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Preventing postoperative burn wound aspergillosis
C Levenson1, P Wohlford, J Djou
1Department of Surgery, University of Southern California Medical Center, Los Angeles 90033.
Abstract:
Between January 1, 1984, and December 31, 1988, 35 patients at the Los Angeles County + University of Southern California Burn Center had postoperative cultures from their burn wounds that grew Aspergillus species; clinical burn-wound aspergillosis occurred in 66% of these cases and death occurred in 53% of these cases. Beginning in November 1984, several modifications in the air-conditioning system and topical antimicrobial wound therapy were undertaken. Cleaning and 8Cu-quinolinolate treatment of air ducts every 2 months did not reliably clear Aspergillus species from the air in patient care areas. Several changes in topical therapeutic regimen failed to prevent both burn wound culture positivity and clinical aspergillosis. Finally, installation of high-efficiency particulate air filters, installation of new air ducts, and inception of wound irrigation with a solution of mafenide hydrochloride plus nystatin both during and after operation were associated with a reduction in wound culture positivity rate to one occurrence in 1988 (Poisson probability less than 0.01 versus the rate in 1984) and no occurrences during the 18 months after the false ceiling of the burn ward was sealed.
Insights
Implementing enhanced air filtration and specific wound irrigation significantly reduced Aspergillus infections in burn patients. This strategy proved effective in preventing invasive aspergillosis and improving patient outcomes at a specialized burn center.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Burn Care
Background:
- Aspergillus species pose a significant threat in burn wound infections, leading to high morbidity and mortality.
- Previous infection control measures, including air duct cleaning and topical antimicrobials, were insufficient to prevent Aspergillus colonization and infection.
Purpose of the Study:
- To evaluate the effectiveness of comprehensive environmental and therapeutic interventions in controlling Aspergillus burn wound infections.
- To reduce the incidence of post-operative burn wound aspergillosis and associated mortality.
Main Methods:
- Installation of high-efficiency particulate air (HEPA) filters and new air ducts.
- Implementation of wound irrigation with mafenide hydrochloride and nystatin during and after surgery.
- Sealing of the burn ward's false ceiling.
Main Results:
- A significant reduction in Aspergillus wound culture positivity was observed, from a high rate in 1984 to one occurrence in 1988 (p < 0.01).
- No cases of Aspergillus burn wound infection occurred in the 18 months following the sealing of the false ceiling.
- Clinical aspergillosis and associated mortality rates, initially high at 66% and 53% respectively, were effectively reduced by the implemented strategies.
Conclusions:
- A multi-faceted approach combining advanced air filtration, updated ventilation systems, and targeted wound irrigation is highly effective in preventing Aspergillus infections in burn patients.
- Environmental controls, particularly HEPA filtration and sealed ventilation systems, are critical in managing airborne fungal contamination in high-risk settings like burn centers.