NOSOCOMIAL INFECTIONS IN A BURN INTENSIVE-CARE UNIT

Although many studies have reviewed burn wound infections (BWls) in bu rn patients, few have prospectively surveyed other nosocomial infectio ns. Seriously burned patients are clearly at increased risk for infect ion due to the nature of the burn injury itself immunocompromising eff ects of burn injury, prolonged hospital stays, and invasive diagnostic and therapeutic procedures. Over 6 months, we prospectively reviewed all patients admitted to our burm intensive care unit (BICU) for nosoc omial infections. We used standard CDC definitions of nosocomial infec tions (NIs). Because we had previously documented a high incidence of nosocomial pneumonias in these patients, we were particularly interest ed in determining risk factors for nosocomial pneumonia. The total cen sus during the study period was 57. There were 40 discharges and death s. Surveillance demonstrated 36 nosocomial infections in 26 patients, for a total of 90 nosocomial infections per 100 discharges and deaths, or 32.3 NIs/1000 patient days. Infections included 22 pneumonias, 10 urinary tract infections, two bacteraemias, one BWI and one episode of cellulitis. Intubation was strongly associated with nosocomial infect ion, particularly with pneumonia, BWI and bacteraemia. Sixty per cent of all patients were intubated al some time during their BICU stay, bu t 88 per cent of those who developed a nosocomial infection were intub ated (P<0.001). Inhalation injury was less significant than intubation in the development of nosocomial infection. All patients who develope d pneumonia or a BWI were intubated. One-half of nosocomial infections were attributed to gram-positive cocci (GPC) and 13 per cent to fungi (Candida albicans), consistent with reports from burn units and other intensive care unit settings of increasing incidence of nosocomial in fections due to these types of organisms.