Indian Journal of Burns

KNOW YOUR BURN UNIT
Year
: 2016  |  Volume : 24  |  Issue : 1  |  Page : 8--11

Making of a burn unit: SOA burn center


Jayant Kumar Dash1, Ipsa Mohapatra2, Abhimanyu Sharma3,  
1 Department of Burns, Plastic and Reconstructive Surgery, IMS and SUM Hospital, Siksha ‘O’ Anusandhan University, Bhubaneswar, Odisha, India
2 Department of Community Medicine, KIMS, Bhubaneswar, Odisha, India
3 Skin Bank, IMS and SUM Hospital, Bhubaneswar, Odisha, India

Correspondence Address:
Jayant Kumar Dash
Department of Burns, Plastic and Reconstructive Surgery, 3rd Floor, IMS and SUM Hospital, Siksha ‘O’ Anusandhan University, Kalinga Nagar, Bhubaneswar - 751 003, Odisha
India

Abstract

Each year in India, burn injuries account for more than 6 million hospital emergency department visits; of which many require hospitalization and are referred to specialized burn centers. There are few burn surgeons and very few burn centers in India. In our state, Odisha, there are only two burn centers to cater to more than 5000 burn victims per year. This article is an attempt to share the knowledge that I acquired while setting up a new burn unit in a private medical college of Odisha.



How to cite this article:
Dash JK, Mohapatra I, Sharma A. Making of a burn unit: SOA burn center.Indian J Burns 2016;24:8-11


How to cite this URL:
Dash JK, Mohapatra I, Sharma A. Making of a burn unit: SOA burn center. Indian J Burns [serial online] 2016 [cited 2017 Nov 19 ];24:8-11
Available from: http://www.ijburns.com/text.asp?2016/24/1/8/195537


Full Text

 Introduction



Burn injuries are a serious issue in India. Every year more than 6 million people sustain burn injuries.[1] Of the patients who require hospitalization, most of them are referred to hospitals equipped with special facilities for the treatment of injuries related to burns. These service capabilities, along with the setting in which they are provided, are termed burn centers.

We have few burn surgeons in India and still lesser burn centers to cater to these victims. In the state of Odisha, there are only two burn centers to cater to more than 5000 burn victims per year. With this background, I planned to establish a well-equipped burn unit in the capital city of Bhubaneswar, Odisha. The main goal was to provide comprehensive and best possible care to the burn victims. This article is an attempt to share the knowledge acquired by me while setting up the burn unit.

I first tried to analyze the problems in managing burn patients. A major cause of death in burn patients is septicemia. Skin is the first line of defense of our body, and this protective barrier is lost in burn patients which leads to infection, septicemia, and ultimately death. We can reduce the mortality and morbidity in these patients by reducing the chances of them getting infections. Therefore, asepsis was the first priority.[2] Other requisite parameters were equipment, infrastructure, and a dedicated team.

 Asepsis



There should be a good air conditioning system and restricted entry to maintain asepsis. Both these factors concern the habitat of the patient. We have an excellent Air Handling Unit [Figure 1] which throws high-efficiency particulate air filtered air into each cubicle of burn Intensive Care Unit (ICU) with laminar flow (horizontal) system. Thus, a reduction of the bacterial content in the air is achieved by multiple filtration and immediate exit of the air from the cubicle (high air change rate with almost 100% fresh air flow). There are eight isolated cubicles [Figure 2] with intensive care beds, motorized air mattresses, infusion pumps, monitors, and in-house facility for ventilator and dialysis. Burn patients require intensive care at the time of admission and also during the course of their treatment.[3] Each cubicle has the facility for temperature (28–38°C) and humidity (50–60%) control.[4] Antibacterial paint (ultra-fresh technology) has been applied on the floors, walls, and roofs which prevent bacterial colonization and fungal growth [Figure 3]. Entry to ICU is restricted with the help of biometric system. Only authorized persons wearing special apparel can enter the ICU area. The supervision of cleaning, disposal of soiled linen, and dressing material is the responsibility of the sister-in-charge of the burn unit, with strict adherence to Biomedical Waste (management and handling) Rules, 2011. There are two air locks; one at the entry gate to ICU and another at the entry gate of toilet area [Figure 4]. Barrier nursing is followed to prevent cross-contamination and hospital acquired infection. Dressing is done at the bedside of each patient (inside their cubicle) to prevent cross-contamination. All cubicles are arranged in a C-shape with nursing station at the center [Figure 5]. There is a large corridor area for the movement of patients. All visitors are required to wash their hands before entering and after leaving the unit. Regular hand washing by all staff and visitors is found to be one of the best ways to reduce the infections related to cross-contamination. Visitors are not allowed to sit on patient's bed, share toiletries, newspaper/magazines, and food, or go into other patient's cubicle.[5]{Figure 1}{Figure 2}{Figure 3}{Figure 4}{Figure 5}

 Infrastructure



This state-of-art facility has an Intensive Care Unit, a special burn care unit and an outpatient clinic - for minor burn assessments and treatment. It started from September 1, 2015, and we have 121 burn patients' admissions till April 30, 2016, with an average 31% total body surface area (TBSA) burns and mortality rate of 23%. All burn patients requiring admission are initially managed in the emergency department of our hospital with intravenous fluids, medications, dressing, and catheterization. After initial resuscitation, the patients are shifted to the burn unit. We have an attached thirty-bedded plastic surgery ward for step-down treatment of all burn patients. Treatment of burn patients does require an adequate infrastructure.[6]

A complete hydrotherapy unit [Figure 6] is attached to the burn unit. The patients are lifted from their beds with a patient carrier. The patient is then immersed in a hydrotherapy tub. Wound gets cleaned with its bubble massage system. Patient is then lifted out from the tub and dressing is done. This system cleanses the wound and also produces a sense of well-being in the patient.[7] It further helps in maintaining asepsis by preventing colonization of bacteria – which is a source of secondary infections in all burn patients in the 2nd week of posttrauma recovery.{Figure 7}

We have a designated modular Operation Theatre (OT) with all the requisite equipment (electric dermatome, mesher, etc.,) for early excision and skin grafting. We have successfully done early excision and skin grafting in eight patients within these eight months. Moreover, we have a skin bank which helps us in early surgery for burn patients. We have received only five skin donations till today. We hope the number will increase with increased awareness about skin donation in the community.

 Dedicated Team



The burn unit team consists of experienced plastic surgeons, round the clock critical care resident doctors, anesthetist (for pain management), microbiologist, physiotherapist, in-house attached psychologist, a dietician, and staff nurses (ratio of nurses to patient is 1:2 and these nurses are trained in the management of burn patients). The pediatrician and nephrologists join the team as and when required. There is a consultant-led ward round each morning accompanied by the nurse in charge to review the treatment of each patient. There is a multidisciplinary meeting every week to monitor the overall progress of the patient and plan the future course of treatment. There are regular academic seminars conducted by the entire team weekly. Physiotherapy consists of exercises, assistance with walking, practice with functional tasks, and splinting. It helps to restore movement and function to as near normal as possible. Our clinical psychologist routinely interacts with patients and tries to motivate them to take life in a positive way. Our social worker tries to rehabilitate the patient after the patient gets discharged from our center. Regular interaction and motivation by staff nurses play an important role in improving the moral of the patients. As health is multidimensional, so also is our dedicated team which always motivates and gives good quality care to the patients, thereby helping to increase the quality of life in these burn survivors. Overall, the team effort has improved the quality of care and the patient treatment outcome.

 Future



Mortality and morbidity of burn patients are quite high in India. Our team organizes social awareness programs on prevention and first-aid in burns. This burn center with an average of 80% bed occupancy now caters to the holistic treatment of burns both in adults and children under one roof. We have tried to make it affordable for most of the patients with an approximate expenditure of 5000 rupees/day only. We also have planned to start a training program (fellowship) exclusively in burns for doctors and paramedics practicing in rural area to improve their clinical acumen. This will help in bridging the gap in primary care of burn victims. Further, timely resuscitation and referral will have a better clinical prognosis and decrease mortality in them.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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