A Wicked Problem: The Burn Wound Swabbing Conundrum

Miss Yvonne Singer1, Edward Raby2, Alex Padiglione1, Fiona Wood2, Hana Menzes1, Lincoln Tracy3, Belinda Gabbe3,4, Heather Cleland1

1Victorian Adult Burns Service, The Alfred, Melbourne, Australia, 2State Adult Burn Service, Fiona Stanley Hospital, , , 3School of Public Health and Preventive Medicine, Monash University, , Australia, 4Heath Data Research UK Institute, Swansea University Medical School, Swansea University, Swansea, Wales


Burn wound colonisation can lead to wound infection, and occasionally sepsis. Wound swabbing is common to determine the presence of micro-organisms and wound infection. However, the burns community is yet to reach consensus on best practice swabbing procedures. This presentation will define the ‘wicked problem’ of burn wound swabbing in Australia and New Zealand through:

  1. Analysis of the Burn Registry of Australia and New Zealand (BRANZ) methicillin-resistant Staphylococcus aureus (MRSA) wound swab data
  2. Benchmarking Australian/New Zealand Burn Unit wound swabbing practices
  3. Synthesis of the peer reviewed literature
  4. Single site analysis of the number of wound swabs taken versus positive yield

Preliminary one-year analysis of BRANZ data shows low incidence of MRSA positive swabs (n=54, 1.6%), but variation across units in incidence. Previous bi-national benchmarking identified differences in triggers and techniques for wound swabbing across units, which likely influences the variance in the incidence of MRSA across units. Furthermore, the scientific evidence’s focus on severe injury does not reflect the contemporary Australian/New Zealand burn population.

“Wicked problems” are complex, have multiple contributing factors, and are hard to describe and resolve. This presentation will analyse 3 years of BRANZ MRSA wound swabbing data, re-benchmark swabbing practices, and synthesise existing evidence.  It is a call to action to our burn community to address this “wicked problem” by developing best practice wound swabbing guidelines to reduce unnecessary procedures and costs, standardise future BRANZ data and set the stage for the future BRANZ based Burn Quality Improvement Program.


Bio to come



ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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