Compassion Fatigue in the Burn Unit: A Review of Quantitative Evidence

Healthcare staff across varied clinical settings are faced with varied stressors that can lead to compassion fatigue. However, there is currently no review examining the phenomenon in-depth in the burn unit. Thus, the current study sought to scope existing studies to ascertain the prevalence, contributing factors, and effects of compassion fatigue in the burn unit. Compassion fatigue was conceptualised as comprising of burnout and secondary traumatic stress. Arksey and O’Malley scoping review approach was used and reported according to the PRISMA extension guidelines. Searches were undertaken across peer-reviewed databases and grey literature sources for quantitative studies. Following the search and screening process, nine studies were retained. Codes were formulated across studies following which narrative synthesis was undertaken. Majority of the studies (n=5) focused on burn care nurses. High levels of emotional exhaustion and depersonalization and comparatively low level of personal achievement were reported among burn care staff which is indicative of burnout. Compassion fatigue was also observed to be high among burn care staff. Contributing factors are varied albeit some variables such as age, staffing levels, remuneration, nature of the work environment, and number of years worked were consistent across some studies. In conclusion, working in the burn unit is challenging with significant stressors that can lead to burnout, traumatic stress, and subsequently, compassion fatigue. Interventions to promote resilience, hardiness, optimal working environment, peer, and psychosocial support are greatly needed.

Electrical injuries in adult patients – 3 years overview

Electrocutions are a particular type of trauma, usually affecting young active people, leading to high morbidity and mortality rates in extensive injured patients. Those patients require complex, multidisciplinary treatment in specialized burn centers. We conducted a three-year retrospective study in the Burn Unit of the Clinical Emergency Hospital Bucharest, Romania, aiming to identify different factors that characterize electrical injuries, with the goal to improve our clinical practice, in order to decrease overall complications, the morbidity and mortality rates and obtain an optimal functional prognosis for those severely injured patients. Patient-related and injury-related parameters were analyzed, and particularities observed in our burn unit were noted. A clear understanding of the physiopathology of those injuries and their complications is essential for providing an optimal therapeutic strategy. Rapid initiation of systemic supportive measures, accurate diagnostic and an adequate surgical treatment, correctly conducted, are essential for improving the vital and functional prognostic of patients who suffer electric injuries.

MRSA COLONITATION DETECTION IN OBJECT NEAR PATIENTS IN BURN UNIT RSUD DR. SOETOMO - INDONESIA

Background: Burn unit is a unit where patients with a burn wound in which the patient’s skin is not intact are taken care of. Methicillin-resistant Staphylococcus aureus (MRSA) as the prototype of a nosocomial pathogen is usually transmitted through contact from the surfaces of the object to the non-intact skin. Therefore, the possibility of MRSA infection increase in the burn unit. Purpose: The purpose of this research is to find out whether there is any colonization of MRSA on the objects around burn unit patients that can contribute to the spreading of MRSA in the RSUD Dr.Soetomo Indonesia. Method: The sampling period was started from October 2019 until March 2020. Samples were taken randomly from 28 patients in the Burn unit RSUD Dr.Soetomo -ndonesia and then tested for identification in the microbiology laboratory of the medical faculty, Universitas Airlangga. Result: Nineteen bacterial growths were obtained from twenty-eight samples taken, nine of them were confirmed as Stahylococcus aureus and one from nine of them was confirmed as MRSA. Conclusion: MRSA contamination was found on an object around the patient burn unit Dr. Soetomo-Indonesia which comes from the stethoscope membrane.

The Difference in TBSA Estimation Between Emergency Room and Burn Unit in Second Tier Hospital in Central Jakarta

Introduction: Burn TBSA estimation is essential to administer fluid resuscitation. There are some methods, including Rule of 9 and Lund-Browder Chart. This study aims to identify the difference in TBSA estimation in Emergency Room & Burn Unit. Method: We conducted a retrospective cross-sectional study in design. The Inclusion criteria are patients admitted to the Jakarta Islamic Hospital Cempaka Putih (JIHCP) burn unit between April 2015-September 2018, acute patients who have complete demographic data, complete TBSA estimation in the emergency room (ER) and burn unit (BU). Exclusion criteria are patients who do not have complete demographical data and incomplete TBSA estimation between the emergency room and burn unit. The estimation of TBSA in the emergency room is done by General Practitioner, while in the burn unit is done by Plastic Surgeon. Result: Of all 160 patients admitted, 142 patients are eligible in the inclusion criteria. Most of it was adult males with an average of 28.3 years old, suffering a grade II burn injury caused by scald. There is a higher mean of TBSA estimation in the Emergency room with 15.83 (SD 12.21) compared to the Burn Unit with 12.92 (SD 12.00). The maximum TBSA overestimation in ER reaches 24% TBSA than BU, while the minimum is 0.5%. The Maximum TBSA underestimation in ER reaches 20% TBSA than BU, while the minimum underestimation is also 0.5%. On average, ER overestimates about 6.7% TBSA and underestimates about 2.8% TBSA compared to BU. Conclusion: The emergency room tends to overestimate the TBSA, with an almost 3% difference in mean (p<0.05). There is an occurrence of a maximum 24% TBSA overestimation while averaging 6.7% TBSA.

627 Strategies for Reducing Emergency Department Lengths of Stay for Admitted Pediatric Burn Patients

Introduction Various strategies to reduce emergency department (ED) lengths of stay (LOS) for admitted pediatric burn patients may be employed as a quality improvement project. Decreasing ED LOS may promote patient outcomes and reduce morbidity. Initial discussions were brought forth during trauma and burn multidisciplinary peer review rounds in March 2019 and have persisted to present day. Methods Several strategies, such as preparation of the burn unit staff within one hour of patient arrival in ED, notification to the burn unit by the burn attending of an incoming pediatric burn patient, allowing the PICU charge nurses or advisors to assist with room set up and admissions, and creating a checklist to assist PICU nurses and advisors in helping prepare for anticipating inpatient admissions. These strategies were designed and enforced in March/April 2019. In addition to these action plans, trauma activation alerts were added in December 2019 to the burn charge nurse phone for pediatric burn trauma one and trauma alerts for more expedient notifications. Finally, communication efforts between ED and burn leadership teams were conducted in June 2020 to help with additional mitigating of ED LOS, such as discussing the appropriateness of specialty consults while in the ED. Results Initial ED LOS was reduced from 209 minutes in March 1019 to 150 minutes in June 2019. Increased trends were noted in early 2020, with a peak at 244 minutes in July 2020. Additional interventions, such as trauma activation alerts and ED/Burn team communications, did not provide sustainable long-term reductions. Conclusions Recent strategies to reduce overall ED LOS trends have been beneficial, but not consistent, in sustaining downward trends. Action to perform a gap analysis to discover persistent barriers and to introduce additional structure, such as a burn trauma one algorithm, may provide stability to this metric.