title: Airborne bacterial dispersal during and after dressing and bed changes on burns patients.
abstract: BACKGROUND
  It is acknowledged that activities such as dressing changes and bed sheet changes are high-risk events; creating surges in levels of airborne bacteria. Burns patients are particularly high dispersers of pathogens; due to their large, often contaminated, wound areas. Prevention of nosocomial cross-contamination is therefore one of the major challenges faced by the burns team. In order to assess the contribution of airborne spread of bacteria, air samples were taken repeatedly throughout and following these events, to quantify levels of airborne bacteria.
  
  
  METHODS
  Air samples were taken at 3-min intervals before, during and after a dressing and bed change on a burns patient using a sieve impaction method. Following incubation, bacterial colonies were enumerated to calculate bacterial colony forming units per m(3) (cfu/m(3)) at each time point. Statistical analysis was performed, whereby the period before the high-risk event took place acted as a control period. The periods during and after the dressing and bed sheet changes were examined for significant differences in airborne bacterial levels relative to the control period. The study was carried out four times, on three patients with burns between 35% total burn surface area (TBSA) and 51% TBSA.
  
  
  RESULTS
  There were significant increases in airborne bacteria levels, regardless of whether the dressing change or bed sheet change took place first. Of particular note, is the finding that significantly high levels (up to 2614cfu/m(3)) of airborne bacteria were shown to persist for up to approximately 1h after these activities ended.
  
  
  CONCLUSIONS
  This is the most accurate picture to date of the rapidly changing levels of airborne bacteria within the room of a burns patient undergoing a dressing change and bed change. The novel demonstration of a significant increase in the airborne bacterial load during these events has implications for infection control on burns units. Furthermore, as these increased levels remained for approximately 1h afterwards, persons entering the room both during and after such events may act as vectors of transmission of infection. It is suggested that appropriate personal protective equipment should be worn by anyone entering the room, and that rooms should be quarantined for a period of time following these events.
  
  
  CONCLUSIONS
  Airborne bacteria significantly increase during dressing and sheet changes on moderate size burns, and remain elevated for up to an hour following their cessation.
authors.affiliation: Burns Unit, Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, UK. Electronic address: sarahbache@doctors.org.uk.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Bache
authors.affiliation: The Robertson Trust Laboratory for Electronic Sterilisation Technologies (ROLEST), Department of Electronic and Electrical Engineering, University of Strathclyde, Glasgow, UK.
authors.forename: Michelle
authors.initials: M
authors.lastname: Maclean
authors.affiliation: Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK.
authors.forename: George
authors.initials: G
authors.lastname: Gettinby
authors.affiliation: The Robertson Trust Laboratory for Electronic Sterilisation Technologies (ROLEST), Department of Electronic and Electrical Engineering, University of Strathclyde, Glasgow, UK.
authors.forename: John G
authors.initials: JG
authors.lastname: Anderson
authors.affiliation: The Robertson Trust Laboratory for Electronic Sterilisation Technologies (ROLEST), Department of Electronic and Electrical Engineering, University of Strathclyde, Glasgow, UK.
authors.forename: Scott J
authors.initials: SJ
authors.lastname: MacGregor
authors.affiliation: Burns Unit, Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Taggart
mesh_terms: D000328:Adult; D000388:Air / Q000032:analysis*; D000391:Air Microbiology; D001419:Bacteria / Q000302:isolation & purification*; D001458:Bandages; D001512:Bedding and Linens; D002053:Burn Units; D002056:Burns / Q000382:microbiology / Q000628:therapy*; D003428:Cross Infection / Q000517:prevention & control; D046508:Culture Techniques; D006801:Humans; D017053:Infection Control; D008875:Middle Aged
keywords: Airborne; Bed change; Cross-contamination; Dressing change; Infection control; Nosocomial infection