Publication: A five-year review of health care-associated infections in a tertiary burn unit in Malaysia
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Date
2022-06
Authors
Fadzullah, Nur Afifah
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Abstract
Introduction Health care-associated infections (HAIs) range between 4.0 to 11.9%. Burn patients often require prolonged hospitalisations and multiple invasive diagnostic and therapeutic procedures. Consequently, patients contract infections which are the most potentially serious complications that occur. In Malaysia, there is limited data on the incidence of these HAIs among burn patients. This study therefore aims to determine the prevalence and risk factors for HAIs in acute burn patients at Hospital Kuala Lumpur, Malaysia, Burn Unit over a 5-year period. Methodology This was a retrospective cohort study that enrolled 219 patients aged 12 years and above who were admitted into the adult Burn Unit of Hospital Kuala Lumpur within 3 days following the burn injury from January 2016 until December 2020. Patients with incomplete data on key variables like HAIs, age, sex, nature and duration of injury and cause of injury were excluded from the study. The prevalence of HAIs was obtained as the proportion of patients who developed HAIs divided by all the patients enrolled into the study. A logistic regression model was used to assess for the risk factors for HAIs. Results The prevalence of HAIs was 16.0% with a 95% CI (12% to 21%). In this study, 42.9% of the participants had scalds, 26.0% had flame burns and 15.1% had burns due to thermal injuries while 7.3% were contact burns. The common causative organisms were Pseudomonas aeruginosa (62.9%), 11.4% had Acinetobacter baumanii (11.4%), MRSA (8.5%) and Staphylococcus aureus (5.6%). Among the patients who had HAIs, 74.3% had wound infections, 17.1% were blood infections and 5.7% were lung infections while only 2.9% had urine as their route of infection. The median hospital stay was 5 days and presence of HAI significantly increases hospital stay by 34 additional days (P < 0.001). Age of more than 50 years OR 2.39 (95% CI; 1.33 to 4.30, P = 0.004), duration of hospital stay of more than 14 days OR 6.79 (95% CI; 2.56 to 17.98, P < 0.001), and total burn surface area of more than 10% OR 5.10 (95% CI; 2.47 to 10.53 P = <0.001) were significant risk factors for HAIs. Conclusion The prevalence of HAIs in the adult Burn Unit of Hospital Kuala Lumpur was slightly higher than what has been reported in other countries and presence of HAIs increases hospital stay by 34 additional days. In addition, TBSA, age of more than 50 years and prolonged hospital stay were significant risk factors for development of HAIs. We therefore recommend improvements in preventive measures, improved infection control and a clear burn management protocol, based on local infection data so as to reduce the mortality and morbidity rates due to burn injuries.
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Keywords
Health Care Associated Infections , burns