Minimizing Infection

Micro-organisms may be found in all burn wounds. However they will only persist in the wound if the right conditions exist for them to grow and multiply. Burn wound infections due to pathogenic organisms occur in the presence of coagulated proteins and microbial nutrients.

Infection of small ‘minor’ burn wounds is not common if they are appropriately managed. Local infection is suggested by the presence of increasing erythema and pain, burn wound discolouration and purulence, or the development of fever. Burn wound infection may result in conversion of a superficial burn to a deep burn.

Prevention of infection

• Assessing the wound for odour and amount of wound exudate will help in the early identification of infection.
• All dressing and wound management procedures require a strict aseptic technique.
• If necrotic tissue is present within the wound a dressing which facilitates debridement should be considered.
• Contaminated wounds require cleaning, adequate debridement and antimicrobial dressings.

Clinical signs of wound infection include:

• Spreading peri-wound erythema.
• Warmth or tenderness of surrounding skin
• Rapid sloughing of eschar
• Conversion of superficial wounds to full thickness.
• Focal, multifocal, or generalised dark brown, black, or violet discoloration of the wound.

Patients with a suspected infection should have their wound swabbed for microbiology and culture, be started on an oral antibiotic that covers staphylococcal aureus and streptococcus pyogenes and referred for medical assessment. Surgical excision maybe required for invasive wound infections

Pseudomonas burn wound infections usually occur one or two weeks after the initial burn and cause discoloration of the burn wound, destruction of the tissue below the scab, early scab loss, bleeding, swelling, and a blue-green drainage

Staphylococcal Toxemia

Staphylococcal toxic shock syndrome in paediatric burns is a life threatening condition. It is caused when the burn wound is colonised by toxic shock syndrome toxin-1 producing Staphylococcus aureus (13). Mortality of this condition can be as high as 50%.

It is not confined to patients with extensive burns, and may occur in smaller burns (less than 10% TBSA) 2 – 4 days post injury

• fever of 38.9C or above
• a rash
• deterioration in the child’s condition a few days after injury.
• Hypotension, diarrhoea and vomiting may occur.
• Late symptoms may include renal failure and liver damage

Awareness, early detection and aggressive treatment are necessary to prevent life-threatening or fatal illness.

Use of Antibiotics

Systemic antibiotics are not routinely prescribed for patients with uncomplicated burn wounds. They should be used with discretion.

The prophylactic use of antibiotics has not been shown to reduce the risk of infection in smaller burns and may facilitate the development of multi resistant bacteria. (18)

In principle, antibiotics should only be given when a known infection is present and according to sensitivities. The use of topical antimicrobial dressings should be considered as an alternative to systemic antibiotics unless there is invasive burn wound infection.