Although prior studies have demonstrated the utility of real-time pressure mapping devices in preventing pressure ulcers, there has been little investigation of their efficacy in burn intensive care unit (BICU) patients, who are at especially high risk for these hospital-acquired injuries. This study retrospectively reviewed clinical records of BICU patients to investigate the utility of pressure mapping data in determining the incidence, predictors and associated costs of hospital-acquired pressure injuries. Of 122 patients, 57 (47%) were studied prior to implementation of pressure mapping and 65 (53%) were studied after implementation. The hospital-acquired pressure injury rate was 18% prior to implementation of pressure monitoring, which declined to 8% post-implementation (chi square: p=0.10). Hospital acquired pressure injuries were less likely to be stage 3 or worse in the post-implementation cohort (p<0.0001). Upon multivariable-adjusted regression accounting for known predictors of hospital-acquired pressure injuries in burn patients, having had at least 12 hours of sustained pressure loading in one area significantly increased odds of developing a pressure injury in that area (odds ratio 1.3, 95%CI 1.0-1.5, p=0.04). Patients who developed hospital-acquired pressure injuries were significantly more likely to have had unsuccessful repositioning efforts in comparison to those who did not (p=0.02). Finally, implementation of pressure mapping resulted in significant cost savings - $6,750 (standard deviation: $1008) for HAPI-related care prior to implementation, versus $3,800 (standard deviation: $923) after implementation, p=0.008. In conclusion, the use of real-time pressure mapping decreased the morbidity and costs associated with hospital-acquired pressure injuries in BICU patients.
Unstructured Abstract
The past decade has demonstrated increased burn wound infections with atypical invasive fungal organisms. The range of previously regiospecific organisms has expanded, and plant pathogens are increasingly represented. Our institution sought to examine changes in severe fungal non-Candida infections in our patients, via retrospective review of patients admitted to our burn center from 2008 to 2021. We identified 37 patients with atypical invasive fungal infections. Non-Candida genera included Aspergillus (23), Fusarium (8), Mucor (6), and 13 cases of 11 different species, including the second-ever human case of Petriella setifera. Three fungi were resistant to at least one antifungal. Concomitant infections included Candida (19), Staphylococcus and Streptococcus (14), Enterococcus and Enterobacter (13), Pseudomonas (9), and 14 additional genera. Complete data was available for 18 patients, who had a median of 3.0 (IQR 8.5, range 0-15) additional bacteria required a median of 1 (IQR 7, range 0-14) systemic antibacterials and 2 (IQR 2.5, range 0-4) systemic antifungals. One case of total-drug-resistant Pseudomonas aeruginosa required bacteriophage treatment. One case of Treponema pallidum was found in infected burn wound tissue. Every patient required Infectious Disease consultation. Eight patients became bacteremic and 1 developed Candida fermentati fungemia. There were 5 patient deaths (13.8%), all due to overwhelming polymicrobial infection. Burn patients with atypical invasive fungal infections can have severe concomitant polymicrobial infections and multi-drug resistance with fatal results. Early Infectious Disease consultation and aggressive treatment is critical. Further characterization of these patients may provide better understanding of risk factors and ideal treatment patterns.
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