The Contribution of a Bacterially Isolated Environment to the Prevention of Infection in Seriously Burned Patients

Abstract

A new system of patient protection from bacterial cross-infection called the Bacteria Controlled Nursing Unit (BCNU) is described, based on strict environmental control of a 6 .times. 10 ft area surrounding the patient''s bed rather than the entire patient room or isolation ward, plus the ability to deliver all medical care without entering the protective environment and maintaining all monitoring, life support and i.v. equipment outside the controlled environment. The clinical effectiveness of this system in the treatment of burn patients was studied and compared with the effectiveness of single room isolation on a burn isolation ward and conventional isolation techniques on an open burn ward. The studies show that BCNU is significantly more effective in preventing bacterial cross-contamination than conventional precautions (3.8% vs. 13.1%, P < 0.001 and 8% vs. 22.8%, P < 0.001) over a 2 and 4 week period. There was a significant increase in probability of infection occurring following cross-contamination than occurring after auto-contamination (65% vs. 39%, P < 0.005), emphasizing the importance of preventing cross-contamination in reducing overall infection rate in seriously burned patients. Clinical evaluation of the unit proved it to be compatible with intensive nursing and medical care without increasing the nurse to patient ratio. The unit provided sufficient control of bacterial cross-infection to allow reduction in mortality and improvement in the effectiveness of burn care through routine prompt excision of burn eschar and immediate wound closure to be carried out in severe and massively burned patients without a limiting threat of bacterial burn wound sepsis.