 hospitals in Michigan implemented a checklist developed by Peter Pronovost, M.D, Ph.D. Health and Human Services Secretary Kathleen Sebelius called on all hospitals across America to use the checklist to reduce central-line infections in ICUs by 75 percent over the next three years, this check list includes:

  • Washing hands before and after examining a patient or inserting, replacing, accessing, repairing and dressing the catheter (line).
  • Disinfecting the skin of the patient before inserting the catheter and during dressing changes.
  • Maintaining aseptic technique by wearing a mask, cap, sterile gown, and a steril gloves when inserting the line.
  • Avoiding placing the catheter in the groin because the groin area is hard to keep clean. A subclavian site is preferred.
  • Removing unnecessary catheters.

Not all hospitals follow this list. If a family member or a friend has to be hospitalized in intensive care, take this list with you and ask whether the intensive care unit uses it, says Dr. Pronovost in Consumer Reports. He also believes that public accountability powerfully motivates hospitals to get their infection rates under control.

Under new laws 27 states are disclosing infection rates or will have to while five years ago only four states did reported hospital infection rates.

This information is not intended nor implied to be a substitute for professional medical advice; it should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. Call 911 for all medical emergencies.

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