A study on the common hydrotheraphy practices and the prevalence of burn wound bacterial colonisation at the university teaching hosipital in lusaka zambia

Abstract

BACKGROUND Hydrotherapy plays an important role in the management of surgical patients, and especially so in those that have sustained burns to their skin. Different centers practice hydrotherapy differently. At the University Teaching Hospital in Lusaka, Zambia, patients with burns in surgical wards use a common bathtub for cleaning their wounds. This breaches patient isolation and increases risk of cross-infection. Audit records from the department of surgery show that burn wound colonization and infection is an important source of morbidity and mortality. However, there is no evidence yet that the hydrotherapy as practiced at our institution does lead to cross infection among patients with burns. OBJECTIVE The general objective was to determine if the hydrotherapy practice plays a role in cross-infection. We also wanted to characterize these organisms being spread by cross-infection. METHODS This was a prospective analytical study. Patients meeting the admission criteria were recruited. Swabs from the burn wounds were collected on admission (day 0), day 4 and day 7. Weekly swabs of the bathtub were also collected, after the tub had been cleaned and declared ready for the next patient. Weekly water samples were also collected. Selected results, for Staphylococcus aureus and Klebsiella pneumoniae, were subjected to further analysis and PCR. Results were analyzed using statistics software, SPSS version 23. RESULTS In this study, there were 96 participants of which 51 (53.1%) were males and 45 (46.9%) were females. Age distribution ranged from 5months old to 91 years old. The modal age range was 1 to 2 years old. The modal burn percentage was 6% to 10%, followed by 11 to 15%. Hot water was the cause of burns in 65.6%. Staphylococcus aureus and Klebsiella pneumoniae were the commonest organisms isolated. These came from wounds that looked clinically clean. Others were enteric organisms. In terms of readily available antibiotics, there was more sensitivity to Amikacin and Chloramphenicol than Ciprofloxacin (our commonly used antibiotic). The bathtub also had Staphylococcus aureus and Klebsiella pneumoniae, besides enteric organisms. Sixty five point four percent (65.4%) of the Klebsiella were ESBL v producers. The tub had samples that were both ESBL producers as well as widely resistant Klebsiella by other means. Of the ESBLs, 29.4% had the SHV gene, 23.5% had the TEM gene and 47.1% had both SHV and TEM. There was no CTX gene identified. MRSA accounted for 30.6% of all the Staphylococcus in this study. The PVL gene was detected in 11.8%, SPA gene in 35.3%, while 5.9% of the Staphylococcus had both PVL and SPA genes. No growth was obtained from the water samples. Seventy-two point nine percent (72.9%) of the patients were discharged, 19.8% died, while 7.3% left against medical advice. CONCLUSION Hydrotherapy as currently practiced at the University Teaching Hospital does contribute significantly to cross-infection among burns patients. The organisms transmitted are widely resistant to available antibiotics and this is posing a serious threat to treatment of infections.