CHAPTER ONE

INTRODUCTION
Background of the Study:
Burn injuries are among the most distressful trauma and a considerable public
health issue all over the world. Approximately 180,000 deaths occur by burn
every year estimated by world health organization (WHO) in 2018. These burn
injuries extensively occur in low income and middle income countries, in the
same way death rate is higher in low income countries as compared to high
income countries. Burns could also leading to many disability-adjusted life-
years (DALYs) lost in low and middle-income countries. WHO has reported
much higher incidence in Pakistan approximately 1388/100000 annually as
compared to global incidence of 110/100000 per annum. (Othman, N., &
Kendrick, D.2010).
Treatment for burn patients depends on the cause, depth, and surface area of
burn injury. Treatment on basis of depth of burn includes many different
approaches such as wound debridement, application of the modern
hydrocolloid; silicone dressings and chlorhexidine coated conventional
dressings for superficial burn. However, deep dermal burn treatment protocol
involve different dressings which stimulate epithelialization and many grafting
procedures. (Leseva, M., Arguirova, M., Nashev, D., Zamfirova, E., &
Hadzhyiski, O. 2013). Furthermore, Empiric Antimicrobial therapy is not rec-
commended to treat fever because most of the time these patients have fever
just because of the systemic inflammatory response to burn.(Weber, J.,
McManus, A., & Nursing Committee of the International Society for Burn
Injuries 2004).
The most common complications associated with burn are burn wound
infections while other frequent complications are sepsis, pneumonia, lung
failure, acute renal failure, acute respiratory distress syndrome (ARDS), and
multi-organ failure (Spanholtz, T. A., Theodorou, P., Amini, P., & Spilker, G.,
2009)
Most of burn wound infections eventually cause morbidity and mortality of
burn patients and become very challenging matter for burn team. It was also
estimated that about 75% of the mortality among burn patients related to
sepsis which is dangerous body response to infection. (Donati, L., Scamazzo, F.,
Gervasoni, M., Magliano, A., Stankov, B., & Fraschini, F. 1993).
Burn wound infections can spread like other infections and follow the universal
chain of infection that includes three components, causative agents of
infection; ways of transmission; and patient susceptibility for infection. Almost
all types of pathogens found in burn patients such as gram positive and
negative and fungal organisms.
The typical burn wound is primarily contaminated with gram-positive
organisms, which mostly replaced by gram- negative more resistant organism
after a week. Secondly, transmission of infection in the case of burn patients, it
majorly by direct or indirect contact. This contact can usually occur either
through the hands of the Nurse or by any other personnel taking care of the
patient or during use of equipment not properly decontaminated. In burn
patients, damage to physical defense can lead to contamination of wound by
opportunistic and pathogenic organisms (Weber, J., McManus, A., & Nursing
Committee of the International Society for Burn Injuries. 2004). This study will
examined the perception of Nurses over the causes and prevention of burns
wound infection among burns patients in National Orthopaedic Hospital
Enugu.

Statement of Problem

Burn injuries are potentially life threatening conditions and burn patients
demand exceptional care. This care should be given by knowledgeable and
competent nurses following specific guideline or protocols that will reduce the
occurrence of infection and complications. Hence, there is evidence that
management and care of patient with burn injury need a unique body of
knowledge and skills from a responsible multidisciplinary team members
especially the Nurses, and specific infection control guidelines should be
develop for preventing infections especially hospital acquired infection (HAI),
HAIs are considered an undesirable outcome, indicator of the quality of patient
care lead to severe complications.
The survival rates for burn patient have improved substantially in the past few
decades due to advance in modern medical care in specialised burn centres.
The improved outcome for severely burned patient have been attributed to
medical advance in fluid resuscitation, nutritional support, pulmonary care,
burns wound care and infection control practices (American Burn
Association,2000).

Although several studies emphasized different measures put in place by Burns

and Plastic Surgery specialists in order to addressed the severe complications
arising as a result of burns wound infections among burns wound patients in
many medical care facilities in Nigeria, those studies focused on the
management and control of burns wound without specifically examining other
potential meaningful area of concern such as the perception of Nurses over the
issue of causes, care and prevention of burn wound infection.
It is based on the increasing cases of burn wound infections in the Nigeria
medical facilities that this study, ‘Nurses Perception of Causes and Prevention
of Burns Wound Infection among Burns Patients’ with the specific reference to
the National Orthopaedic Hospital Enugu (NOHE) is being carried out.

Objectives of the Study:

The major objectives of this study is to examine the Nurses Perception of

Causes and Prevention of Burns Wound Infection among Burns Patients in
National Orthopaedic Hospital Enugu (NOHE). However, specifically the study
is designed:

i. To determine Nurses perception of causes of burn wound infection in

National Orthopaedic Hospital Enugu(NOHE)
ii. To assess Nurses adequate knowledge of prevention of burn wound
infection among burn patients in National Orthopaedic Hospital
Enugu (NOHE)
iii. To evaluate Nurses’ practices on prevention of burn wound infection
among burn patients in National Orthopaedic Hospital Enugu (NOHE)
iv. To determine the effective control measures taken during the care of
a burn patient in National Orthopaedic Hospital Enugu (NOHE)
v. To determine the Nurses care plan for a burn patient in National
Orthopaedic Hospital Enugu (NOHE)

Research Questions:
i. What are Nurses’ perception of causes of burn wound infection in
National Orthopaedic Hospital Enugu?
ii. How do Nurses prevention burn wound infection among burn patients
in the National Orthopaedic Hospital Enugu?
iii. Do Nurses practice guidelines on the prevention of burn wound
infection among burn patients in National Orthopaedic Hospital Enugu?
iv. What are the effective control measures taken during the care of burn a
patient in National Orthopaedic Hospital Enugu?
v. What are the Nurses care plan for a burn patient in National
Orthopaedic Hospital Enugu?
Significant of the Study:

This research study will go a long way to unravel some of the Nurses
perception of causes and prevention of burn wound infection among burn
patients in National Orthopaedic Hospital Enugu, This will enable medical care
facilities in the country, especially National Orthopaedic Hospital Enugu to pay
specific attention to these causes and prevention of burn wound infection
among patients under its care while fashioning out more measures of
management and control of burn wound infection among burn patients in the
hospitals. The burn patients on their part would be educated on the causes of
burn wound infection and different ways it can be prevented.

The outcome of this research study would also fill an information gap that
existed on the Nurses perception of causes and prevention of burn wound
infection among burn patients in many medical care centres across the globe.
It would therefore add to the scarce literature on the subject matter, thus
serve as useful material to potential researchers, medical professionals,
especially those in the area of Burns and Plastic Surgery, academicians and
those in the para-medics arena.

Scope of the Study:

This study fall within the scope of Nurses perception of causes and prevention
of burn wound infection. The study variables will includes: Burn patients and
Nursing care and preventive measures. The National Orthopaedic Hospital
Enugu will be the choice of location because of easy access of information due
to the already existing opportunity of carrying out a post-basic study in Burns
and Plastic Surgery under the Post-Basic School of Nursing, National
Orthopaedic Hospital Enugu. The duration of this research study will be Six (6)
months, from June, 2020 to November, 2020; and Nurses delivering various
medical care services to the burn patients in the Burns and Plastic Surgery Unit
of the National Orthopaedic Hospital Enugu will be covered as the entire
population of the study.

Operational Definition of Terms

i. Nurses: Persons trained to care for the sick or infirm, especially in a
hospital.
ii. Causes: Things that gives rises to an action of infection.
iii. Infection: It occurs when another organism enters burn wound and
causes diseases.
iv. Prevention: It’s the action of stopping burn wound infection.
v. Burn: A flame of fire consuming a person’s skin.
vi. Wound: Is an injury to a living tissue, typically one which affect the
skin.
 CHAPTER TWO

LITERATURE REVIEW

Introduction:
This chapter will review relevant literatures on the subject under
investigation. It will specifically captured the conceptual review, theoretical
review and empirical review.

Conceptual Review:
The perception of Nurses about causes and prevention of infection in burn
patients is that, Infection in the burn patient is a leading cause of morbidity
and mortality remains one of the most challenging concerns for the burn
wound health care team. The importance of preventing infection has been
recognized in organized burn care facilities since its inception and has followed
recurring themes through the years.
These included strict aseptic technique, use of sterile gloves and dressing
materials, wearing masks for dressing changes, and special separation of
patients, either using private rooms or cubicles. Certain practices have been
discarded, such as routine use of prophylactic antibiotics; use of sterile sheets,
introduced following the exposure method of burn treatment; and the practice
of infrequent dressing changes in the early post-burn period. Greenfield, E.
(2010).

Burn Wound Infection

Overall, the incidence of burn wound infection has declined in recent years
with the change to early excision and wound closure. As the size of the wound
increases, so does the risk of infection. Causes of burn wound infection relate
to the loss of the protective barrier of the skin and thrombosis of the
subcutaneous blood vessels. The resulting avascular wound bed makes an
excellent medium, which can support the growth of microorganisms as well as
prevent the penetration of systemically administered antimicrobial drugs. Burn
wound infection can be subdivided into local or non-invasive infection and
invasive infection.
 Flannagan, M. & Graham, J. (2001) also submitted that, local wound infection
is characterized by erythema or cellulitis, purulent, drainage, graft loss, fever
>38.5°C and leukocytosis. Invasive wound infection is characterized by
conversion of partial-thickness to full-thickness injury, rapid eschar separation,
necrosis of small blood vessels, edema, erythema, and tenderness at the
wound edges. Systemically, the patient may be hypothermic or hyperthermic,
hypotensive, have a decreased urine output and illeus. Laboratory results will
reveal leukocytosis or leukopenia, thrombocytopenia, positive blood cultures,
hyperglycemia and invasion of organisms into viable tissue on histopathologic
examination of the wound.

Epidemiology of Infection:
The development of infection depends on the presence of three conditions, a
source of organisms; a mode of transmission; and the susceptibility of the
patient. Infection risk for burn patients is different from other patients in
several important respects.
Sources of organisms are found in the patient’s own endogenous (normal)
flora, from exogenous sources in the environment, and from healthcare
personnel. Exogenous organisms from the hospital environment are generally
more resistant to antimicrobial agents than endogenous organisms. Organisms
associated with infection in burn patients include gram-positive, gram-
negative, and yeast/fungal organisms. The distribution of organisms changes
over time in the individual patient and such changes can be ameliorated with
appropriate management of the burn wound and patient. The typical burn
wound is initially colonized predominantly with gram-positive organisms,
which are fairly quickly replaced by antibiotic-susceptible gram-negative
organisms, usually within a week of the burn injury. If wound closure is delayed
and the patient becomes infected, requiring treatment with broad-spectrum
antibiotics, these flora may be replaced by yeasts, fungi, and antibiotic-
resistant bacteria.
Gram-positive organisms of particular concern include methicillin-resistant
S.aureus (MRSA), enterococci, group A beta-hemolytic Streptococcus and
coagulase negative Staphylococcus. MRSA was first seen in the United States in
the late 1960s and has become an endemic organism in many burn units. It has
been argued that no extraordinary efforts be made to control its spread,
however this view has been increasingly challenged in the era of vancomycin-
resistant enterococcus (VRE). With the increasing incidence of VRE in hospitals,
the risks associated with infection with this organism are increasing. Risk
factors identified in patients colonized with VRE include prior vancomycin use,
prior use of third generation cephalosporins and antibiotics active against
anaerobes, a critically ill patient with severe underlying disease or
immunosuppression, and a prolonged hospital stay. These factors are all
present in patients with a large burn injury, including prior vancomycin use in
units with a high endemic rate of MRSA. Sorte, D. (2015). Gram-negative
organisms have long been known to cause serious infection in burn patients.
Gram negative bacteremia has been associated with a 50% increase in
predicted mortality for patients with bacteremia compared to those without
bacteremia. This is in contrast to gram positive bacteremia, which was
associated with no increase in predicted mortality. According to El-Sayed, M.,
Gomaa, M., & Abdel-Aziz, M. (2015), it was found that this increased risk of
mortality could be reversed if the occurrence of the bacteremia was delayed
which was related to a longer exposure to the effects of treatment and wound
closure. Fungal organisms, especially Candida (yeast) species and true fungi
(mold) like Aspergillus, Mucor and Rhizopus, have been associated with serious
infections in burn patients. Candida colonization appear to be primarily from
endogenous sources while true fungi are ubiquitous in the environment and
can be found in air handling and ventilation systems, plants, and soil,
Spanholtz, T. A., Theodorou, P., Amini, P., & Spilker, G. (2009).

Mode of Transmission
Modes of transmission include contact, droplet and airborne spread. According
to Nnabuko REE, Ogbonnaya IS, Otene CI et al, (2009); in burn patients the
primary mode is direct or indirect contact, either via the hands of the
personnel caring for the patient or from contact with inappropriately
decontaminated equipment. Burn patients are unique in their susceptibility to
colonization from organisms in the environment as well as in their propensity
to disperse organisms into the surrounding environment. In general, the larger
the burn injury, the greater the volume of organisms that will be dispersed into
the environment from the patient, Williams, W. (2002).

Patient Susceptibility
The patient has three principal defenses against infection: physical defenses,
nonspecific immune responses, and specific immune responses. Changes in
these defenses determine the patient’s susceptibility to infection.
In the views of Pankhurst, S. and Pochkhanawala, T. (2002), invasive devices,
such as endotracheal tubes, intravascular catheters and urinary catheters,
bypass the body’s normal defense mechanisms. In general, pediatric patients
have fewer problems with pneumonia than do adults because they are less
likely to have pre-existing lung damage. Infection from intravascular catheters
is of particular concern in burn patients, as often these lines must be placed
directly through or near burn injured tissue. Catheter associated bloodstream
infection (BSI) is caused by organisms which migrate along the catheter from
the insertion site and colonize the catheter tip. Catheter tips are also
susceptible to colonization from hematogenous seeding of organisms from the
colonized burn wound.

Prevention of Burn Wound Infection:

Williams, W. (2002) observed that, prevention of burn wound infection
involves assessment of the wound at each dressing change for changes in the
character, odor or amount of wound drainage, with immediate notification of
the physician if any deterioration occurs. Strict aseptic technique should be
used when handling the open wound and dressing materials as well as
frequency of dressing should be based on the assessment of the wound
condition. If the wound has necrotic material present, a debriding dressing
should be chosen while a protective dressing is best for clean, healing wounds.
Treatment of an existing wound infection includes consideration of a change of
the topical agent being used along with increasing the frequency of the
dressing changes. If an invasive infection is present, surgical excision of the
infected wound is usually required, as well as appropriate systemic
antimicrobial therapy.

Theoretical Review: In the opinion of the bmj on “the importance of theories

in health care’’, (2009): Medical researchers are concerned mainly with
practical factual study research. However, theories are at the heart of practice,
planning and research. All thinking involves theories because of how powerful
and influential are theories on the collected evidence, analysis and findings of
a research work. For the purpose of the subject under investigation, “Nurses
perception of causes and prevention of infection in burn wound among burn
patients in the National Orthopaedic Hospital Enugu” We will adapt the
“theory of Positivism”.
In the field of medical practice, the emphasis on specific body parts,
conditions, and treatment assumes that these are universally constant, and
replicable facts. Positivism aims to discover general laws about relations
between phenomena, particularly causes and effect. Nurses in the Burns and
Plastic Surgery unit of the National Orthopaedic Hospital who are the most
close frontline health workers to burn wound patients, whose responsibility is
basically to care for the sick patient in the hospital are often influenced by the
pains of these patients and could develop some feelings as to what else can be
done to give a relief to an excruciating pains that a burn wound patient is
passing through. Positivism is relevant to this research study because, Nurses
in the Burns and Plastic Surgery Unit of the National Orthopaedic Hospital
Enugu who are at the centre of this research study possessed clinical norms
and standard treatments that can be set for effective pain control. Nurses also
think partly in non-positivist ways to accept patients’ subjective views and see
pain as more than physical, involving the mind as well as the body. Thus, and
all of these factor could possibly informed Nurses perception about a health
challenge like causes and prevention of infection in burn patients.

Empirical Review:
Nurses who care for a patient with burn wound should be knowledgeable
about the physiologic changes that occur after a burn, as well as astute
assessment skills to detect subtle changes in the patient’s condition.
Burn injury is the result of heat transfer from one site to another.
Burns disrupt the skin, which leads to increased fluid loss; infection;
hypothermia; scarring; compromised immunity; and changes in function,
appearance, and body image, Jiburum BC, Olaitan PB,(2005).
Young children and the elderly continue to have increased morbidity
and mortality when compared to other age groups with similar injuries.
Inhalation injuries in addition to cutaneous burns worsen the prognosis.
The severity of each burn is determined by multiple factors that when assessed
help the burn team estimate the likelihood that a patient will survive and plan
for the care for each patient,
https://nurseslabs.com/wp-content/uploads/2016.
Causes of Burn Wound Infection:
Khadijah Y. A, (2016) stated that, major challenges for a burn team is
nosocomial infection in burn patients, which is known to cause over 50% of
burn deaths, and represents a serious health problem in burn wound patients.
It has been estimated that about 75% of the mortality associated with burn
injuries is related to sepsis especially in developing countries like Nigeria,
deMacedo J.L, and Santos J.B, (2005). In addition, overcrowding in burns units
is also found to be an important cause of infection in burn patients.
Classification of burn wound:
Burns are classified according to the depth of tissue destruction as superficial
partial-thickness injuries, deep partial thickness injuries, or full thickness
injuries.
Superficial partial-thickness. The epidermis is destroyed or injured and a
portion of the dermis may be injured.
Deep partial thickness. A deep partial thickness burn involves the destruction
of the epidermis and upper layers of the dermis and injury to the deeper
portions of the dermis.
Full thickness. A full thickness burn involves total destruction of the epidermis
and dermis and, in some cases, the destruction of the underlying tissue,
muscle, and bone.

Assessment and Diagnosis:

Weber, J., McManus, A., & Nursing Committee of the International Society for
Burn Injuries, (2004) described various methods used to determine the TBSA
affected by burns to include the following:
Rule of Nines: A common method, the rule of nines is a quick way to estimate
the extent of burns in adults through dividing the body into multiples of nine
and the sum total of these parts is equal to the total body surface area injured.
Lund and Browder Method: This method recognizes the percentage of surface
area of various anatomic parts, especially the head and the legs, as it relates to
the age of the patient.
Palmer Method: The size of the patient’s palm, not including the surface area
of the digits, is approximately 1% of the TBSA, and the patient’s palm without
the fingers is equivalent to 0.5% TBSA and serves as a general measurement
for all age groups.
Nursing diagnoses for burn injuries include:
Impaired gas exchange related to carbon monoxide poisoning, smoke
inhalation, and upper airway obstruction.
Ineffective airway clearance related to edema and effects of smoke inhalation.
Fluid volume deficit related to increased capillary permeability and evaporative
losses from burn wound.
Hypothermia related to loss of skin microcirculation and open wounds.
Pain related to tissue and nerve injury.
Anxiety related to fear and the emotional impact of burn injury.
Pathophysiology:
Tissue destruction results from coagulation, protein denaturation, or ionization
of cellular components.
Local response. Burns that do not exceed 20% of TBSA according to the Rule of
Nines produces a local response.
Systemic response. Burns that exceeds 20% of TBSA according to the Rule of
Nines produces a systemic response.
The systemic response is caused by the release of cytokines and other
mediators into the systemic circulation.
The release of local mediators and changes in blood flow, tissue edema, and
infection, can cause progression of the burn injury.
Statistics and Epidemiology:
A burn injury can affect people of all age groups, in all socioeconomic groups.
In the study of Pankhurst, S. and Pochkhanawala, T. (2002), an estimated 500,
000 people are treated for minor burn injury annually.
Ayodeji, O. and Jimoh, K. O,( 2010) asserted that, the number of patients who
are hospitalized every year with burn injuries are under reported, hence it is
difficult to ascertained exact numbers of cases. Although by estimation, more
than 40, 000, including 25, 000 people who require hospitalization in
specialized burn centers across the country.
The remaining 5, 000 hospitals see an average of three burns per year.
Of those people admitted in burn centers, , 47% of their injuries occurred at
home, 27% on the road, 8% are occupational, 5% are recreational, and the
remaining 13% from other sources.
40% of these injuries are flame related, 30% scald injuries, 4% electrical, 3%
chemical, and the remaining unspecified.
Males have greater than twice the chance of burn injury than women.
The most frequent age group for contact burns is between 20 to 40 years of
age.
The National Fire Protection Association reports 4, 000 fire and burn deaths
each year.
Of the 4,000, 3, 500 deaths occur from residential fires and the remaining 500
from other sources such as motor vehicle crashes, scalds, or electrical and
chemical sources.
The overall mortality rate, for all ages and for total body surface area burned is
4.9%.
Clinical Manifestation:
The changes that occur in burns include the following:
Hypovolemia. This is the immediate consequence of fluid loss and results in
decreased perfusion and oxygen delivery.
Decreased cardiac output. Cardiac output decreases before any significant
change in blood volume is evident.
Edema. Edema forms rapidly after burn injury.
Decreased circulating blood volume. Circulating blood volume decreases
dramatically during burn shock.
Hyponatremia. Hyponatremia is common during the first week of the acute
phase, as water shifts from the interstitial space to the vascular space.
Hyperkalemia. Immediately after burn injury hyperkalemia results from
massive cell destruction.
Hypothermia. Loss of skin results in an inability to regulate body temperature.

Complications:
There are a lot of consequences involved in burn injuries that may progress
without treatment.
Ischemia. As edema increases, pressure on small blood vessels and nerves in
the distal extremities causes an obstruction of blood flow.
Tissue hypoxia. Tissue hypoxia is the result of carbon monoxide inhalation.
Respiratory failure. Pulmonary complications are secondary to inhalational
injuries.
Medical Management:
Burn care is a delicate task any nurse can have and being knowledgeable in
the proper sequencing of the interventions is very essential.
Transport. The hospital and the physician are alerted that the patient is en
route so that life-saving measures can be initiated immediately.
Priorities. Initial priorities in the ED remain airway, breathing, and circulation.
Airway. 100% humidified oxygen is administered and the patient is encouraged
to cough so that secretions can be removed by coughing.
Chemical burns. All clothing and jewelry are removed and chemical burns
should be flushed.
Intravenous access. A large bore (16 or 18 gauge) IV catheter is inserted in the
non-burned area.
Gastrointestinal access. If the burn exceeds 20% to 25% TBSA, a nasogastric
tube is inserted and connected to low intermittent suction because there are
patients with large burns that become nauseated.
Clean beddings. Clean sheets are placed over and under the patient to protect
the burn wound from contamination, maintain body temperature, and reduce
pain caused by air currents passing over exposed nerve endings.
Fluid replacement therapy. The total volume and rate of IV fluid replacement is
gauged by the patient’s response and guided by the resuscitation formula.

Nursing Management:
Nursing management in burn care requires specific knowledge on burns so
that there could be a provision of appropriate and effective interventions.
Nursing Assessment and Perception:
The nursing assessment and perception focuses on the major priorities for any
trauma patient; the burn wound is a secondary consideration, although
aseptic management of the burn wounds and invasive lines continues.
Assess circumstances surrounding the injury. Time of injury, mechanism of
burn, whether the burn occurred in a closed space, the possibility of inhalation
of noxious chemicals, and any related trauma.
Monitor vital signs frequently. Monitor respiratory status closely; and evaluate
apical, carotid, and femoral pulses particularly in areas of circumferential burn
injury to an extremity.
Start cardiac monitoring if indicated. If patient has history of cardiac or
respiratory problems due to electrical injury. Check peripheral pulses on
burned extremities hourly; use Doppler as needed.
Monitor fluid intake (IV fluids) and output (urinary catheter) and measure
hourly. Note amount of urine obtained when catheter is inserted (indicates
preburn renal function and fluid status).
Obtain history. Assess body temperature, body weight, and history of pre-
burn weight, allergies, tetanus immunization, past medical surgical problems,
current illnesses, and use of medications.
Arrange for patients with facial burns to be assessed for corneal injury.
Continue to assess the extent of the burn; assess depth of wound, and identify
areas of full and partial thickness injury.
Assess neurologic status: consciousness, psychological status, pain and anxiety
levels, and behavior.
Assess patients and family’s understanding of injury and treatment. Assess
patient’s support system and coping skills.

Nursing Care and Prevention of burn wound infection:

Provide a clean and safe environment; protect patient from sources of cross
contamination (e.g., visitors, other patients, staff, and equipment).
Closely scrutinize wound to detect early signs of infection.
Monitor culture results and white blood cell counts.
Practice clean technique for wound care procedures and aseptic technique for
any invasive procedures. Use meticulous hand hygiene before and after
contact with patient.
Caution patient to avoid touching wounds or dressings; wash unburned areas
and change linens regularly.
Maintaining Adequate Nutrition. Initiate oral fluids slowly when bowel sounds
resume; record tolerance—if vomiting and distention do not occur, fluids may
be increased gradually and the patient may be advanced to a normal diet or to
tube feedings.
Collaborate with dietitian to plan a protein and calorie-rich diet acceptable to
patient. Encourage family to bring nutritious and patient’s favorite foods.
Provide nutritional and vitamin and mineral supplements if prescribed.
Document caloric intake. Insert feeding tube if caloric goals cannot be met by
oral feeding (for continuous or bolus feedings); note residual volumes.
Weigh patient daily and graph weights.
Promoting Skin Integrity.
Assess wound status.
Support patient during distressing and painful wound care.

Coordinate complex aspects of wound care and dressing changes. Assess burn
for size, color, odor, eschar, exudate, epithelial buds (small pearl-like clusters
of cells on the wound surface), bleeding, granulation tissue, the status of graft
take, healing of the donor site, and the condition of the surrounding
skin; report any significant changes to the physician.
Inform all members of the health care team of latest wound care procedures
used for the patient.
Assist, instruct, support, and encourage patient and family to take part in
dressing changes and wound care.
Early on, assess strengths of patient and family in preparing for discharge and
home care.
Relieving Pain and Discomfort. Frequently assess pain and discomfort;
administer analgesic agents and anxiolytic medications, as prescribed, before
the pain becomes severe. Assess and document the patient’s response to
medication and any other interventions.
Teach patient relaxation techniques. Give some control over wound care and
analgesia. Provide frequent reassurance.
Use guided imagery and distraction to alter patient’s perceptions and
responses to pain; hypnosis, music therapy, and virtual reality are also useful.
Assess the patient’s sleep patterns daily; administer sedatives, if prescribed.
Work quickly to complete treatments and dressing changes.
Encourage patient to use analgesic medications before painful procedures.
Promote comfort during healing phase with the following: oral antipruritic
agents, a cool environment, frequent lubrication of the skin with water or a
silica-based lotion, exercise and splinting to prevent skin contracture, and
diversional activities.
Promoting Physical Mobility. Prevent complications of immobility (atelectasis,
pneumonia, edema, pressure ulcers, and contractures) by deep breathing,
turning, and proper repositioning.
Modify interventions to meet patient’s needs. Encourage early sitting and
ambulation. When legs are involved, apply elastic pressure bandages before
assisting patient to upright position.
Make aggressive efforts to prevent contractures and hypertrophic scarring of
the wound area after wound closure for a year or more.
Initiate passive and active range-of-motion exercises from admission until after
grafting, within prescribed limitations.
Apply splints or functional devices to extremities for contracture control;
monitor for signs of vascular insufficiency, nerve compression, and skin
breakdown.
Strengthening Coping Strategies. Assist patient to develop effective coping
strategies: Set specific expectations for behavior, promote truthful
communication to build trust, help patient practice coping strategies, and give
positive reinforcement when appropriate.
Demonstrate acceptance of patient. Enlist a non-involved person for patient
to vent feelings without fear of retaliation.
Include patient in decisions regarding care. Encourage patient to assert
individuality and preferences. Set realistic expectations for self-care.
Supporting Patient and Family Processes. Support and address the verbal and
nonverbal concerns of the patient and family.
Instruct family in ways to support patient.
Make psychological or social work referrals as needed.
Provide information about burn care and expected course of treatment.
Initiate patient and family education during burn management. Assess and
consider preferred learning styles; assess ability to grasp and cope with the
information; determine barriers to learning when planning and executing
teaching.
Remain sensitive to the possibility of changing family dynamics.
Monitoring and Managing Potential Complications. Heart failure: Assess for
fluid overload, decreased cardiac output, oliguria, jugular vein distention,
edema, or onset of S3 or S4 heart sounds. Pulmonary edema: Assess for
increasing CVP, pulmonary artery and wedge pressures, and crackles; report
promptly. Position comfortably with head elevated unless contraindicated.
Administer medications and oxygen as prescribed and assess response. Sepsis:
Assess for increased temperature, increased pulse, widened pulse pressure,
and flushed, dry skin in unburned areas (early signs), and note trends in the
data. Perform wound and blood cultures as prescribed, Uba AFF, Edino ST,
Yakubu AA, (2007).
Give scheduled antibiotics on time. Acute respiratory failure and acute
respiratory distress syndrome (ARDS): Monitor respiratory status for
dyspnea, change in respiratory pattern, and onset of adventitious sounds.
Assess for decrease in tidal volume and lung compliance in patients on
mechanical ventilation. The hallmark of onset of ARDS is hypoxemia on 100%
oxygen, decreased lung compliance, and significant shunting; notify
physician of deteriorating respiratory status.
Visceral damage (from electrical burns): Monitor electrocardiogram (ECG) and
report dysrhythmias; pay attention to pain related to deep muscle ischemia
and report. Early detection may minimize severity of this complication.
Fasciotomies may be necessary to relieve swelling and ischemia in the muscles
and fascia; monitor patient for excessive blood loss and hypovolemia after
fasciotomy.
Contractures: Provide early and aggressive physical and occupational therapy;
support patient if surgery is needed to achieve full range of motion.
Impaired psychological adaptation to the burn injury: Obtain psychological or
psychiatric referral as soon as evidence of major coping problems appears.
Promoting Activity Tolerance: Schedule care to allow periods of uninterrupted
sleep. Administer hypnotic agents, as prescribed, to promote sleep.
Communicate plan of care to family and other caregivers.
Reduce metabolic stress by relieving pain, preventing chilling or fever, and
promoting integrity of all body systems to help conserve energy. Monitor
fatigue, pain, and fever to determine amount of activity to be
encouraged daily. Incorporate physical therapy exercises to prevent
muscular atrophy and maintain mobility required for daily activities. Support
positive outlook, and increase tolerance for activity by scheduling diversion
activities in periods of increasing duration.
Improving Body Image and Self-Concept. Take time to listen to patient’s
concerns and provide realistic support; refer patient to a support group to
develop coping strategies to deal with losses.

Assess patient’s psychosocial reactions; provide support and develop a plan

to help the patient handle feelings. Promote a healthy body image and self-
concept by helping patient practice responses to people who stare or
ask about the injury. Support patient through small gestures such as providing
a birthday cake, combing patient’s hair before visitors, and sharing information
on cosmetic resources to enhance appearance. Teach patient ways to direct
attention away from a disfigured body to the self within. Coordinate
communications of consultants, such as psychologists, social workers,
vocational counselors, and teachers, during rehabilitation.
Teaching Self-care. Throughout the phases of burn care, make efforts to
prepare patient and family for the care they will perform at home. Instruct
them about measures and procedures. Provide verbal and written instructions
about wound care, prevention of complications, pain management,
and nutrition.
Inform and review with patient specific exercises and use of elastic pressure
garments and splints; provide written instructions.
Teach patient and family to recognize abnormal signs and report them to the
physician.
Assist the patient and family in planning for the patient’s continued care by
identifying and acquiring supplies and equipment that are needed at home.
Encourage and support follow-up wound care. Refer patient with inadequate
support system to home care resources for assistance with wound care and
exercises. Evaluate patient status periodically for modification of home care
instructions and/or planning for reconstructive surgery.
Evaluation
In a patient with burn injury, the expected outcomes are:
 Absence of dyspnea.
 Respiratory rate between 12 and 20 breaths/min.
 Lungs clear on auscultation,
  Arterial oxygen saturation greater than 96% by pulse oximetry.
 ABG levels within normal limits.
 Patent airway
 Respiratory secretions are minimal, colorless, and thin.
 Urine output between 0.5 and 1.0 mL/kg/h.
 Blood pressure higher than 90/60 mmHg.
 Heart rate less than 120 bpm.
 Body temperature remains between 36.1ºC and 38.3ºC

CHAPTER THREE

RESEARCH METHODOLOGY

Introduction:
This Chapter presents and discusses the methodology adopted for the study. It
specifically consist of the research design, settings, target population of the
study, sample and sampling techniques, method of data for the study,
instruments adopted for data collection, method of data analysis, validity and
reliability of the instrument utilised for analyses of the data.

Research design:
The research design for this research study is the survey research design. The
study examined primarily Nurses perception of causes and prevention of burn
wound infection among burn patients in National Orthopaedic Hospital Enugu.
Questionnaire instrument was constructed and distributed to selected study
sample to elicit data. The questionnaire was also complemented with guided
interviews; the responses gathered were analysed using descriptive statistics,
and based on the findings, conclusion were drawn and recommendation made.

Research Settings: This study has National Orthopaedic Hospital Enugu and
the Burn and Plastic Surgery Unit as the setting. The Nursing care services to
burn patients admitted in the hospital also formed part of the study’s research
setting.
Target Population of the Study: The population of the study consist of all
Nurses in the Burns and Plastic Surgery Unit in National Orthopaedic Hospital
Enugu. The total valid population size for the study was Sixty (60) Nurses.

Sample and Sampling Techniques: This sampled Sixty (60) respondents made
of Nurses providing health care services to burn patients in the Burns and
Plastic Surgery Unit in National Orthopaedic Hospital Enugu. The Sixty Nurses
were selected based on the requisite experiences they acquired over a long
period of time in the Burns and Plastic Surgery Unit. The Nurses were furthered
stratified into two categories: General Nursing & Midwifery (GNM) and
Bachelor of Science in Nursing BSN.

Method of Data for the Study:

This study sourced data from both primary and secondary sources.
Primary source of data were collected via questionnaire administered and
interview conducted by the researcher on the selected study sample.
Secondary source of data consist of information obtained from Textbooks,
Journals, and internet publications.
Two instruments were used for the purpose of data collection: Questionnaire
and Interview. The questionnaire was designed on the Likert Scale basis in a
range of 4-1 (4points), with 4 denoting Strongly Agree (SA), 3 as Agree (A), 2 as
Disagree (D), 1 as Strongly Disagree ( SD). A total of 60 questionnaires were
administered. Personal interview was employed in the data collection process
where some senior nurses who were the unit-in-charge of the Burns and
Plastic Surgery in National Orthopaedic Hospital Enugu were interviewed to
probe into some issues raised on the questionnaire. The interview conducted
was therefore an additional tool to the questionnaire in the data collection
process.

Validity of Instrument: In the views of Oyesola (2007), validity of instrument is

necessary because the measuring tools sometimes do not measure what they
are supposed to measure. A measuring instrument is only taken to be valid and
reliable when it truly and accurately measured what supposed to be measured.

Reliability of Instrument: According to www.scribbr.com>methodology,

(2019), reliability refers how consistently a method measures something. If the
same result can be consistently achieved by using the same method under the
same circumstances, the measurement is considered reliable. For instance,
measurement of temperature of a burn patient several times and obtaining
same result.

Method of Data Analysis for the Study:

Simple percentage statistics, mean, mode and median were used to analyse
the study data. Measures of descriptive estimate like the range, standard
deviation and variance were also utilized in order to measure the degree of
variability of the sample responses. The relevant formulae applied were:

MEAN =
Where: X = Value of observation
n = Number of observation.
∑ = Summation

MODE =

Mode =

Range = L –S
Where:
L = Largest observation

S= Smallest observation

VARIANCE (S2) AND STANDARD DEVIATION (S)

Where: X = Value of the observation

N= Number of observation

∑= Summation

The descriptive statistics employed for analysing the study data was consistent
with Oyesola (2007). The difference however, in the use of the technique by
this study was that, apart from utilizing the mean, mode, median, variance and
standard deviation, percentage was use to explain the study results.
Simple percentage was adopted for the study because of its ability to show
comparative difference of samples, while the use of mean, variance and
standard deviation was because of being good measures of central tendency.
 QUESTIONNAIRE
SECTION-A: (DEMOGRAPHIC DATA)
1. Sex: Male [ ] Female [ ]
2. Age Distribution: A. 20- 25 [ ] B. 25-35 [ ] C. 35-45 [ ] D. 45-55 [ ]
E. 55 and above [ ]
3. Qualification: General Nursing & Midwifery (GNM) [ ]
Bachelor of Science in Nursing (BSN) [ ]

1. Years of Experience in Burn and Plastic Surgery Unit:

A. 0-5years [ ] B. 5-10years [ ] C. 10-15years [ ]
A. 15-20years [ ] E. 20-25years [ ] F. 30years and above [ ]

SECTION-B: (TOPICAL ISSUES)

SN VARIABLES RESPONSES
STRONGLY AGREE DISAGREE STRONGLY
AGREE 4 3 2 DISAGREE
1
5 Nurses [ ] [ ] [ ] [ ]
perceived that
most common
causes of burn
wound
infections
were bacteria,
yeast,
filamentous
fungi and
viruses.
6 Topical [ ] [ ] [ ] [ ]
antimicrobials
 for prevention
and treatment
of burn
wound
infection
include
mafenide
acetate, silver
sulfadiazine,
silver nitrate
solution, and
silver-
impregnated
dressing.
7 Nurses’ [ ] [ ] [ ] [ ]
practices on
prevention of
burn wound
infection
include good
hygiene,
removal of
unnecessary
intravascular
catheters or
urinary
catheters and
environmenta
l infection
control.
8 Effective [ ] [ ] [ ] [ ]
control
measures
taken during
the care of a
burn patient
include
physical
isolation in a
private room,
 use of gloves
and gowns
and
appropriate
empirical
antimicrobial
therapy
9 Nursing Care [ ] [ ] [ ] [ ]
Plan for burn
patient is
made up of
Impaired
Physical
Mobility,
Deficient
Knowledge,
Disturbed
Body Image,
Fear/Anxiety,
Impaired Skin
Integrity,
Imbalance
Nutrition, Risk
for Ineffective
Tissue
Perfusion,
Acute Pain,
Risk for
Infection, Risk
for Deficient
Fluid Volume
and Risk for
Ineffective
Airway
Clearance.
 CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND DISCUSSION
Introduction
This chapter presents the description, analysis and interpretation of the data
collected for this study. This involves the application of statistical techniques to
provide the basis for answering the research questions. The first part starts
with the preliminary analysis by describing the data using frequency table.
Thereafter, item response analysis was done through interpreting mean,
median, variance, standard deviation in order to answer the research
questions.
Description of the Data
In this section, the data collected through survey instrument was described
according to the study’s research questionnaire items.
SECTION 1: Demographic and Practice Characteristics of Studied Sample (N=
60)
Table 1 below describe demographic and practice characteristics of
respondents (Nurses working in the Burn and Plastic Surgery Unit of the
National Orthopeadic Hospital Enugu (NOHE) which include Gender, Age,
Qualification and years of Experience.
Table 1: Demographic and Practice Characteristics of Nurses in Burn & Plastic
Surgery Unit, NOHE.
Variables Frequency Percentage %
Gender:
Male 20 33.3
Female 40 66.7
Total 60 100
Age:
20-25yrs 10 16.7
25-35yrs 30 50
35-45yrs 15 25
 45-55yrs 5 8.3
55yrs & above 0 0
Total 60 100
Qualifications:
General Nursing & 35 58.3
Midwifery(GNM)
Bachelor of Science in 25 41.7
Nursing (BSN)
Total 60 100
Years of
Working
Experience in Burn &
Plastic Surgery Unit :
0-5yrs 13 21.7
5-10yrs 20 33.3
10-15yrs 15 25
15-20yrs 7 11.7
20-25yrs 5 8.3
25yrs & above 0 0
Total 60 100
Source: Field Survey, 2020

SECTION 2: (TOPICAL ISSUES)

Nurses’ perception of the causes of burn wound
Table 2 presented descriptive information in percentage on questionnaire item
one which stated that nurses perceived that most common causes of burn
wound infections were bacteria, yeast, filamentous fungi and viruses.
Table 2: Nurses’ perception of the causes of burn wound
Freq. Percent Cum.
Agree 15 25.00 25.00
Strongly Agree 45 75.00 100.00
Total 60 100.00
Source: Field Survey, 2020
As seen in table 2, 15 of the respondents comprises 25% agreed that common
causes of burn wound infections are bacteria, yeast, filamentous fungi and
viruses. While, 45 of the respondents which comprises 75% strongly agreed.
More than 50% of the respondents strongly assert that the common cause of
burn wound infections are bacteria, yeast, filamentous fungi and viruses.
Nurses prevention of burn wound infection among burn patients
The second statement item on the questionnaire made a statement on
methods prevention and treatment burn wound infection as presented Table 3
below:

Table 3: Prevention and treatment of burn wound infections

Freq. Percent Cum.
Strongly Disagree 2 3.33 3.33
Disagree 5 8.33 11.67
Agree 13 21.67 33.33
Strongly Agree 40 66.67 100.00
Total 60 100.00
Source: Field Survey, 2020
Table 3 above showed that two (3.33%) of the respondents strongly disagreed
with listed methods of prevention and treatment of burn wound infections -
mafenide acetate, silver sulfadiazine, silver nitrate solution, and silver-
impregnated dressing. Five (8.33%) respondents disagreed. 13 (21.67%) agreed
and 40 (66.67%) of the respondents strongly agreed with the methods. Most of
the respondents strongly agreed that mafenide acetate, silver sulfadiazine,
silver nitrate solution, and silver-impregnated dressing are the common
methods of burn wound infections prevention and treatment.
Prevention of Burn Wound Infection
The table 4 below presented description on burn wound infections prevention
practices. It is revealed in the table 4 that 2 (3.33%) of the respondents
disagreed with good hygiene, removal of unnecessary intravascular catheters
or urinary catheters and environmental infection control as nurses’ practice
burn wound infections. However, 13 (21.67%) of the respondents agreed with
the mentioned nurses’ practice of burn wound infections preventive measures.
Table 4: Nurses’ Practice of Burn Wound Infection Prevention
Freq. Percent Cum.
Disagree 2 3.33 3.33
Agree 13 21.67 25.00
Strongly Agree 45 75.00 100.00
 Total 60 100.00
Source: Field Survey, 2020
Furthermore, 45 (75.00%) of the respondents strongly agreed that the
aforementioned practices are the best practices of burn wound infection
preventive measures. Most of the respondents agreed with good hygiene,
removal of unnecessary intravascular catheters or urinary catheters and
environmental infection control as nurses’ practice of burn wound infections
prevention.
Control Measures Taken During the Care of a Burn Patient
Item 4 on the questionnaire solicited responses on the control measures taken
during care for patients with burn wound. Table 5 below presented the
description of the data collected.
Table 5: Control Measures in Caring for Burn Wound Patient
Freq. Percent Cum.
Disagree 5 8.33 8.33
Agree 15 25.00 33.33
Strongly Agree 40 66.67 100.00
Total 60 100.00
Source: Field Survey, 2020
As it can be seen from table 5, 8.33% (5) of the respondents disagreed with the
statement that physical isolation in a private room, use of gloves and gowns
and appropriate empirical antimicrobial therapy are among the control
measures usually taken while caring for burn wound patients. However, 25%
(15) of the respondents at least agreed, while 66.67% (40) of the respondents
strongly agreed with the stated control measures taking during caring for
patients with burn wound.
Nursing Care Plan for Burn Patients
Nursing care plan for burn wound patients addresses complete care and
control measures to ensure faster, infection free and complete cure. The
question statement number 5 outlined in statement form some of the key care
plan points to include plan for: impaired physical mobility, deficient
knowledge, disturbed body image, fear/anxiety, impaired skin integrity,
imbalance nutrition, risk for ineffective tissue perfusion, acute pain, risk for
infection, the risk for deficient fluid volume and risk for ineffective airway
clearance. Table 6 presented the description of the respondents’ perception on
the care plan items.
Table 6: Care Plan for Patients with Burn Wound
Freq. Percent Cum.
Disagree 1 1.67 1.67
Agree 19 31.67 33.33
Strongly Agree 40 66.67 100.00
Total 60 100.00
Source: Field Survey, 2020
Only 1.67% (1) disagreed with the basic outlined care plan items for treating
and managing patients with burn wound. However, 31.67% of respondents
agreed and 66.67 (40) of the respondents strongly agreed that the listed plan
items as basic care points for patients with burn wound.

Data Analysis
In this section, the analysis of the collected data to achieve the objective of the

study are presented in table 7. The analysis was done according to the

respective research questions which were directly ask from the objectives of

the study.

Table 7: Mean estimation

Mean Median Variance St.Dev. Skew Kurt

Q1 3.750 4 .191 .437 -1.155 2.333
Q2 3.517 4 .627 .792 -1.605 4.816
Q3 3.717 4 .274 .524 -1.651 4.831
Q4 3.583 4 .417 .645 -1.267 3.412
Q5 3.650 4 .265 .515 -1.000 2.794
Number of observation = 60
Source: Field Survey, 2020
Observing from table 7 Q1 represents responses of Nurses’ perception of the
causes of burn wound infection. The responses were solicited through
questionnaire item 1 which directly answers research question 1. The mean
score of 3.75 signifies the most of the respondents agreed an. The variance
(0.191) and standard deviation (0.437) means that which are both small
compared to the mean signifies that responses are not far from the median (4).
The skewness and kurtosis value -1.155 and 2.333 respectively indicated that
most of the responses are not dispersed from the mean. Therefore, based on
the information in table 4.6 Q1, the study concluded that the common causes
of burn wound infections as perceived by nurses are bacteria, yeast,
filamentous fungi and viruses.
Row 3 (Q2) in table 7 assessed the perception of nurses on the topical
antimicrobials for prevention and treatment of burn wound infection. The
mean value of the responses is 3.517 with standard deviation value of 0.437
means the perception of the respondents was not from each other. In further
confirmation, the variance 0.627 which is least the means also means that
there was less differences among perception of the respondents. The skewness
value of -1.607 revealed that the responses are largely clustered on the left-
hand side of the distribution. Since the median was 4 which represents
strongly agreed, further revealed that more than half of the respondents
agreed with the statement 2 on the questionnaire. Hence, it is sufficing to
conclude that nurses agreed that mafenide acetate, silver sulfadiazine, silver
nitrate solution, and silver-impregnated dressing are most common topical
antimicrobials for prevention and treatment of burn wound infections.
The study also assessed the common practices on prevention of burn wound
infections. The score of 3.717 for Q3 in table 7 with the standard deviation of
0.524 indicated that most of the respondents agreed with the statement
number 3 on the questionnaire. The small standard deviation value signifies
that most of the respondent’s perception are closer to each other. Skewness
value of -1.651 means that the data collected for item 3 on the questionnaire
are clustered on the left-hand side of the data distribution. The kurtosis value
of 4.816 revealed that the responses are heavily clustered around the mean.
Based on the information in table 7 for Q3, it can be concluded that the
common practices of prevention of burn wound infections among nurses
includes good hygiene, removal of unnecessary intravascular catheters or
urinary catheters and environmental infection control.
Furthermore, the study solicited the perception of nurse on effective control
measures taken during caring for patients with burn wound. The responses
questionnaire item 4 are presented in table 7 row 5 which is represented by
Q4. The mean score 3.583 which is close to median 4 for the responses showed
that most of the respondents agreed with statement item 4 on the
questionnaire. The variance and standard deviation score 0.417 and 0.645
respectively indicates that perception of the nurses is closer to each other.
Skewness value of -1.267 revealed that the distribution of responses is
clustered or skewed to the left-hand side of the distribution plot. Meanwhile,
the kurtosis value of 3.412 indicated that most of the responses scored the
value 4 on the scale. Therefore, the study deduced its conclusion that nurses
perceived that physical isolation in a private room, use of gloves and gowns
and appropriate empirical antimicrobial therapy are appropriate and the most
effective control measures taken when caring for patients with burn wound.
The last perception of the nurses the study assessed is care plan for burn
wound patients. The questionnaire statement 4 solicited respondents rating of
their perception of the items that must be included on care plan for patients
with burn wound. The mean value of their responses is 3.650 with standard
deviation of 0.515. This implies that most of the responses are closer to the
mean. This is further buttress by the median score 4 and variance score of
0.265, indicating that only few responses disperse from the mean score. The
skewness score of -1.00 also revealed how closer to the mean are the
responses on one side, where the kurtosis score of 2.794 supported the fact
that responses was not dispersed from the mean and media. The study
therefore concludes that impaired physical mobility, deficient knowledge,
disturbed body image, fear/anxiety, impaired skin integrity, imbalance
nutrition, risk for ineffective tissue perfusion, acute pain, risk for infection, risk
for deficient fluid volume and risk for ineffective airway clearance are
important elements that made up care plan for caring for patients with burn
wound.
 CHAPTER FIVE

SUMMARY, CONCLUSIONS AND RECOMMENDATIONS

Summary

This research study is made up of five chapters, chapter one forms the
introduction to the study. In the chapter, it was posited that treatment for
burn patients and prevention of infections depends on the cause, depth, and
surface area of burn injury. Treatment on basis of depth of burn includes many
different approaches such as wound debridement, application of the modern
hydrocolloid; silicone dressings and chlorhexidine coated conventional
dressings for superficial burn. However, deep dermal burn treatment protocol
involve different dressings which stimulate epithelialization and many grafting
procedures. Also Nurses perceived that, most of burn wound infections
eventually cause morbidity and mortality of burn patients can become very
challenging matter for burn team.

Chapter two was devoted to literature review. Relevant literatures on the

subject matter were reviewed. Specifically, the review of various causes of
burn wound infection, treatment and preventive measures. A theoretical
framework for study was the theory of Positivism which aims at discovering
general laws about relations between phenomena, particularly causes and
effect. Empirical review were basically on studies done on the Nurses
management of burn cases and their perception on the causes of burns
wound infection and prevention.
Chapter three presented the methodology. The research design was the survey
type. The population of the study was identified to be made up of Nurses in
the Burns and Plastic Surgery Unit in National Orthopaedic Hospital Enugu. The
total valid population size for the study was Sixty (60) Nurses. The population
was further sampled into two, Nurses with General Nursing and Midwifery
(GNM) and Bachelor of Science in Nursing (BSN) qualifications. Data were
collected by the use of questionnaire, while Simple percentage statistics,
mean, mode and median were used to analyse the study data. Measures of
descriptive estimate like the range, standard deviation and variance were also
utilized in order to measure the degree of variability of the sample responses.

In chapter four, the analysis of the study data collected from the questionnaire
administered shows that Nurses perceived common causes of burn wound
infections to be associated with bacteria, yeast, filamentous fungi and viruses;
and Nursing care plan for burn wound patients addresses complete care and
control measures to ensure faster, infection free and complete cure.

Chapter five which is the last chapter of the research study summaries the
entire study, draw relevant conclusions and recommendations that could
ensure Burns and Plastic Surgery Unit of the National Orthopeadic Hospital
Enugu (NOHE) and other Burns care unit facilities to effectively manage burn
wound cases.

Conclusion:
Based on the findings of the study, it is concluded that nurses working in Burn
and Plastic Surgery Unit of the National Orthopeadic Hospital Enugu (NOHE)
have the perception that common causes of burn wound infections to be
associated with bacteria, yeast, filamentous fungi and viruses; and Nursing
care plan for burn wound patients addresses complete care and control
measures to ensure faster, infection free and complete cure. Hence practices
regarding prevention of Infections among burn patients must be strictly
observed. Therefore, hospitals are required to organize adequate trainings and
to develop unit specific clinical infection control guidelines and protocols.
Suggested Nursing Guidelines for burn patients
Based on the study findings and pre-mentioned discussion, the present study
recommends following guidelines:-
Isolation Guidelines
 Standard precautions should be applied when care is provided to all patients
with burn injury.

 Appropriate barrier garb (clean gowns, gloves & plastic aprons) is

recommended for any burn patient during contact.

 Standard precautions also include appropriate hand washing.

 Proper removal of PPE after providing care to patients.

 Gloves should be change when they contaminated with body fluids of the
patient and before starting another nursing procedure.

 Use sterile equipment along with wearing gloves, caps and masks when
dealing with open burn wounds or other invasive procedures.

 Appropriate decontamination of equipment and surfaces should be before

storage or use on other patients and proper barrier grab should also worn
during decontamination of equipment.

Need Specific Precautions:

 Specific group of burn patients are distinctive and demand extra precautions
such as patients with larger burn injury greater than 25% to 30 % TBSA and
those identified with multi resistant organisms (MDR).

 These patients should be placed in isolated cabins or other enclosed areas to

ensure physical separation because their contaminated wounds becomes a
huge source for transmission of organisms by spreading them in the
surrounding environment.

Environmental Issues:

 Surrounding environment can be source of resistant organisms so prohibited

items should not allowed in burn units such as flowers and pets.

Sites of Infection and Prevention Techniques

Burn Wound Infection:

 Regular assessment of burn wound help in early identification of

deterioration in the character, odour or amount of wound drainage.
 Strict aseptic technique should be applied during dressing of open wounds of
burn.

 Twice a daily chlorhexidine bath is recommended in burn patients.

 If necrotic tissue develops over wounds, a debriding dressing should be

applied.

Prevent Intravenous infection

 Personal protective equipment should be used correctly and select site away
from wound.

 Maintained hand hygiene before and after the procedure.

 Cleaned the skin at the site of entry with antiseptic swab and used a circular
motion, moving from the centre outward
 Permitted solution to dry on the skin
 Use a no-touch technique for any part of the needle or cannula.

 Checked any leakage or damage or contaminated before insertion.

 Apply transparent dressing after insertion.

 Label the dressing with the date and time of insertion.

Suggestion for Further Study:

Infections of burn sites are very dangerous problems that can compromise the
patient’s survival and the outcome of reconstructive treatment. This Study only
examined Nurses perception of causes and prevention of burn wound infection
among burn patients. Further research may focus on issues of
Hygiene of the Patient and Patient’s relatives and other approaches such as
modification of hospital environment as measure to increase control of the
causes of burn wound infections.
Abstract:
Burns are one of the most common and devastating forms of trauma. Patients with serious
thermal injury require immediate specialized care in order to minimize morbidity and
mortality. Significant thermal injuries induce a state of immunosuppression that predisposes
burn patients to infectious complications. The major objective of this study was to examine N
To assess nurses’ knowledge and evaluate their practice for prevention of infection among
burn patients, also to suggest guidelines especially of nursing practice for prevention of
infection in burn patients. Study Design: A descriptive cross sectional study. Place and
Duration: Six months, from June, 2020 to November, 2020, in burn units of 03 selected
hospitals of Lahore. Methods: The study included all nurses who were providing care to burn
patients (N=60). Nurses’ knowledge was assessed by using a self-structured questionnaire
and their practices were evaluated by direct monitoring using an observational Checklist.
Results: Females constituted 100% of study participants. 62.5% of nurses had a GNM whilst
37.5 % had a Nursing degree. 73% (35) of participants had less than 2 years of experience
working in the Burns Unit. Knowledge regarding infection control was received by 89% of
nurses but their source of information was practice not in-service educational programs.
Consequently they had unsatisfactory level of knowledge and practices indicated by
knowledge and practice score less than 75%. Conclusion: The findings of the current study
revealed nurses’ low level of knowledge and practices. Hence, healthcare settings are
required to organize advanced training sessions and to develop unit specific clinical
guidelines and protocols.
Keywords: Burn, Nurses, infection control, Knowledge, Practice.
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Enugu, Nigeria - aetiology and prevention. A six-year retrospec-

tive review (January 2000-December 2005). Ann Burns Fire Dis-
asters, 22: 40-3, 2009
Enugu, Nigeria - aetiology and prevention. A six-year retrospec-
tive review (January 2000-December 2005). Ann Burns Fire Dis-
asters, 22: 40-3, 2009

Enugu, Nigeria - aetiology and prevention. A six-year retrospec-

tive review (January 2000-December 2005). Ann Burns Fire Dis-
asters, 22: 40-3, 2009