bluuebunny/crossref_metadata_2025_split huggingface dataset:
807 Implementation of an Evidence-based Wound Care Process at a Regional Burn Center Reduces Hospital Acquired Infections
Authors: Mullins Sydney , Bernardy Sarah , MacLachlan Marianne , Evans Maureen , Olszewski Anna , Kidd Kara N , Maroon Angela , Renteria-Turley Alessandra , Mattison Sarah , Barsun Alura , Sterling Leonard , Romanowski Kathleen S , Sen Soman , Palmieri Tina L , Greenhalgh David G 
Published: March 2020

Abstract

Introduction
Central line associated blood stream infection (CLABSI) rates in burn patients exceeds the national average. The purpose of this study was to determine if implementation of an evidence-based process for wound care and central line management reduce infections.

Methods
A protocol for central line and wound care was developed in conjunction with another burn center with lower CLABSI rates and a care bundle, based on colorectal surgical literature. The new protocol required hand to elbow washing prior to wound care, separating the dirty and clean steps of the wound care process, changing protective gear when going from dirty to clean and performing the Hospital Acquired Infection (HAI) bundle elements separate from wound care. CLABSI and Ventilator Associated Pneumonia (VAP) rates were then compared with the previous year.

Results
Following implementation of the new wound care guidelines, the number of CLABSIs declined from 10 in 2017 to 2 in 2018 and 1 so far in 2019 (through August 2019). The median number of CLABSIs per 1000 days was 0 (range of 0 to 11) before the bundle and 0 (range of 0 to 4.2) after implementation of the bundle. Using the Wilcox rank sum test, there was no significant difference (p=0.09) between the CLABSI rate per 1000 device days between the time period before the bundle implementation and after the bundle implementation, however this may be due to the small sample size. Although the CLABSI rate did not show a statistically significant decrease, the proportion of positive blood cultures decreased by 50% after implementation of the bundle. The number of VAPs declined from 8 in 2017 to 6 in 2018 and so far in 2019 no VAPs have been reported (through August 2019). There was no difference in device days between groups.

Conclusions
Creating a wound care process that clearly defines and separates clean and dirty steps, similar to colorectal surgical bundles in the reduction of Surgical Site Infection, reduced CLABSI and HAI rates in a clinically significant, if not statistically significant way in the Burn Intensive Care Unit. Further study is needed to increase the power of this study to possibly detect statistically significant differences.

Applicability of Research to Practice
Implementation of an evidence-based, standardized practice for wound care improved infection rates at one regional burn center. It would be beneficial for this process to be replicated at other centers to further test correlation with infection reduction.
813 Burn Care in the Patient’s Home: Development of a Secure HIPPA Compliant Process to Share Photographs with the Provider
Authors: Ayers Brittany , Johnston Mark , Mohr William J , Altamirano Heidi M 
Published: March 2020

Abstract

Introduction
Burn Telemedicine programs are shown to improve care, increase access to specialists, provide real-time education, and reduce rates of missed outpatient visits. Many occur in acute care facilities or outpatient clinics and conducted with video technology. This center has expanded the depth of options for the care team to include a Burn Telemedicine Store and Forward Program. This program is unique in that patients receive an outpatient burn visit from their home.

Methods
Photographs instead of video are uploaded into the patient’s electronic medical record. The provider reviews the photographs then conducts a phone visit to review the plan of care and recommendations.
This program is reserved for patients requiring outpatient evaluation and meet specific criteria including having technology available to upload photographs into the medical record, minor burns not requiring complex dressing changes, or burns located in areas needing range of motion evaluation.
Burn telemedicine coordinators assist patients in creating access to their electronic medical record prior to discharge or during their initial clinic visit. Training relating to lighting, camera angles, and number of photos to include is performed. Photographs are uploaded into the medical record within a prescribed timeframe. The phone visit is then scheduled and conducted between the patient and provider.

Results
Benefits of this program include flexibility for patients to receive follow up care from their home, increased access to burn specialists in areas where healthcare facilities are scarce, and the ability to speak to their providers to review the care plan. Additionally, this program is beneficial to providers who have flexibility to review photographs and formulate the plan within the electronic medical record for this subset of patients instead of having them travel to a busy outpatient burn clinic. The providers bill the patient’s insurance for the phone visit. Finally, this process is fully secure and HIPPA compliant.
Challenges have occurred within this program. The telemedicine coordinators have had to assist patients with limited experience with technology to upload photos into the electronic medical record which is time consuming and complex. In addition, some patients are not available during their scheduled phone visit time, resulting in additional time to reschedule their visits. Still this program has helped reduce the number of patients lost to follow up.

Conclusions
This program is a beneficial option for this subset of patients. Patients comment how much they appreciate the ability to do an outpatient appointment from their home.

Applicability of Research to Practice
This is applicable as it describes the benefits and challenges of developing a secure option for outpatient burn care. Outpatient visits directly into a patient’s home is unique and innovative.
817 A Proactive Feeding Regimen on Meeting Caloric Goals with Continuous Enteral Nutrition Support: A Quality Improvement Project
Authors: Lu Elizabeth 
Published: March 2020

Abstract

Introduction
Severe burn injuries are characterized by elevated metabolic demands. Numerous studies have documented iatrogenic underfeeding of critical care patients, which can lead to malnutrition, impaired wound healing, weakened immune response, and increased risk of infections. Enteral nutrition (EN) support is often utilized to help meet the increased caloric demands of burn patients. However, discrepancies between prescribed and delivered EN can occur due to frequent interruptions, delays initiating EN, gradual advancement of EN rate, and/or physician directed changes. The objective of this quality improvement project is to assess whether a proactive calculation of EN regimens can improve the provision of calories compared to a traditional calculation method.

Methods
A retrospective review of patients in a pediatric acute burn unit that received continuous EN for greater than three days was performed. The pre-protocol group consisted of patients from January 1st, 2017 to November 30th, 2017 who had continuous EN rates calculated by the dietitian based on 24 hours per day. This group was compared to patients from September 1st, 2018 to July 31st, 2019 who had EN rates calculated by the dietitian based on 23 hours per day (post-protocol group). Periods in which parenteral nutrition was administered or the EN regimen was prescribed in a non-continuous fashion were excluded. The primary outcome measure was the percentage of admissions in which patients met at least 85% of calorie estimations. This project was undertaken as a Quality Improvement initiative and, as such, was not formally supervised by an Institutional Review Board.

Results
A total of 132 patients (73 pre- and 59 post-protocol) from 134 separate inpatient admissions (73 pre- and 61 post-protocol) were identified. The average total body surface area burn was 40.9% (SD 18.8) vs. 49.4% (SD 19.8) and average age was 8.6 years (SD 5.9) vs. 7.9 years (SD 5.4) in the pre- and post-protocol groups, respectively. Continuous EN ran for an average of 20 hours a day (SD 2.2, median = 21) vs. 21 hours a day (SD 2.7, median = 22) in the pre- and post-protocol groups, respectively. The average number of days on continuous EN was comparable in both groups. The post-protocol group had 75% of admissions meet at least 85% of calorie estimations compared to the pre-protocol group with 52% of admissions having met the goal.

Conclusions
Due to the heightened metabolic demands of burn patients and the barriers to meeting caloric goals, it is important to minimize calorie deficits with EN support. Although a seemingly small change, calculating continuous EN rates based on 23 hours per day can yield improved caloric provisions compared to rates based on 24 hours per day.

Applicability of Research to Practice
A proactive approach to calculating continuous EN support should be considered to help decrease caloric deficits.
818 A Themed Approach to Decreasing CAUTI
Authors: Ladwig Melanie R 
Published: March 2020

Abstract

Introduction
In 2017 a high incidence of Catheter Associated Urinary Tract Infection (CAUTI) was recognized in the burn unit. Initially, when there were 4 CAUTIs recognized, analysis of the factors that led to the CAUTIs was done by the practice council and leadership team.

Methods
Initially, education specific to burn catheter use and areas of improvement was disseminated and included the CDC’s research on biofilm formation, variables that cause CAUTI, and the key factors to prevent CAUTI. This was followed by a test to assess for knowledge retention. In addition, one on one education was provided to each Burn staff member to ensure appropriate performance and documentation of insertion, pericare, urinary catheter care, and the significance of discontinuation of urinary catheter utilization at the earliest possible time. This education was then disseminated in a hospital wide campaign called “CAUTI Task Force: May the “Force” be with us”. This was a Star Wars themed initiative that featured a video of Star Wars clad task force members battling the CAUTI. Emphasis was placed on pericare, documentation, and decreasing the urinary catheter standard utilization ration based on a hospital acceptable reasons to continue catheter use. Urinary catheter utilization was addressed by staff daily at morning multidisciplinary rounds. Self-audits and audits by nursing leadership were performed to evaluate for improvement of the main education points of pericare, documentation, and early urinary catheter removal/necessity of catheter use.

Results
Successes were noted by continuing to count how many weeks since the last CAUTI and were celebrated with “Pee Parties” that had yellow themed food and drinks. A total of 36.5 weeks (8.5 months) without a CAUTI was recognized at 12 weeks and at 6 months. Ultimately, here was a reduction in CAUTIs from 6 in 2017 to 1 in 2018. The standard utilization ratio for catheter use decreased from 1.66 in 2017 to 1.18 in 2018.

Conclusions
There was great momentum and staff interest in the Star Wars theme and the recognition with “Pee Parties”. Further work is ongoing to decrease the standard utilization ratio for catheter use to below 1. This initiative has continued into 2019 to add other methods to reduce utilization use of a hospital wide data tool to detect usage of catheters in place longer than 4 days.

Applicability of Research to Practice
The interventions chosen were all focused on increased awareness, focus, and placing importance on improving a problem that nurses knew was harmful to their patients. There were negligible costs other than staff time for implementation, audits, and education. The results achieved are statistically significant. The implementation had great benefit with little risk. Engagement and entertainment helped to increase nurse retention and focus on the actions that would achieve results.
825 Electrical Injuries as a Result of Solar Panels: A New Trend
Authors: Halleluyan Ran , Kopari Nicole M 
Published: March 2020

Abstract

Introduction
Solar panels are associated with a number of potential injuries from manufacturing through installation. Among these are electrical injuries, which increased in frequency with the recent increase in the production of photovoltaic panels. The burn literature is currently limited regarding these injuries, the aim of this study was to summarize our institutional experience with electrical injuries from solar panels.

Methods
A retrospective review of all electrical injuries evaluated at an ABA verified Burn Center from 2014–2018 was performed. Electrical burns unrelated to solar were excluded from analysis. Data collected included demographics, injury severity, and associated morbidity and mortality.

Results
A total of 39 electrical burns were treated during the study duration, 5 of which (13%) were related to solar panel production or installation. Two patients were burned while working in a solar factory, two while installing solar panels, and one while cleaning solar panels. The average age was 29 years (range 20–47) and all were male. All patients had &lt; 5% TBSA; 1 patient had burns to the face, 1 had burns to the foot, 2 patients had burns to the hand/finger, and 1 patient had burns including the hands, abdomen, and thigh. One patient developed v-fib following his injury. He had a prolonged hospital stay of 74 days complicated by pneumonia, encephalitis, and acute kidney injury with rhabdomyolysis causing compartment syndrome of the hand which required fasciotomy. When excluding this outlier, the average length of stay was 2 days and none required ICU care. One patient required toe amputations and one presented with corneal abrasions, but no other significant complications including cardiac arrhythmias. All 5 patients survived.

Conclusions
Electrical burns from solar panels make up a significant proportion of electrical burns cared for at our institution. With the recent and continued rise in solar panel production and installation, burn centers should expect to see an increase in patients presenting with electrical burns associated with these products, especially in states seeing a greater push to adopt this technology.

Applicability of Research to Practice
Burn center staff should be aware of this emerging pattern and prepared to care for the patient injured though this mechanism.
839 Early Ambulation After a Lower Limb Burn Is Associated with Reduced Length of Stay: A Quantitative Longitudinal Study
Authors: Edgar Dale W , Hince Dana A , Edwick Dale O , Wood Fiona M 
Published: March 2020

Abstract

Introduction
A lower limb burn arguably has a significantly greater effect than an upper limb burn due to the detrimental impact on ambulation and return to daily roles and function. The patterns of functional recovery following a lower limb burn are poorly understood and has only been studied in small cohorts. It was hypothesized that patients, following an early ambulation pathway will have a reduced length of stay (LOS), and improved functional outcomes compared to patients with delayed ambulation after burn or after surgery.

Methods
The study aimed to explore if the timing of ambulation after lower limb burn and after skin grafting influenced acute LOS and functional outcomes. The study examined patients between 2011–2019 who sustained a lower limb burn injury in two phases. In Phase I, a preliminary sample (2011–2016) of 1209 lower limb burn patients with 1215 burn events was extracted and their date of ambulation confirmed retrospectively from the digital medical record. Phase II, in progress since 2017, prospectively collected the dates of ambulation. The definition of ‘early ambulation’ varies significantly and is poorly described in the literature. This study defined early and late ambulation through the categorization of four ambulatory pathways in surgically managed patients. The outcomes measured were acute LOS, and the Lower Limb Functional Index (LLFI-10) at six weeks after the burn. Conservatively managed patients were described as a reference only and not further analysed.

Results
Ambulatory data was available for 95% of cases, and the cohort had a mean age of 37.3 years; 65.6 % were male; and, 57% required surgery. Late ambulation was associated with TBSA; presence of a foot burn; and, when patients burn occurred in a rural area. Phase I results confirmed early ambulation, particularly after surgery, was significantly associated with reduced LOS (p&lt; 0.001). Excluding ICU cases (n=33), median LOS increase was 2 days where ambulation was delayed after surgery. Phase I results indicated a similar trend in LLFI-10 data. The pooling and analysis of Phase I and Phase II data underway now, will substantially increase the sample size and allow definitive understanding of the influence of sub-groups such as ICU patients on the outcomes of interest.

Conclusions
Ambulation by 48 hours after lower limb grafting surgery is associated with reduced acute burn unit length of stay.

Applicability of Research to Practice
Where appropriate, achieving early ambulation within two days after surgery will assist patients to progress more rapidly on their journey towards desired participation goals.
844 The alpha-7 Nicotinic Acetylcholine Receptor Mediates a Uniquely Human Response to Burn Injury
Authors: Costantini Todd W , Williams Elliot C , Cohen Olga , Eliceiri Brian P , Baird Andrew 
Published: March 2020

Abstract

Introduction
CHRFAM7A is a uniquely human gene that is a dominant negative inhibitor of the alpha-7 nicotinic acetylcholine receptor (a7nAchR). The relative balance of CHRFAM7A and a7nAchR expression may play an important role in mediating the human immune response to injury. We have previously shown that CHRFAM7A expression increased the hematopoietic stem cell reservoir in bone marrow and altered emergency myelopoiesis after injury. Here, we hypothesized that loss of the a7nAchR would produce a phenotype similar to CHRFAM7A overexpression, with an increased bone marrow reservoir of stem cells that would modulate myeloid cell mobilization after burn injury.

Methods
a7nAchR knockout (KO) mice (CHRNA7-/-) underwent 30% TBSA steam burn and were compared to age- and sex-matched wild-type mice. Bone marrow and blood were harvested 24 hours following burn injury for flow cytometry analysis. To measure bone marrow hematopoietic stem cells (HSC) we used flow cytometry to measure Lin−Sca1+c-Kit+ (LSK) cell expression. Bone marrow short term (ST) and long term (LT) HSCs were identified with CD48 and CD150. Immune cells were identified with myeloid markers including CD45, CD11b, Gr1, Ly6C, and Ly6G.

Results
a7nAchR KO mice have an increased bone marrow reservoir of LSK HSCs compared to WT. While bone marrow expression of ST-HSC and LT-HSC decreased after severe burn injury in WT mice, a7nAchR KO prevented the burn-induced depletion of ST-HSC and LT-HSC leaving a bone marrow HSC reservoir similar to sham. a7nAchR KO attenuated burn-induced mobilization of CD11b+ monocytes and CD11b+Ly6CHi inflammatory monocytes into the systemic circulation compared to WT.

Conclusions
Loss of the a7nAchR increases myeloid cell mobilization into the circulation after severe burn injury. There is significant variability in CHRFAM7A expression between individuals, suggesting that the relative balance of CHRFAM7A and a7nAchR expression may alter the host inflammatory response and influence human resilience after injury.

Applicability of Research to Practice
Understanding the factors that mediate the human response to burn injury could give important insights into variability in the inflammatory response between individuals and lead to therapeutics targeting the uniquely human response to burn injury.
851 Hidradenitis Suppurativa: Our Institutional Experience over the Last 6 Months with Improved Definitive Management and Quality of Life
Authors: Pang Alan , Van Hoorebeke Justin , Kopari Nicole M 
Published: March 2020

Abstract

Introduction
Hidradenitis suppurativa (HS) has prevalence of 0.05–4.1% and is more common in women, with an onset typically occurring after puberty. HS is often under-recognized, mismanaged, and is associated with comorbidities and decreased quality of life. Currently, management is tailored to the phase of the disease; medically treating the inflammatory phase and surgically managing the fibrotic phase. The tissue-sparing surgery can be disfiguring and may not protect against recurrence. The aim of this case series is to highlight a novel therapy as a treatment option for chronic, recalcitrant HS.

Methods
Four HS patients underwent a novel treatment in the burn unit at our institution. Patients underwent excision of wounds, dermal regenerative template (DRT) placement, and were dressed with a silver-impregnated negative pressure therapy wound vac. On hospital day 5 the wound vac was changed and on day 10 the patient returned to the operating room for removal of the silastic layer of the DRT with formal split thickness skin grafting (STSG) over the neodermis and replacement of the silver-impregnated negative pressure therapy wound vac. On hospital day 15, the VAC was taken down, the graft site was transitioned to daily xeroform and bacitracin dressing, and the patients were discharged home.

Results
Four patients with ages ranging from 27–60 years with an average disease duration of six-years underwent the novel treatment at our institution. Two patients had HS more prominent on the buttock with the other two patients presenting with axilla involvement. One patient had limited range of motion to the shoulders secondary to chronic contractures. All patients had failed multiple local incision and drainage procedures as well as complex medical therapies including but not limited to chronic antibiotic suppression and immunotherapies. Each patient underwent two operative procedures with three patients requiring one additional bedside wound vac change. All patients were discharged home within fifteen days from the initial procedure with acceptable wound coverage.

Conclusions
Four patients with HS underwent a novel therapy; tolerated the procedures well, had excellent adherence, and were satisfied with the results. This provides evidence for the validity of this therapy utilizing the above described staged operative approach resulting in definitive management and acceptable cosmetic results.

Applicability of Research to Practice
By utilizing this novel approach and the multidisciplinary burn team, patients who suffer from long-standing HS may have improved quality of life.