Burn injuries result in loss of skin barrier and altered immune responses that in turn make patients especially vulnerable to healthcare-associated infections. Despite prolonged exposures of these patients to hospital environments, burn-specific infection prevention strategies are understudied. We present a research agenda identifying key research gaps and organizing them into priority areas to guide future investigations in this high-risk population.

Members of the Society for Healthcare Epidemiology of America (SHEA) Burn Infection Prevention and Control Special Interest Group and the American Burn Association (ABA) collaborated to develop this research agenda, combining expertise in infection prevention, antimicrobial stewardship, and burn care.

We identified five priority areas: (1) improving surveillance and epidemiologic data on burn infections; (2) better understanding of microbiology, including biofilms and the microbiome; (3) evaluating wound healing strategies; (4) refining infection prevention and control practices unique to burn units; and (5) building burn patient specific risk assessment and predictive models. The agenda highlights the need for standardized definitions and shared data platforms. It calls for evaluation of practical strategies for infection prevention, stewardship, and environmental control.

This research agenda intends to help guide future studies aimed at furthering knowledge and improving outcomes in burn care.

Most outbreaks associated with contaminated antiseptics and disinfectants had been attributed to user errors, as identified in our previous review in 2007. Although numerous regulations and guidelines have been established for proper use of antiseptics and disinfectants since then, such outbreaks continue to occur. To address this issue, we conducted a literature review of outbreaks and pseudo-outbreaks linked to contaminated antiseptics and disinfectants, aiming to update the outbreak characteristics and propose new prevention strategies.

We searched the published literature from 2006 to 2024 via the PubMed database.

Among 2,307 publications identified, twenty-one outbreaks and 4 pseudo-outbreaks were reviewed. Among the outbreaks, seventeen (81%) were linked to antiseptics including chlorhexidine or low-level disinfectants including quaternary ammonium compounds. A median of 12 individuals (range: 3–256) developed infections, including ventilator-associated pneumonia, skin and soft tissue infections, or catheter-related infections, resulting from direct use of contaminated mouthwashes and skin antiseptics on patients, leading to 55 fatalities. Thirteen (62%) outbreaks were attributed to intrinsically contaminated products, which led to product recall and regulatory changes. Seven (33%) were linked to extrinsically contaminated antiseptics or disinfectants, all associated with improper practices in preparation and storage. Control measures included use of sterile water for preparation, disinfection or replacement of dispensers and containers, and prohibition of using solutions prepared in the hospital laboratory.

To avoid outbreaks associated with contaminated antiseptics and disinfectants, healthcare personnel should understand the risks of contaminated antiseptics and disinfectants, and prevention strategies to avoid extrinsic contamination.