JBUR-4326; No. of Pages 6 burns xxx (2014) xxx–xxx
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Awareness and attitude of doctors and nurses at a teaching hospital to skin donation and banking A.I. Michael a,*, S.A. Ademola a,b, O.A. Olawoye a,b, A.O. Iyun a, O.M. Oluwatosin a,b a b
Department of Plastic and Reconstructive Surgery, University College Hospital, Ibadan, Oyo State, Nigeria Department of Surgery, College of Medicine, University of Ibadan, Oyo State, Nigeria
article info
abstract
Article history:
Introduction: This study sought to determine the awareness and attitude of doctors and
Accepted 12 March 2014
nurses in a teaching hospital to skin donation and banking, and to identify needs for
Keywords:
Methods: A cross sectional survey on doctors and nurses was carried out using a 44-item
personnel educational programmes. Skin donation
questionnaire that included a Likert scale on attitudes. Predictors of favourable attitudes
Skin banking
were determined. Results: Eighty (49.7%) doctors and 81 (50.3%) nurses participated in the study. Many participants, 126 (78.3%), knew that skin could be donated, but only 96 (59.6%) participants were aware of skin banking. The main source of information was during professional training (17.4%). Only 41 (25.5%) participants were willing to donate skin after death. Body disfigurement was the major reason (20.5%) against skin donation. Participants who were doctors, were aware of skin banking, and who were previous blood donors had higher attitudes scores ( p < 0.001, p = 0.004, p = 0.007 respectively). Being a doctor and having heard of skin banking were predictors of favourable attitudes to skin donation and banking. Conclusion: Knowledge transfer during health professional training on the usefulness of banked skin in patients with major burns may lead to improved attitude of health professionals and acceptance of this modality of burn management. # 2014 Elsevier Ltd and ISBI. All rights reserved.
1.
Introduction
Fire related deaths in Africa are approximately six times that occurring in developed countries [1]. Several reports on burn epidemiology in Africa and recommended strategies towards burn prevention have been documented [2,3]. The influence of this on the incidence of new burn cases in Africa still needs to be evaluated. In-patient mortality figures in Nigeria remain alarmingly high for patients with burns greater than 30% Total
Body Surface Area (TBSA) [4]. It has been established that the introduction of early burn surgery in severely burned patients reduces the incidence of septic complications, modulates the systemic inflammatory response, improving morbidity, survival and length of hospital stay [5,6]. Autologous split skin graft (SSG) is the best replacement for lost skin. However, in patients with extensive burns, this is limited. Allograft skin, a well established temporary skin substitute is used while awaiting healing of autograft donor areas between multiple harvesting, it is largely cost effective and often life-saving [6–8]. The clinical
* Corresponding author. Tel.: +234 705 923 8585. E-mail address: [email protected] (A.I. Michael). http://dx.doi.org/10.1016/j.burns.2014.03.009 0305-4179/# 2014 Elsevier Ltd and ISBI. All rights reserved.
Please cite this article in press as: Michael AI, et al. Awareness and attitude of doctors and nurses at a teaching hospital to skin donation and banking. Burns (2014), http://dx.doi.org/10.1016/j.burns.2014.03.009
JBUR-4326; No. of Pages 6
2
burns xxx (2014) xxx–xxx
use of allograft skin in burn wound coverage was first described in 1938 when Bettman reported his success in the treatment of children with extensive full thickness burns [9]. The establishment of the United States Navy skin bank in 1949 paved the way for modern day skin banking [10]. The implementation of skin banks in developed countries has decreased the risk of burn mortality in adults and children significantly by being able to maintain an adequate supply of allograft skin [7,9]. In Singapore, the skin bank was established in 1998. It has provided severely burned patients with skin allograft cover that has proven to be life-saving. Five years following its establishment, there were no reports of adverse reactions in donor skin recipients with a significant decrease in mortality of 29% for patients who underwent excision within 72 h of burn and completed within a week. Similarly, length of hospital stay (LOS) was also shown to reduce significantly by 10 days [7]. India, a developing nation like Nigeria saw the need for acceptance of the concept of skin donation and skin banking as a feasible option for saving the life of patients with extensive burns. Awareness campaigns through the media changed the perception of the people. A skin bank was set up in 2000 and a ten year review showed that they had received 262 deceased donor skin allografts [11]. Due to a high demand for allograft skin in developed countries, skin banks which were once institutionalized are moving more towards regional and national tissue banking organizations [12]. Skin donation and skin banking are not practiced in Nigeria despite the high incidence of severe burns and high morbidity figures. Health workers are positioned to educate the populace on the available standard of care. They are also positioned to advocate for policy implementation on best practices in patient care, not least of all, the burn patient. The University College Hospital, Ibadan is Nigeria’s foremost tertiary health care facility. It serves as a referral centre for patients with major burns. It also has one of the first dedicated burn unit in the country which has been managing burn patients for the past 10 years. The need to determine the awareness and attitude of doctors and nurses at the University College Hospital to skin donation and skin banking and to identify areas of emphasis in formulating personnel educational programmes were the objectives of the study.
2.
Methods
2.1.
Ethical considerations
Ethical approval was obtained from University College Hospital/University of Ibadan Institutional review board.
2.2.
Setting and study design
A cross sectional survey between February and July 2012 on randomly selected doctors and nurses was carried out using a pretested, validated, structured self administered anonymous questionnaire.
2.3.
Study instrument
The questionnaire was generated by modifying a previously validated questionnaire [13] to suit the study objectives. This was pretested on doctors and nurses not included in the actual study. The 44-item questionnaire was structured into 3 sections. Section A sought the sociodemographic characteristics, sections B and C constituted multiple-choice questions, open ended questions and a Likert scale that determined attitude to skin donation and banking.
2.4.
Study participants
These were doctors and nurses working at the University College Hospital. Filling the questionnaire signified consent to participate in the study.
2.5.
Data analysis
The responses were coded and the data entered into the Statistical Software for Social Sciences (SPSS) version 16. Descriptive statistics were used to analyze the socio-demographics. Pearson’s Chi square test was used to identify associations between variables and computed attitude scores. Multiple logistic regression analysis of predictors of favourable
Fig. 1 – Awareness of organ and blood donation. Please cite this article in press as: Michael AI, et al. Awareness and attitude of doctors and nurses at a teaching hospital to skin donation and banking. Burns (2014), http://dx.doi.org/10.1016/j.burns.2014.03.009
JBUR-4326; No. of Pages 6 burns xxx (2014) xxx–xxx
3
Fig. 2 – Source of information on organ donation. Fig. 4 – Participants’ recommendation for increasing public awareness on skin donation and skin banking. attitudes was analyzed. p values
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.elsevier.com/locate/burns
Awareness and attitude of doctors and nurses at a teaching hospital to skin donation and banking A.I. Michael a,*, S.A. Ademola a,b, O.A. Olawoye a,b, A.O. Iyun a, O.M. Oluwatosin a,b a b
Department of Plastic and Reconstructive Surgery, University College Hospital, Ibadan, Oyo State, Nigeria Department of Surgery, College of Medicine, University of Ibadan, Oyo State, Nigeria
article info
abstract
Article history:
Introduction: This study sought to determine the awareness and attitude of doctors and
Accepted 12 March 2014
nurses in a teaching hospital to skin donation and banking, and to identify needs for
Keywords:
Methods: A cross sectional survey on doctors and nurses was carried out using a 44-item
personnel educational programmes. Skin donation
questionnaire that included a Likert scale on attitudes. Predictors of favourable attitudes
Skin banking
were determined. Results: Eighty (49.7%) doctors and 81 (50.3%) nurses participated in the study. Many participants, 126 (78.3%), knew that skin could be donated, but only 96 (59.6%) participants were aware of skin banking. The main source of information was during professional training (17.4%). Only 41 (25.5%) participants were willing to donate skin after death. Body disfigurement was the major reason (20.5%) against skin donation. Participants who were doctors, were aware of skin banking, and who were previous blood donors had higher attitudes scores ( p < 0.001, p = 0.004, p = 0.007 respectively). Being a doctor and having heard of skin banking were predictors of favourable attitudes to skin donation and banking. Conclusion: Knowledge transfer during health professional training on the usefulness of banked skin in patients with major burns may lead to improved attitude of health professionals and acceptance of this modality of burn management. # 2014 Elsevier Ltd and ISBI. All rights reserved.
1.
Introduction
Fire related deaths in Africa are approximately six times that occurring in developed countries [1]. Several reports on burn epidemiology in Africa and recommended strategies towards burn prevention have been documented [2,3]. The influence of this on the incidence of new burn cases in Africa still needs to be evaluated. In-patient mortality figures in Nigeria remain alarmingly high for patients with burns greater than 30% Total
Body Surface Area (TBSA) [4]. It has been established that the introduction of early burn surgery in severely burned patients reduces the incidence of septic complications, modulates the systemic inflammatory response, improving morbidity, survival and length of hospital stay [5,6]. Autologous split skin graft (SSG) is the best replacement for lost skin. However, in patients with extensive burns, this is limited. Allograft skin, a well established temporary skin substitute is used while awaiting healing of autograft donor areas between multiple harvesting, it is largely cost effective and often life-saving [6–8]. The clinical
* Corresponding author. Tel.: +234 705 923 8585. E-mail address: [email protected] (A.I. Michael). http://dx.doi.org/10.1016/j.burns.2014.03.009 0305-4179/# 2014 Elsevier Ltd and ISBI. All rights reserved.
Please cite this article in press as: Michael AI, et al. Awareness and attitude of doctors and nurses at a teaching hospital to skin donation and banking. Burns (2014), http://dx.doi.org/10.1016/j.burns.2014.03.009
JBUR-4326; No. of Pages 6
2
burns xxx (2014) xxx–xxx
use of allograft skin in burn wound coverage was first described in 1938 when Bettman reported his success in the treatment of children with extensive full thickness burns [9]. The establishment of the United States Navy skin bank in 1949 paved the way for modern day skin banking [10]. The implementation of skin banks in developed countries has decreased the risk of burn mortality in adults and children significantly by being able to maintain an adequate supply of allograft skin [7,9]. In Singapore, the skin bank was established in 1998. It has provided severely burned patients with skin allograft cover that has proven to be life-saving. Five years following its establishment, there were no reports of adverse reactions in donor skin recipients with a significant decrease in mortality of 29% for patients who underwent excision within 72 h of burn and completed within a week. Similarly, length of hospital stay (LOS) was also shown to reduce significantly by 10 days [7]. India, a developing nation like Nigeria saw the need for acceptance of the concept of skin donation and skin banking as a feasible option for saving the life of patients with extensive burns. Awareness campaigns through the media changed the perception of the people. A skin bank was set up in 2000 and a ten year review showed that they had received 262 deceased donor skin allografts [11]. Due to a high demand for allograft skin in developed countries, skin banks which were once institutionalized are moving more towards regional and national tissue banking organizations [12]. Skin donation and skin banking are not practiced in Nigeria despite the high incidence of severe burns and high morbidity figures. Health workers are positioned to educate the populace on the available standard of care. They are also positioned to advocate for policy implementation on best practices in patient care, not least of all, the burn patient. The University College Hospital, Ibadan is Nigeria’s foremost tertiary health care facility. It serves as a referral centre for patients with major burns. It also has one of the first dedicated burn unit in the country which has been managing burn patients for the past 10 years. The need to determine the awareness and attitude of doctors and nurses at the University College Hospital to skin donation and skin banking and to identify areas of emphasis in formulating personnel educational programmes were the objectives of the study.
2.
Methods
2.1.
Ethical considerations
Ethical approval was obtained from University College Hospital/University of Ibadan Institutional review board.
2.2.
Setting and study design
A cross sectional survey between February and July 2012 on randomly selected doctors and nurses was carried out using a pretested, validated, structured self administered anonymous questionnaire.
2.3.
Study instrument
The questionnaire was generated by modifying a previously validated questionnaire [13] to suit the study objectives. This was pretested on doctors and nurses not included in the actual study. The 44-item questionnaire was structured into 3 sections. Section A sought the sociodemographic characteristics, sections B and C constituted multiple-choice questions, open ended questions and a Likert scale that determined attitude to skin donation and banking.
2.4.
Study participants
These were doctors and nurses working at the University College Hospital. Filling the questionnaire signified consent to participate in the study.
2.5.
Data analysis
The responses were coded and the data entered into the Statistical Software for Social Sciences (SPSS) version 16. Descriptive statistics were used to analyze the socio-demographics. Pearson’s Chi square test was used to identify associations between variables and computed attitude scores. Multiple logistic regression analysis of predictors of favourable
Fig. 1 – Awareness of organ and blood donation. Please cite this article in press as: Michael AI, et al. Awareness and attitude of doctors and nurses at a teaching hospital to skin donation and banking. Burns (2014), http://dx.doi.org/10.1016/j.burns.2014.03.009
JBUR-4326; No. of Pages 6 burns xxx (2014) xxx–xxx
3
Fig. 2 – Source of information on organ donation. Fig. 4 – Participants’ recommendation for increasing public awareness on skin donation and skin banking. attitudes was analyzed. p values
