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Risk Factors for Healthcare-Associated Infections in Adult Burn Patients

Published online by Cambridge University Press:  30 October 2017

Paula D. Strassle ,
Felicia N. Williams ,
David J. Weber ,
Emily E. Sickbert-Bennett ,
Anne M. Lachiewicz ,
Sonia Napravnik ,
Samuel W. Jones ,
Bruce A. Cairns  and
David van Duin
Paula D. Strassle
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
Felicia N. Williams
Affiliation:
Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina North Carolina Jaycee Burn Center, Chapel Hill, North Carolina
David J. Weber
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
Emily E. Sickbert-Bennett
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
Anne M. Lachiewicz
Affiliation:
Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
Sonia Napravnik
Affiliation:
Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
Samuel W. Jones
Affiliation:
Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina North Carolina Jaycee Burn Center, Chapel Hill, North Carolina
Bruce A. Cairns
Affiliation:
Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina North Carolina Jaycee Burn Center, Chapel Hill, North Carolina
David van Duin*
Affiliation:
Division of Infectious Diseases, University of North Carolina, Chapel Hill, North Carolina
*
Address correspondence to David van Duin, MD, PhD, Division of Infectious Diseases, Department of Medicine, University of North Carolina, 130 Mason Farm Road, Mail code CB #7030, Chapel Hill, NC 27599-7030 (david_vanduin@med.unc.edu).
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Abstract

OBJECTIVE

Burn patients are particularly vulnerable to infection, and an estimated half of all burn deaths are due to infections. This study explored risk factors for healthcare-associated infections (HAIs) in adult burn patients.

DESIGN

Retrospective cohort study.

SETTING

Tertiary-care burn center.

PATIENTS

Adults (≥18 years old) admitted with burn injury for at least 2 days between 2004 and 2013.

METHODS

HAIs were determined in real-time by infection preventionists using Centers for Disease Control and Prevention criteria. Multivariable Cox proportional hazards regression was used to estimate the direct effect of each risk factor on time to HAI, with inverse probability of censor weights to address potentially informative censoring. Effect measure modification by burn size was also assessed.

RESULTS

Overall, 4,426 patients met inclusion criteria, and 349 (7.9%) patients had at least 1 HAI within 60 days of admission. Compared to <5% total body surface area (TBSA), patients with 5%–10% TBSA were almost 3 times as likely to acquire an HAI (hazard ratio [HR], 2.92; 95% CI, 1.63–5.23); patients with 10%–20% TBSA were >6 times as likely to acquire an HAI (HR, 6.38; 95% CI, 3.64–11.17); and patients with >20% TBSA were >10 times as likely to acquire an HAI (HR, 10.33; 95% CI, 5.74–18.60). Patients with inhalational injury were 1.5 times as likely to acquire an HAI (HR, 1.61; 95% CI, 1.17–2.22). The effect of inhalational injury (P=.09) appeared to be larger among patients with ≤20% TBSA.

CONCLUSIONS

Larger burns and inhalational injury were associated with increased incidence of HAIs. Future research should use these risk factors to identify potential interventions.

Infect Control Hosp Epidemiol 2017;38:1441–1448

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 12 , December 2017 , pp. 1441 - 1448
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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