Burn unit research

Brooke Army Medical Center (BAMC) is a University of Texas Health Science Center at San Antonio and USUHS teaching hospital and is home to the Army Burn Center. BAMC provides safe, quality, evidence-based care for up to 425 military and civilian inpatients. As the sole verified Level I Trauma Center within the Department of Defense (DoD), 40 of the hospital’s beds are designated for the US Army Institute for Surgical Research (USAISR) Burn Center. The verified Burn Center serves alongside the Level I Trauma Center to provide emergency services for residents from 22 separate counties in South Texas.

Highlights
• Pulsed xenon ultraviolet disinfection reduced environmental bioburden in a burn ICU.
• This reduction was driven by decreases in skin commensal organisms.
• After introduction of pulsed xenon UVC disinfection, the burn ICU experienced the longest interval without hospital-acquired C. difficile infection in a 2 year period: 290 days, though this decrease did not achieve statistical significance.

Background
Portable pulsed xenon ultraviolet disinfection (PPX-UVD) may reduce healthcare associated infections (HAI). There is limited data to inform use in burn intensive care units (BICU), where multidrug-resistant organisms (MDRO), especially gram negative rods (GNR), commonly cause disease.

Methods
The researchers evaluated PPX-UVD effects on environmental bioburden and rates of HAI and MDRO acquisition in a BICU. PPX-UVD was used for 3 months after standard cleaning of patient and operating rooms (ORs). Settle and touch plates in patient rooms and ORs were obtained after standard cleaning, pre-and post-PPX-UVD. HAI and MDRO acquisition were evaluated 1 year prior to and for 3 month periods before, during, and after PPX-UVD. 110 touch and settle plates (33 pre- and 30 post-PPX-UVD) were obtained after standard cleaning, pre- and post-PPX-UVD.

Results
After PPX-UVD, environmental samples with any growth decreased (48% vs 31%, p = 0.02), as did mean colony count/sample (2.8 pre- vs 1.6 post-, p = 0.03). The 379 colonies largely represented skin commensals, without identified MDRO. Following PPX-UVD, no changes in device-associated infections, overall MDRO, or MDR GNR were seen, though a prolonged interval without healthcare-associated Clostridium difficile infection was observed.

Conclusions
PPX-UVD in a BICU reduced overall environmental bioburden, without a statistically significant impact on HAI or MDRO.