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[Pathogen spectrum and pathways of infection at an intensive care burn unit]
D Kistler1, N Jahns, K Pichulla
1Klinik für Verbrennungs- und Plastische Wiederherstellungschirurgie, Klinikum der RWTH Aachen.
Abstract:
Coagulase-negative staphylococci have gained increasing importance in burns, whereas interest is no longer focussed on Pseudomonas bacteria. By means of microbiological analysis of swabs taken from patients, environment and staff, we trailed the routes of infection in an intensive-care unit for burns. Analysis of patients: In 27 out of 11 patients the same biotype of Staphylococcus epidermidis could be identified; 22 of these occurred in swabs from wounds. The phagotypification of Staphylococcus aureus showed the same phagotype in 28 out of 41 swabs taken from infected wounds of 10 patients. The pathogen mostly caused the destruction of already healed grafts in a later phase of the treatment. Further microbiological analysis showed a severe infestation of the patients by enterococci. Analysis of environment: Here, greatly increased counts of coagulase-negative staphylococci of the same lysotype as in the patients could be demonstrated. Analysis of staff: The naso-pharyngeal area is of minor importance in the spreading of germs, whereas that of protective clothing and especially the hands should be considered to be more crucial. Regular environmental tests enable rapid detection of hygienic errors so that appropriate countermeasures can be taken.
Insights
Coagulase-negative staphylococci are a growing concern in burn infections, often originating from the hospital environment and staff hands. Regular environmental testing is crucial for identifying and preventing hygiene lapses in intensive care units.
Area of Science:
- Microbiology
- Infectious Diseases
- Burn Care
Context:
- Increasing prevalence of coagulase-negative staphylococci (CoNS) in burn wound infections.
- Shifting focus from Pseudomonas species to CoNS as primary pathogens in burn units.
- Need to understand infection transmission routes in intensive care settings.
Purpose:
- To investigate the sources and transmission pathways of bacterial infections, particularly CoNS, in a burn intensive care unit.
- To identify the role of patients, environment, and healthcare staff in the spread of pathogens.
Summary:
- Microbiological analysis of swabs from burn patients revealed high rates of Staphylococcus epidermidis and Staphylococcus aureus infections.
- Environmental sampling demonstrated elevated levels of CoNS consistent with patient isolates, indicating environmental contamination.
- Staff hands and protective clothing were identified as significant vectors for pathogen transmission, more so than nasopharyngeal carriage.
Impact:
- Highlights the critical role of environmental hygiene and hand hygiene among healthcare workers in preventing burn wound infections.
- Emphasizes the need for regular environmental monitoring to detect and rectify hygienic deficiencies promptly.
- Informs targeted infection control strategies to reduce CoNS-related morbidity in burn patients.