Modifying burn care in a low- and middle-income countries (LMIC) to meet global best practice: A burn unit or burn isolation ward?

Abstract

The overwhelming burden of burns in low-income (LIC) and low-middle-income (LMIC) countries has been well-documented. Though best global practice is for major burns to be treated in burn units, the prohibitive cost makes it difficult. In this article we attempt to present the improvement in outcome recorded over a period of 3 years as we transitioned from nursing our burns patients in the general surgical wards (Group A), then a separate cubicle within the wards (Group B) and then an isolated burn ward (Group C). Other practices such as physiotherapy, traditional wound dressings, and limb splinting remained the same.

Data of patients who met criteria for burn unit admission during these periods were analysed and compared. The groups were matched across age, depth of burn, total body surface area burned (TBSA) and length of hospital stay (LOHS). There was an improvement in the lethal area 50% (LA50) at 31.1 %, and in mean LOHS of 18 ± 3.8 days in group C.

Most LICs and LMICs do not have functional health insurance schemes for burns patients and overall resources allocated for healthcare cannot support a state-of-the-art burn unit. Our report attempts to encourage such countries to adapt global practice to their economic reality. Minimal changes like an isolated burn ward, separate shower room for wound dressings, strict hygiene practices, and limiting visitor traffic may go a long way to improve burn patient outcome.