THE RELATIONSHIP BETWEEN STERILIZATION AND MAJOR INFECTION IN BURN PATIENTS: THE SITUATION AT THE BURNS CENTRE IN PARMA, ITALY

Toschi S., Caleffi E., Bocchi A., Papadia F.

Division of Plastic Surgery, University of Parma, Italy

SUMMARY. The sterilization of the environments is one of the most important clinical factors for the prevention of major infection in burn patients. The authors describe the situation at the Burns Centre in Parma before and after the use of sterilization and conclude that periodic sterilization decreases the incidence of sepsis and mortality in bum patients.

The control of infection in the severely burned patient plays an important role in prognosis because the onset of serious infection may lead to the patient's death, either directly or through related mechanisms (such as the postponement of surgery because of poor general conditions).
The goal of antiseptic therapy in burn patients is not to prevent infection, which is impossible, but to make the infection slight in duration and morbidity.
Among the means used - apart from medical and surgical therapy and careful respect of antiseptic rules in patient management - the sterilization of the environments (bedroom, dressing room and hydrotherapy room) is in our opinion an important and necessary factor, not replaceable by simple washing, as the situation at our Bums Centre shows.

Following a regulation introduced by our Hospital Medical Management, sterilization of the environments in our Bums Centre was not carried out after 1990, because a daily careful washing of the bedrooms and bathrooms and, after every dressing, of other rooms was considered sufficient. However, from the beginning of the new procedure, we noted a significant increase in severe infections, an important decrease in the time period between admission and the onset of infection (which often occurred on the first day of admission) and a higher mortality rate without any increase in the average TBSA burned.

For these reasons we were authorized in February 1993 to carry out total sterilization.

The bacteriological quantitative analysis of microbial species before and after sterilization (Table 1) and the clinical evaluation of the effect of sterilization (decrease of severe infection, increase of onset time) showed the effectiveness of periodic sterilization of the environments, whether partial (based on patient turnover) or total (every six months).
We therefore recommend initiating sterilization as soon as possible in order to ensure a better chance of survival and a more rapid and better qualitative healing in the bum patient.

RESUME. La stérilisation des milieux est un des facteurs cliniques les plus importants pour prévenir les grandes infections chez les patients brûlés. Les auteurs, après avoir décrit la situation au Centre des Brûlés de Parme avant et après l'emploi de la stérilisation, concluent que la stérilisation périodique réduit la fréquence des infections et le taux de mortalité des patients brûlés.

BIBLIOGRAPHY

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3. Herruzo-Cabrera R. et al.: Comparative study of sepsis in burn during three periods of time. Ann. Medit. Burns Club, 6: 84-9, 1993.