BURNS UNITS AND THEIR ROLE IN MANAGEMENT OF BURNS

 

BURNS UNITS AND THEIR ROLE IN MANAGEMENT OF BURNS


By Sepo Mwikisa

 

The management of burns patients not only requires the physical aspect of care but involves tending to the psychological care of both the patients and their caregivers.

Burns patients are at a substantial risk of contaminating their environment with organisms which may spread to other patients admitted in the same ward. Aside from this, preventing infections in these patients is a big challenge as they are more susceptible to infections due to the loss of the protective barrier of the skin.

It is for this reason that medical institutions that are in frequent contact with burns patients require a burns unit that enables the staff to take care of patients in an environment isolated from other types of illnesses and bacteria.

At the University Teaching Hospital (UTH), burns patients are placed in Side wards adjacent to the main wards in the Surgical block which is one of the areas with the biggest patient population. The nurses in these blocks cater to both the patients in the main wards and side wards.

Currently paediatric and adult burns patients share the same wards as the department of paediatrics does not have burns wards with female and male children placed in female and male surgical wards respectively.

There is no exact estimate of the   number of patients’ received in these burns wards as the numbers vary from week to week. However, there is a notable increase in the numbers during the cold season, with some people accidently getting burned by braziers and boiling water. Another common factor amongst children as alluded to by one of the nurses taking care of paediatric patients is children getting burnt with hot porridge after accidently bumping into the pot (mostly common in families that use braziers to do their cooking).

With the ever increasing number of patients comes a need for expansion of certain areas and services and thus the need for a burns unit at UTH is clearly evident. The unit will not only help in decongesting the wards and reducing the burden of care on caregivers, but will ultimately affect the management of these patients as they will have a team of staff dedicated solely to the care and rehabilitation of burn patients.

The skin, which consists of two layers is the largest organ of the body and some of its important functions include; preventing entry of bacteria and other harmful environmental agents, a function carried out by the upper layer known as epidermis; regulating body temperature, storing water/fat, preventing water loss, and aiding as a sensory organ, which is all carried out by the lower layer (dermis). When the skin burns, all these functions are interrupted and this means a person is at risk of catching infections.

Burns can be classified as first- degree, second- degree and third –degree burns. The extent of damage to the skin in these burns vary with first degree burns affecting the upper epidermis, second degree burns affect the entire epidermis, including a part of the dermis and third degree burns affecting both areas completely.

In an ideal situation, burns patients are placed in separate rooms according to the extent of their injuries. Consequently, the unit requires specialized medical staff that are well equipped to take care of these patients. This is especially important for patients with severe burns who are need of enclosed bed spaces to guarantee that they are physically separated from other patients. The separation of patients helps immensely in the reduction of cross infection from their fellow patients and in the case of UTH cross infections from the main wards.

The John Hopkins Health Library asserts that burn patients need the highly specialised services of medical professionals who work together on a multidisciplinary team which includes, physiatrists, plastic surgeons, internists, orthopaedic surgeons, infectious diseases specialists, physical therapists, vocational counsellors, social workers, just to mention a few.

With psychological care being an important instrument in the recovery of these patients, especially in cases which involve considerably large amounts of scarring and disfigurement, it is imperative that children be kept in a child friendly unit separate from the adult unit which will helps make them comfortable in an environment that is very different than what they are accustomed to. Counselling is also encouraged for caregivers and this empowers them to be a pillar of strength for the patients.

The hospital has a team of staff from various disciplines that are responsible for the following; skin grafting which is the transplantation of skin from one area of the body to the damaged part; orthopaedic surgery for contractures, which occurs when a burn scar matures, thickens and tightens, therefore preventing movement; the physical rehabilitation of patients carried out by physiotherapists which help reduce contractures/gain mobility. The social work department also plays a pivotal role in cases involving families do not have the financial means to take care of their patients, including circumstances were signs of abuse and negligence are evident (most common in children and intimate relationships).

Plans for a specialized burns unit at the University Teaching Hospital are underway and this is a welcome initiative as it will be a great factor in establishing and improving the management of burns in the institution. Subsequently, it will create a huge platform for specialization and training of staff, but most importantly it will help save and restore the lives of patients especially those who may have burns more severe than that of others.

Sources: Indian Journal of Plastic Surgery. The pivotal role of nursing personnel in burn care. September 2010.

www. mtpinnacle.com. infection control in burns patients. Retrieved on 6th June 2016

www.britannica.com. Encyclopedia Britannica, inc retrieved 6th June 2016

Dulner, J. E, Fetterman, A. Preventing Scars and  Contractures. University of Rochester Medical Center@ 2016

www.hopkinsmedicine.org John Hopkins Medicine. Health Library. Retrieved on 6th June 2016