Annals of Burns and Fire Disasters - vol. XIII - n. 3 - September 2000

THE NEW BURNS CENTRE AT THE A. PERRINO HOSPITAL, BRINDISI, ITALY

Verrienti P.

A. Perrino Burns and Plastic Surgery Centre, Brindisi, Italy

SUMMARY.A new burns centre was opened at the A. Perrino Hospital, Brindisi, Italy in November 1999. The new centre continues in the traditions of the previous burns centre, but is more functional. A full description of the new centre is provided. An outline is given of the activity of the burns centre in the period 1986-99 in order to give an idea of the amount of work done and the effectiveness of the treatment administered. Some epidemiological considerations are also expressed.

The new Burns Centre at the A. Perrino Hospital, Brindisi, Italy became operative on 8 November 1999.
The new centre continues i11 the traditions of the old burns centre, which was founded in 1975, but is more functional. It possesses a section for intensive care, with two 4-bed islands equipped for reanimation, a state-ofthe-art operating theatre connected to the burns centre, and two balneotherapy rooms, one for immediate care and first aid and the other for the daily treatment of burn patients.
The intensive care section has two medication rooms and a room for the growth of cultivated skin from cadavers or skin substitutes obtained by bioengineering. Access to the intensive therapy section, which has its own airconditioning system with absolute filters, is regulated by a special filter zone. Contact with visitors is by way of an intercom system.
The intensive section unit is adjacent to a semiintensive module with 12 beds. Each room contains three beds and has its own independent and complete hygiene facilities.
There is an adjacent fully equipped room for out-patient treatment, and a common room for visitors and patients.
It may be of interest to provide an outline of the activity of our burns centre in the period 1986-99 in order to give an idea of the amount of work done and the effectiveness of the treatment administered. We will also express some epidemiological considerations.
The A. Di Summa Division of Plastic Surgery and Burns Centre in Brindisi, now part of the new and more extensive A. Perrino Hospital, admits burn patients from a large area that includes all of Apulia, Basilicata, the Ionic coast of Calabria, and the nearer Provinces of Campania.
Between 1 January 1986 and 31 December 1999, 4638 burn patients were admitted, two-thirds to the Division of Plastic Surgery and one-third (1649, to be precise) to the Burns Unit. This represents an average annual number of 331 patients. The annual distribution is given in Fig. 1.
The average number of monthly admissions varied during the year, with peaks in winter and summer. This trend reflects the seasonal use of potentially dangerous heating systems (e.g., open fires, electric heaters, braziers), the occurrence of school-holidays, and the use of barbecues in the summer season. In certain periods of the year (especially the summer months) all beds in the Burns Centre are occupied. The annual peak of admissions is in June, with a mean number of over 13 patients; after June the mean number of admissions drops as there can be no new admissions until beds are vacated (Fig. 2).
Distribution by sex shows that the majority of the patients admitted to our Burns Centre were male (62.4%).
Distribution by age confirms the general trend that children, also in our territory, are most exposed to the risk of burns: the age group 0-12 yr accounted for 32.8% of our admissions (Fig. 3).
The distribution of patients as a function of aetiology varied if we consider the seriousness of the burn: more than 50% of our admissions were due to hot liquids, while two-thirds suffered lame burns. Another significant feature is the disparity of aetiologies as regards the age of the patients: under the age of 13 yr about 70% of burns were due to liquids, while in older patients the predominant aetiology was flame (Fig. 4).
In our case records the home was the place where burn injuries most commonly occurred, confirming the widespread finding that the vast majority of burns are caused by improper or careless use of everyday objects and substances.
With regard to accidents at work, there was a significant difference between the two sexes: in our territory industrial burn accidents involved almost exclusively male patients (who represented about 25% of the burn patients we admitted), while over 93% of the women suffered their burns in the home, a reflection of the fact that women rarely have jobs in which they are exposed to the risk of burns (e.g., factory workers, artisans, etc.) (Fig. 5).

The effectiveness of the therapy we administered is reflected in the mortality trend in our Department in the period in question. The most outstanding finding is the reduction in mortality from an average of 11.5% of patients admitted in 1998 to 6% in 1999. This drop can be attributed to the use of more effective topical treatments, increased attention to the patients' energy requirements (with wide use of supplementary or substitutive enteral and parenteral nutrition), and earlier and more frequent recourse to surgery (28% of patients were subjected to surgery in 1986, compared to 53% in 1999.
The paramedical staff in our burns centre consists of one charge nurse, 22 professional nurses, and three technical assistants.
The medical staff, which is shared with the Department of Plastic Surgery, consists of one Level II Director plus 13 Level I Directors. These guarantee a 24-hour a day active medical duty, plus on-call surgeons. Our medical staff is made up of the following physicians: