Effects of environment on infection in burn patients
K. Z. Shirani, A. T. McManus, G. M. Vaughan, W. F. McManus, B. A. Pruitt Jr and A. D. Mason Jr
Burn patients in an early cohort (n = 173) treated in an intensive care
ward without separate enclosures were compared with a later cohort (n =
213) treated in a renovated unit with separate bed enclosures. The number
of patients developing infection was significantly reduced in the late
group. Observed mortality was compared with mortality predicted on the
basis of burn size and age alone. Reduction in observed compared with
predicted mortality, inapparent in the early group, was seen in the late
group and was restricted to the subgroup of patients with predicted
mortality of 25% to 75%, in which the observed mortality of 28.3% was less
than the predicted mortality of 48.7%. The incidence of infected patients
was reduced from 58.1% in the early cohort to 30.4% in the late cohort. In
comparison of the early cohort with the late cohort, the overall proportion
of patients with bacteremia was reduced from 20.1% to 9.4%, while the
incidences of both pneumonia and burn wound invasion remained unchanged.
Providencia and Pseudomonas species, endemic in the early cohort, were
eliminated in the late cohort. Reduction of infection by environmental
manipulation in burn patients was possible and was associated with improved
survival.
