bluuebunny/crossref_metadata_2025_split huggingface dataset:
589 Enhancing Care Providers’ CAUTI (Catheter-associated Urinary Tract Infection) Knowledge, Skills and Attitudes in the Burn Intensive Care Unit (BICU) and Burn Special Care (BSC) Environments
Authors: Beckwith Emily , Zynkian Megan 
Published: March 2020

Abstract

Introduction
CAUTIs, or Catheter-associated Urinary Tract Infection, are one of the leading causes of healthcare associated infections. Since 2008, Centers for Medicare and Medicaid Services (CMS) stopped reimbursing hospital for the cost of CAUTIs, forcing hospitals to modify and improve care provided to patients with indwelling urinary catheters (IUC). They are reportable events to CMS, which can signify the quality of care provided at any medical institution. These infections also cause extra pain and suffering and can complicate any hospital stay. Treatment requires antibiotic use, which helps create and spread antibiotic-resistant organisms with excessive use.

Methods
BICU and BSC staff were evaluated for knowledge of IUC care, maintenance and policies using a quiz dispersed to RNs. This quiz identified knowledge gaps to help focus on specific topics for training. During Skills Day, all Burn RNs were given a mandatory training, including a PowerPoint presentation, hands-on training performing catheter care, and a handout with quick tips for maintenance. All technical partners (TP) were also trained, though they were not given the quiz. To assess effectiveness of training, RNs were encouraged to take a post-training quiz. Rates of CAUTI will also be closely monitored.

Results
For the pre-training quiz, average scores were 13.1 correct answers (out of 23 questions) or 56.5%. Post-training quiz scores were 18.5 correct answers (out of 23 questions) or 81%. Since the training in September 2018, no new CAUTIs have been recorded.

Conclusions
The training provided helped enhance burn staff skills to maintain and care for indwelling urinary catheters, as well as changed attitudes on the unit.

Applicability of Research to Practice
CAUTIs are a reflection of the quality of care an institution and unit provides its patients. It is also closely monitored and used to compare similar units across the nation. The training provided to the burn staff has shown to decrease the number of CAUTIs in the Burn ICU and Burn Special Care environments, thus decreasing costs, pain and suffering and antibiotic use.
601 A Simple Dressing for Prevention of Central Line Infections in Pediatric Burn Patients
Authors: Vanamala Milly , Hartman Brett , Zieger Madeline 
Published: March 2020

Abstract

Introduction
Between 2017 and 2018, the burn unit saw 16 patients with major burns. A major burn is considered a total body surface area of 20% or greater. The burns ranged from 20% to 85% total body surface area averaging 44.14 %. Of those 16 patients, 8 patients required central lines that could not utilize a traditional occlusive central line dressing. Central line access is often placed near a burn or grafted site, and an occlusive dressing cannot be maintained. On average, a central line was changed in the operating room every seven days for infection prevention or sooner if an infection is suspected. The lines were changed preferably to a new site or over a wire if limited sites. In 2017, our Burn unit’s central line associated bloodstream infection rate of 4.1 infections per 1000 catheter days. This was higher than the national benchmark centerline from the Children’s Hospital Solutions for Patient Safety national collaborative for pediatric intensive care units of 1.365 infections/1000 catheter days. The unit implemented the use of a 4x4 betadine dressing for microbial coverage as an innovative strategy to prevent central line associated blood infections. The method not only proved to be effective but also cost efficient.

Methods
While the standard of changing the central line every 7 days remained the same, our unit began using a 4x4 gauze soaked in betadine and placed over the central line insertion site. The gauze is moistened with the betadine solution, then rung out so that the gauze is not oversaturated. That gauze is placed directly over the insertion site using sterile technique. A dry gauze is then placed over the wet one to protect from pathogens in the environment. Both gauze pads are then changed every 4 hours to keep the betadine moist and working as an antimicrobial agent.

Results
In 2018, 4 patients with various central lines utilized the betadine technique with our overall central line associated blood infection rate for 2018 decreased to 0 infections/1000 catheter days. The cost of each occlusive central line dressing in our facility is $2.10, whereas the betadine method costs $0.97. These supplies can be used for more than one dressing change on each patient compared to the occlusive dressing that is used once.

Conclusions
Using the betadine dressing technique to protect against central line associated bloodstream infections has proven to be an effective, low cost technique to prevent line infections and improve patient outcomes for major burn patients with compromised skin integrity. By utilizing this technique, our overall central line infection rate has dropped significantly below the national average, while decreasing cost by over 50%.

Applicability of Research to Practice
Maintaining a low cost, effective dressing to help prevent line infections in major pediatric burn patients.
610 Small Pediatric Burns Can Be Safely Managed on an Outpatient Basis
Authors: Grote Andrea C , Lacey Alexandra M , Garner Warren L , Gillenwater Justin , Maniago Ellen , Yenikomshian Haig A 
Published: March 2020

Abstract

Introduction
American Burn Association guidelines recommend that all pediatric burns be transferred to a burn center if their presenting hospital lacks the necessary personnel or equipment for their care. Our institution often treats small (&lt; 10% TBSA) burns in pediatric patients as outpatients with a non-daily dressing. The aim of this study was to determine if small pediatric burns could be managed in an outpatient manner and risk factors for failure.

Methods
A retrospective chart review was conducted from July 2016 to July 2019 at a single ABA-verified burn center. All patients under the age of 18 who presented for evaluation were included. Post burn day, age, sex, TBSA, burn etiology, body area burned, burn dressing type, outpatient versus inpatient management, reason(s) for admission, and any operative intervention were collected.

Results
In total, 742 patients were included in our cohort (Table 1). The most common burn etiologies were scald (68%), contact (20%), and flame (5%). From initial presentation, 101 patients (14%), mean TBSA 9%, were admitted to the burn unit and 641 patients (86%), mean TBSA 3%, were treated outpatient. Of those, 613 (96%) were treated entirely outpatient and 28 (4%) were admitted at a later date. There were no significant differences in age (p=0.6) nor gender distribution between those who were successfully treated outpatient and those who failed. There was a significant difference (p &lt; 0.001) in TBSA between the patients who were treated successfully as outpatients (3±2%) versus those who failed outpatient care (4±3%). The primary reason for admission of these patients was nutrition optimization (61%).

Conclusions
The vast majority of small pediatric burns can be treated as an outpatient with a non-daily dressing with good results. Over 80% of pediatric patients seen in our clinic were successfully managed in this manner. As suspected, when the burns are larger in size (&gt;4% TBSA) there is a potential increased risk for admission especially with regards to poor PO intake, so this requires close monitoring and family education.

Applicability of Research to Practice
Pediatric patients with small burns can be safely managed in an outpatient setting with a non-daily dressing. Those who fail will most likely fail from poor PO intake at home.
637 Disparities in Discharge Disposition: A Burn Model Systems National Database Study
Authors: Mason Stephanie A , Carrougher Gretchen J , Kowalske Karen J , Schneider Jeffrey C , Amtmann Dagmar , Gibran Nicole S 
Published: March 2020

Abstract

Introduction
Previous data suggest that disparities exist in access to inpatient rehabilitation following burn injury. We aimed to characterize the association between patient race/ethnicity and discharge disposition across multiple centers.

Methods
Data were derived from the prospectively maintained Burn Model Systems national database. All participants admitted to one of five participating centers between 1994 and 2019, who survived to discharge with a known disposition, were included. The relationship between patient characteristics, injury factors and discharge to home, a skilled nursing facility (SNF), or inpatient rehabilitation was modeled using multinomial generalized estimating equations. Pre-specified stratified analyses were conducted to examine effect modification.

Results
We identified 4395 participants who met inclusion criteria. Participants were 74% White non-Hispanic (n=3269), 18% Black non-Hispanic (n=812), 3% Hispanic (n=122), 0.5% Asian (n=24), and 4% Other (n=168). Most were aged 18–64 years (68%, n=2998). Overall, 79% (n=3585) of participants were discharged home, 12% to inpatient rehabilitation (n=534), and 6% to SNF (n=276). After adjustment for patient characteristics and injury factors, there were no differences in discharge destination by race/ethnicity. However, subgroup analyses demonstrated effect modification by both center and burn size. At 2 centers, Black participants were significantly more likely to be discharged to SNF or inpatient rehabilitation (Center 1 OR 1.98, 95% CI 1.02–3.85; Center 2 OR 2.36, 95% CI 1.07–5.19). Similarly, among all participants with &gt;20% TBSA, Black participants were more likely to be discharged to SNF or inpatient rehabilitation (OR 1.38, 95% CI 1.06–1.81). Across all groups, having insurance was associated with discharge to SNF or inpatient rehabilitation (OR 1.68, 95% CI 1.21–2.33).

Conclusions
Although no overall difference in discharge destination by race was identified, stratified analyses indicate disparities in discharge disposition at the patient and system level. At specific centers, and among those with &gt;20% TBSA injury, Black participants are more likely to be discharged to SNF and inpatient rehabilitation than other ethnic groups.

Applicability of Research to Practice
Both patient and system level factors are associated with discharge to higher levels of post-discharge care, suggesting that further characterization of these factors is warranted. Such data can inform interventions and policy changes aimed at ensuring equitable access to appropriate post-discharge care.
638 Auricular Splinting Following Severe Facial Burn Injury and Reconstruction
Authors: LePage Lisa 
Published: March 2020

Abstract

Introduction
With a severe facial burn, injury often involves the ear(s) resulting in damage or loss which may require reconstruction. In consideration of the functional and psychological effect that loss of a defined ear lobe may entail, reconstruction is an important consideration for the burn survivor. Two cases described in detail with illustration will highlight an auricular contracture release; one with V-Y Advancement and the other with a transposition flap. Preservation of the auricular reconstruction is accomplished by implementing necessary splinting. The auricular splint fabricated was made from a combination of silicone and low-temperature thermoplastic material. A step-by-step process will illustrate the needed materials and techniques to fabricate a worthy splint in order to preserve what was surgically achieved. The splint maintains the space between the ear and head to properly position and prevent contracture through the healing and scar maturation process. It secured with a one-inch head band that is sublime enough to foster compliance with wear. The auricular splint material also serves as scar management with the many proven benefits of silicone.

Methods
Two case studies are reviewed with auricular contractures that required release and reconstruction. The auricular splints were fabricated to stabilize and preserve the reconstructed ear lobe. The wear schedule was intermittent during the day and overnight in combination with scar massage. The patients reported good compliance with wear and stability of splint position with overnight wear. Skin integrity was not compromised with overnight or intermittent wear. The splint fabrication process is reviewed and illustrated with a simplistic innovative end result that is user friendly.

Results
Surgical reconstruction was required following development of auricular contractures and partial loss. With post-operative bandage removal and wound closure, positioning was a necessary consideration to preserve post-surgical reconstruction.

Conclusions
In conclusion, the peri-auricular splint is fabricated with low temperature splinting material lined in silicone proved worthy for effective positioning and reported comfort with wear. Effective splinting is necessary for the preservation of surgical reconstruction and to prevent contracture from sabotaging surgical efforts.

Applicability of Research to Practice
Consideration of fabrication of silicone auricular splints to preserve the accomplishments of auricular surgical reconstruction.
642 The Use of Laser Speckle Contrast Imaging in Assessing Depth and Progression of Burn Wounds
Authors: Cooper Laura , Chan Rodney K , Bohan Phillip Kemp , Carlsson Anders H , Everett Tyler 
Published: March 2020

Abstract

Introduction
The ability of laser speckle contrast imaging (LSCI) to provide real-time images of blood flow makes this modality appealing in the assessment of burn wounds, particularly for clinicians making treatment decisions based on burn wound depth and presumed progression. Here we present 2 preclinical studies that used LSCI to assess wound progress, both immediately and months after injury.

Methods
LSCI images were taken 10-40cm away from the wound and captured with a 1388x1038-pixel CCD camera. In the first study, LSCI images were captured prior to and immediately following creation of superficial partial-thickness (SPTB, 10s), deep partial-thickness (DPTB, 15s), and full-thickness burns (FTB, 20s), and on post-burn day (PBD) 1, 2, and 3. In the second study, LSCI images were obtained before and after DPTB creation and on PBD 7, 14, 21, 28, 60, 90, and 120.

Results
92 wounds from 9 swine were included. Speckle data was normalized to control sites and converted to percentages ([speckle wound/speckle control] x 100), producing speckle percentage of control (SPOC) which quantifies the relative decrease or increase in speckle output (vascularity). SPOC was significantly decreased for all burn times on PBD 0, 1, and 2. By PBD 3, only DPTB and FTB remained diminished (p=0.028 and p=0.005, respectively), and FTB SPOC was significantly less than the SPTB (p=0.015). In the second study, SPOC showed an increase post-debridement on PBD 7, noted as post-debridement day (PDD) 0. SPOC continued to increase significantly to a peak at PDD 7 (p&lt; 0.0001) and remained elevated until PDD 28. By PDD 60, SPOC was no longer significantly increased.

Conclusions
LSCI is a reliable method for analyzing burn depth and wound progression in the preclinical setting. LSCI data shows an immediate decrease in vascularity at all burn depths immediately following burn creation, followed by a peak in vascularity on PDD 7, with a trend back to normal by PDD 60.

Applicability of Research to Practice
The correlation of wound bed vascularity based on LSCI to known data on burn depth and progression suggests that LSCI could be a useful measurement tool in the clinical setting for the provider determining wound viability.
645 Topical Application of a Novel Powdered Scaffold for Rapid Treatment of Skin Injuries
Authors: Jalili Reza , Verly Myriam Maude , Russ Breshell , Kilani Ruhangiz T , Ghahary Aziz 
Published: March 2020

Abstract

Introduction
In large skin injuries, lack of matrix deposition impedes timely healing process. The longer a wound remains open, the greater is the risk of infection, non-healing, and other complications. It is therefore crucial to find effective means to promote rapid closure of skin defects. Our group has previously developed a liquid in situ-forming nutritional scaffold, known as MeshFill (MF). MF has been previously proven to be very effective in accelerating the wound repair process, notably that of complex wounds. However, MF is limited in its application to deep and tunnelling wounds, and requires reconstitution with a solvent as well as maintenance at cold temperature until application. To address these limitations, our group has developed a powdered form of MF for rapid topical application on superficial skin injuries such as dehisced surgical wounds and burn injuries.

Methods
Our goal was to investigate whether a powdered form of MF could be directly applied onto the wounds to accelerate healing. Ideally, powdered MF would absorb the moisture within the wound environment and reconstitute into the gel form in situ. We examined the efficacy of powder MF (PMF) compared to reconstituted gel MF (GMF) and to a standard dressing protocol. To do so, splinted full thickness wounds were generated on the back of mice and treated with either PMF or GMF or were bandaged with no treatment (NT). The healing process was monitored until wounds were fully closed. Clinical wound measurements and histological assessments were performed to compare different treatment regimens.

Results
Application of both PMF and GMF accelerated wound epithelialization at days 7 and 14, compared to NT, and had faster wound closure times. On average, the PMF treatments healed 17% faster than the NT control, and the GMF treatments healed 21% faster than the NT control. No significant difference between PMF and GMF was found for any outcomes. Additionally, our results suggest that epidermis formation was more effective in P and MF conditions compared to NT.

Conclusions
These findings suggest that topical application of a powdered form of MeshFill is as effective as standard reconstituted MeshFill gel in accelerating the healing process of skin injuries.

Applicability of Research to Practice
Topical application of a powdered scaffold may be a very convenient and practical method for rapid treatment of large superficial wounds such as dehisced surgical wounds, burn injuries, and filling gaps in meshed skin grafts.
646 Impact of Inflammation on Wound Healing
Authors: Luze Hanna , Holzer Judith , Kainz Sonja , Reisenegger Peter , Holecek Christian , Kotzbeck Petra , Hofmann Elisabeth , Birngruber Thomas , Mautner Selma , Kamolz Lars-Peter 
Published: March 2020

Abstract

Introduction
Inflammation is part of the physiological phases of wound healing. It serves the purpose to attract different immune cells in order to clean the wound from pathogens and debris and create an ideal environment for fibroblasts and keratinocytes to differentiate, migrate and divide in order to close the wound. Pathological inflammation caused by many different factors is often the underlying cause of prolonged wound healing and unfavourable outcome in burn patients. We wanted to investigate what influence an induced hyper-inflammation on wound healing has in a controlled environment.

Methods
In a porcine wound model, pigs received full-thickness wounds on their backs where hyper-inflammation was induced by application of a chemotherapeutic for 6 days. Control wounds were left without induction. Wound were scored on a daily basis for 16 days in total and biopsies were taken for RNA analysis as well as histological assessment.

Results
The results showed a rise in inflammation of the wounds and the surrounding tissue due to the induction. The wounds healed slower, needing up to seven more days to completely heal. The results of the RNA analysis showed high values of pro-inflammatory cytokines after the induction in comparison to the baseline and control wounds. Histological assessment showed thick layers of necrosis, adipocyte as well as leucocyte infiltration in the hyper-inflamed wounds compared to completely healed control wounds with all layers of epidermis visible.

Conclusions
Hyper-inflammation, even just for a short period of time, can significantly prolong the time of wound healing. These findings underline the importance of preventing and treating wound infections of burn patients in order to support physiological wound healing as well as to avert complications such as infections with multi-resistant microbes that are associated with prolonged hospital stays.

Applicability of Research to Practice
The findings of these experiments cannot be directly applied to practice however, the influence of inflammation should kept in mind when treating burn patients.
666 The Effect of Burn Wound Size on Caloric Requirements: A Correlation of Nutritional Changes to the Clinical State
Authors: Matthews Marc , Calder Sara , Kowal-Vern Areta , Spadafore Philomene , McCollum Hunter , Richey Karen J , Foster Kevin N 
Published: March 2020

Abstract

Introduction
Caloric intake has been a vital component for burn wound healing and recovery. The hypothesis was that caloric requirements are based on injury severity & post-burn week as predicated by indirect calorimetry (IC)/predictive equations.

Methods
This was a retrospective chart review of 115 burn patients (2012–2017). Caloric requirements were determined by the Curreri equation [which includes % total body surface area (TBSA)] and IC for a 5-week period provided mainly by enteral nutrition. Patients received supplements and total parenteral nutrition as needed.

Results
The mean±sd age was 43±18 years, 41±18 % TBSA, Body Mass Index of 28±7 kg/m2, and mortality of 26 (23%). The major mechanisms of injury were flame/flash/explosions. There were 59 (51%) of patients with &lt; 40 % TBSA burns, [median Injury Severity Score (ISS) 9; Apache score 14], and 56 (49%) with ≥40 % TBSA (median ISS 25; Apache score 21), p &lt; .0001. The Respiratory Quotient (RQ) had a median of 0.94 (range 0.79 to 1.02). The median number of surgeries for the &lt; 40 % TBSA group was 5 versus 12 for the ≥40 % TBSA, p &lt; .0001. The Injury Factor did not differ from weeks 1–5 (1.8 for &lt; 40 % TBSA and 2.0 for the ≥ 40 % TBSA). The Curreri equation calculation for this study was a median 3640 (range 2161–5950) calories. The Curreri equation resulted in significantly increased caloric recommendations for the ≥ 40 %TBSA compared to the &lt; 40 %TBSA patients, p &lt; .0001. The &lt; 40 %TBSA group had caloric requirements ranging between 1500- 2700 calories compared to the ≥ 40 %TBSA group, whose calories ranged between 2000–3700. The total daily caloric recommendations were also significantly increased in the ≥40 %TBSA compared to the &lt; 40 %TBSA patients. The maximum levels of resting energy expenditure (REE) from IC, total daily calories recommended by the dietitian and average calories ranged between 3000–4500 in the &lt; 40 %TBSA group and 3600–6700 in the ≥ 40 %TBSA group. The caloric recommendations increased for all patients from week 1 to week 3 and leveled off during weeks 4–5.

Conclusions
Patient caloric requirements were dependent not only on the severity of the burn injury but also the post-burn hospitalization during which surgeries, debridement/grafting, and infectious complications occurred. They increased until the third week post-burn and leveled off in the recovery period. The study caloric recommendations and requirements were consistent with the REE and Curreri equation assessments.

Applicability of Research to Practice
There is no constant number of calories for all patients. Caloric requirements are modified by the severity of Burn %TBSA and phases of resuscitation through recovery.