Wound management in burn centres in the United Kingdom

Despite advances in the use of topical and parenteral antimicrobial therapy, and the practice of early tangential excision, infection of the burn wound remains a leading cause of morbidity and mortality. The aim of this study was to survey and compare wound management and antibiotic usage in burn surgery in all UK burn centres. A postal questionnaire was used, followed up by telephone. Answers were obtained from all 39 units treating burns in the UK. A written policy on antibiotic usage was used by 13 centres. Excisions were covered routinely by prophylactic antibiotic therapy in 18 units, and three of these used antibiotic cover during all procedures in which the wound was manipulated. No routine antibiotic cover was given in 21 units. All units obtained surface swab cultures, but only two performed punch biopsy of the wounds. Quantitative bacteriology (counting colony forming units) was employed by three centres. Most units cleaned the burn with saline (17 of 39) or chlorhexidine (eight of 39) but combinations of these and other agents were also used. Nearly half (17 of 37) of those who replied had not seen any cases of proven or suspected toxic shock syndrome in the past 2 years. Four units gave prophylaxis against Staphylococcus aureus, and four gave antibiotics against Streptococcus pyogenes, despite recommendations in the literature. Twenty-nine units gave no prophylaxis. This study has revealed that there is no consensus on antibiotic usage amongst centres treating burns in the UK and that most units rely on surface swab cultures to monitor infection.