research study on knowledge of interns regarding wound care

University of Santo Tomas HospitalDepartment of Medical Education and ResearchEspaa, Manila

February 10, 2015

Wilson Tan De Guzman, MDChair, Institutional Review BoardUniversity of Santo Tomas Hospital

Dear Sir: Greetings! We are the postgraduate interns in the Department of Medical Education and Research in the University of Santo Tomas Hospital. We are currently in the process of completing our research paper entitled: A Survey of Wound Care Knowledge Among Health Care Workers in the University of Santo Tomas Hospital which aims to ascertain how much time is devoted by the nurses, junior and senior interns in teaching their patients and relatives regarding proper wound care, and (ii) to determine the state of knowledge about wound care among health care workers in the University of Santo Tomas HospitalIn this regard, we would like to ask the Institutional Review Board approval. Your favorable response to this matter will highly be appreciated. Attached to this letter is our research protocol.Thank you very much for your consideration. Sincerely,

Rachel Ann ReyesAna Katrina RubinJessica Nicole SabidoPrincipal InvestigatorPrincipal InvestigatorPrincipal Investigator

Madeleine Ann SalazarMaxinne Arielle SampangLaurice San JosePrincipal Investigator Principal InvestigatorPrincipal Investigator

Demie Dane SanoriaBritten Norman SantiagoMadelyn SevillaPrincipal InvestigatorPrincipal InvestigatorPrincipal Investigator

Michelle SimPrincipal Investigator


February 10, 2015

Wilson Tan De Guzman, MDChair, Institutional Review BoardUniversity of Santo Tomas Hospital

Dear Sir: Greetings! I, Clarissa Mendoza, training officer of the postgraduate interns in the Department of Medical Education and Research in the University of Santo Tomas Hospital would like to ask you good office to approve the research paper of the group 9 senior interns entitled A Survey of Wound Care Knowledge Among Health Care Workers in the University of Santo Tomas Hospital which aims to ascertain how much time is devoted by the nurses, junior and senior interns in teaching their patients and relatives regarding proper wound care, and to determine the state of knowledge about wound care among health care workers in the University of Santo Tomas Hospital.Your favorable response to this matter will highly be appreciated. Attached to this letter is their research protocol.Thank you very much for your consideration. Sincerely,

Clarissa Mendoza, MDTraining Officer of Postgraduate InternsDepartment of Medical Education and Research

Noted by:

Marcellus Francis Ramirez, MDChair, Department of Medical Education and Research

A SURVEY OF WOUND CARE KNOWLEDGE AMONG HEALTH CARE WORKERS IN THE UNIVERSITY OF SANTO TOMAS HOSPITAL

A Research Paper Submitted to theDepartment of Medical Education and ResearchUniversity of Santo Tomas Hospital

In partial fulfillment of the Requirements for thePostgraduate Internship

Reyes, Rachel AnnRubin, Ana KatrinaSabido, Jessica NicoleSalazar, Madeleine AnnSampang, Maxinne ArielleSan Jose, LauriceSanoria, Demie DaneSantiago, Britten NormanSevilla, MadelynSim, Michelle

February 2015

University of Santo Tomas HospitalTable of Contents

Title Page3Table of Contents4

Chapter I: Introduction5Chapter II: Review of Related Literature7Chapter III: Methodology12Chapter IV: Results, Discussion, and Conclusions

REFERENCES17

Appendix A: Time Table (Gannt Chart)18Appendix B: Budget19Appendix C: Informed Consent20Appendix D: Questionnaire22Appendix E: Curriculum Vitae and Good Clinical Practice28Appendix F: Approval Letter (Medical director, DMER Chair, UST-FMS Dean, Chief of Nursing Services)38

CHAPTER I: INTRODUCTION

What are wounds? These are injury to living tissue caused by a cut, blow, or other impact, typically one in which the skin is cut or broken. These wounds may also be due to vascular insufficiency, complications of diabetes, skin damage due to pressure and postoperative complications. (1) These are encountered in the everyday life of Filipino citizens. People tend to handle these events in different ways. It became apparent that knowledge in this regard was scarce and that treatment guidelines were not readily available. Hence, this study aims (i) to ascertain how much time is devoted by hospital care workers in teaching their patients and relatives regarding proper wound care, and (ii) to determine the state of knowledge about proper wound care among healthcare workers in the University of Santo Tomas Hospital.

STATEMENT OF PROBLEM1. How much time is devoted by health care professionals in teaching proper wound care to their patents?2. How knowledgeable are the health care professionals regarding proper wound care?

OBJECTIVESThis cross sectional study aims (i) to ascertain how much time is devoted by the nurses, junior and senior interns in teaching their patients and relatives regarding proper wound care, and (ii) to determine the state of knowledge about wound care among health care workers in the University of Santo Tomas Hospital.SIGNIFICANCE OF STUDY

These data that would be gathered in this research would help the hospital to reassess or to improve their knowledge in giving proper wound cleansing and caring among patients. This study will therefore help us know the weakness on wound care knowledge thereby giving information on what heathcare workers need to strengthen. This will help reduce the possibility of infection and in due course this study will improve the attitude, knowledge and practices of patients and healthcare workers towards overall wound care.

CHAPTER II: REVIEW OF RELATED LITERATUREThe skin is the largest external organ of the body. Human skin is composed of two distinct layers: the epidermis, the outermost layer; and the dermis, the innermost layer. The dermal-epidermal junction, commonly referred to as the basement membrane zone (BMZ), separates the two layers. Under the dermis lies a layer of loose connective tissue, called subcutaneous tissue, or hypodermis. The epidermis is a thin, avascular layer that regenerates itself every 4 to 6 weeks. Its divided into four layers or strata (presented in order from the outermost layer inward). Stratum corneumconsists of dead keratinocytecells; flakes and sheds; is easily removed during bathing activities and more efficiently by scrubbing the surface of the skin. Stratum granulosum also contains Langerhans cells in addition to keratinocytes. Stratum spinosum contains keratinocytes and Langerhans cells. Stratum basale or germinativum single layer of epidermal cells (keratinocytes); contains melanocytes; can regenerate. A fifth layer, the stratum lucidum, lies between the stratum corneum and the stratum granulosum. This packed translucent line of cells is found only on the palms and soles and is not seen in thin skin. (5)Wounds can be acute or chronic, open or closed. A chronic wound is defined as any break in skin integrity that persists for longer than six weeks or recurs frequently. (4) Open wounds, in which the skin is broken or torn or closed wounds. Although open wounds can bleed and run the risk of infections, closed wounds can also be dangerous depending on the extent of tissue damage. The five major categories of wound include incision, abrasion, laceration, contusion and puncture wound. An incision wound is a cut in the skin caused by a sharp object such as a knife, broken glass, scissors or surgeons scalpel. Incision wounds are neat and the edges of the skin are usually smooth. A laceration is injury to the skin that results in the skin being cut or torn open; these wounds can be shallow, only injuring the surface skin, or deep, causing injury to the muscles, tendons, ligaments, blood vessels or nerves. Lacerations are most commonly made by some sort of blunt trauma such as being hit with a fist or baseball bat. An abrasion on the other hand, is a type of wound in which the skin is scraped or rubbed off. These are usually superficial, in which only the outer layers of skin are affected. A deep abrasion is the one that penetrates to the inner layers of skin and can leave a scar. A contusion is a kind of closed wound that are caused by blunt force trauma to the skin that results in tissue damage. A puncture wound is created when a sharp object enters the skin. These wounds are usually small and do not bleed a lot. Although these wounds tend to close over quickly, they still need treatment as infection is a possibility. (2)Wound healing, as a normal biological process in the human body, is achieved through four precisely and highly programmed phases: hemostasis, inflammation, proliferation, and remodeling. For a wound to heal successfully, all four phases must occur in the proper sequence and time frame. Many factors can interfere with one or more phases of this process, thus causing improper or impaired wound healing. These factors include oxygenation, infection, age and sex hormones, stress, diabetes, obesity, medications, alcoholism, smoking, and nutrition. (3)In wound healing the platelet is the cell which acts as the utility worker sealing off the damaged blood vessels. The blood vessels themselves constrict in response to injury but this spasm ultimately relaxes. The platelets secrete vasoconstrictive substances to aid in process but their prime role is to form a stable clot sealing the damaged vessel. Under the influence of ADP (adenosine diphosphate) leaking from damaged tissues the platelets aggregate and adhere to the exposed collagen. They also secrete factors which interact with and stimulate the intrinsic clotting cascade through the production of thrombin, which in turn initiates the formation of fibrin from fibrinogen. The fibrin mesh strengthens the platelet aggregate into a stable hemostatic plug. Finally platelets also secrete cytokines such as platelet-derived growth factor (PDGF), which is recognized as one of the first factors secreted in initiating subsequent steps. Hemostasis occurs within minutes of the initial injury unless there are underlying clotting disorders. (6) Clinically inflammation, the second stage of wound healing presents as erythema, swelling and warmth often associated with pain, the classic rubor et tumor cum calore et dolore. This stage usually lasts up to 4 days post injury. In the wound healing analogy the first job to be done once the utilities are capped is to clean up the debris. This is a job for non-skilled laborers. These non-skilled laborers in a wound are the neutrophils or PMNs (polymorphonucleocytes). The inflammatory response causes the blood vessels to become leaky releasing plasma and PMNs into the surrounding tissue. The neutrophils phagocytize debris and microorganisms and provide the first line of defense against infection. They are aided by local mast cells. As fibrin is broken down as part of this clean-up the degradation products attract the next cell involved. (6) The granulation stage starts approximately four days after wounding and usually lasts until day 21 in acute wounds depending on the size of the wound. It is characterized clinically by the presence of pebbled red tissue in the wound base and involves replacement of dermal tissues and sometimes subdermal tissues in deeper wounds as well as contraction of the wound. In the wound healing analogy once the site has been cleared of debris, under the direction of the contractor, the framers move in to build the framework of the new house. Sub-contractors can now install new plumbing and wiring on the framework and siders and roofers can finish the exterior of the house. The framer cells are the fibroblasts which secrete the collagen framework on which further dermal regeneration occurs. Specialized fibroblasts are responsible for wound contraction. The plumber cells are the pericytes which regenerate the outer layers of capillaries and the endothelial cells which produce the lining. This process is called angiogenesis. The roofer and sider cells are the keratinocytes which are responsible for epithelialization. In the final stage of epithelializtion, contracture2 occurs as the keratinocytes differentiate to form the protective outer layer or stratum corneum. (6)Once the basic structure of the house is completed interior finishing may begin. So too in wound repair the healing process involves remodeling the dermal tissues to produce greater tensile strength. The principle cell involved in this process is the fibroblast. Remodeling can take up to 2 years after wounding and explains why apparently healed wounds can break down so dramatically and quickly if attention is not paid to the initial causative factors. (6)There are three basic principles which underlie wound healing. 1. Identify and control as best as possible the underlying causes. 2. Support patient centered concerns 3. Optimize local wound care. (6) In 1979 Turner described the ideal dressing as having the following characteristics13: Removes excess exudate and toxins High humidity at the dressing wound interface Allows for gaseous exchange Provides thermal insulation Protects against secondary infection Free from particulate and toxic components No trauma with removal. (6)In a cross sectional study done by Dr. JF Coetzee et al., Their objective was to determine the extent of knowledge acquired by fifth year medical students, general practitioners and surgical registrars, concerning chronic wound management. In this study four medical schools participated but only two schools offered formal courses in wound care. In the their study 162 medical students, 45 General Practitioner and 47 surgical registrars completed their questionnaires. The overall median (25th75th percentiles) knowledge scores for registrars, GPs and students were 65%;(55%70%), 55%;(45%65%) and 45%;(35%50%) respectively. Whereas the scores of surgery registrars and general practitioners did not change, the student scores were significantly less. Out of the study population only 32% of registrars and 18% of GPs attained scores of greater than 70%. Almost all of the participants deemed that the training for wound care is inadequate or incomplete. Interest in wound-care was observed to be only mild to moderate, with more general practitioners than registrars requesting literature. According to Dr. JF Coetzee et al, miniscule, if any training on chronic wounds is noted to be given in South Africa. The levels of knowledge cannot be considered adequate for successful treatment, nor for teaching to undergraduates. They have stated that it is clear that improvement in education about these topics to have a huge impact in their society and would give great economic consequences. (1)

CHAPTER III: METHODOLOGYStudy subjects are mainly registered nurses, senior interns and junior interns of the University of Santo Tomas Hospital, they would be involved in a survey concerning about the knowledge on proper wound care. The survey would represent different level of medical practice relating to wound care. These groups were targeted because they were the first line in monitoring the patients immediately post-operatively. They were targeted in order to estimate the amount of knowledge by means of answering a series of questions mainly involving proper wound care. This survey would also gauge the competence of the said study subjects in managing acute and chronic wounds. Informed consents and knowledge based questionnaires would be distributed to registered nurses, junior interns, senior interns of University of Santo Tomas Hospital. Data from these survey would be collated and analyzed based on ANOVA statistical analysis to detect a significant statistical difference between groups.

SETTING OF STUDYThe study would be limited to the University of Santo Tomas Hospital working staff consisting of nurses, junior interns, postgraduate interns.

STUDY SUBJECTIncludes members of the hospital staff including nurses, junior interns, postgraduate interns. The groups in the knowledge survey represent important levels of medical practice relating to wound care; nurses are the ones monitoring patients every now and then in the ward, junior and senior interns are the future health care workers that will have to treat patients with different kinds of wounds. These groups were targeted in order to estimate the amount of the knowledge they have regarding wound care.

INCLUSION CRITERIA1. University of Santo Tomas junior interns batch 2014-2015 who understands the English language.2. University of Santo Tomas Hospital postgraduate interns batch 2014 2015 who understands the English language.3. Nurses currently employed under University of Santo Tomas Hospital either assigned at the pay or clinical division who understands the English language.

EXCLUSION CRITERIA1. Excludes other University of Santo Tomas Hospital healthcare staffs such as residents, consultants, radiation and medical technologist and nurse aids. WITHDRAWAL CRITERIAIn any case that the participant decides not to take part in this research the participants may stop answering the survey at any time that they wish without their job being affected. SAMPLE SIZEThe sample size was computed with a confidence interval set at 16 at a confidence level of 95%. The researchers would assume that 50% of the study groups total population would be competent on wound care. The total population for each group are 200 for USTH nurses, 540 for junior interns and 120 for senior interns. With these in mind, the computed sample sizes for each group are 35 for UST nurses, 40 for the Junior Interns and 32 for the Senior Interns.SAMPLING TECHNIQUERandom sampling would be used as a means of obtaining a sample.

QuestionnaireThe questionnaire used by the researchers is from the study of JF Coetze entitled A Survey of Wound Care Knowledge in South Africa The questionnaire was compiled from evidence-based resources regarding chronic wound treatment and it was subjected to analysis by a panel of experts who attended the 3rd National Conference of WHASA in Durban, April 2009. After which the questionnaire was validated. The final, approved questionnaire is composed of two sections. The first included items to identify demographics that may influence wound care knowledge such as age group, gender, institution, level of training, qualifications held, professed level of interest in wound care and their opinion of the adequacy of their wound care training. The second comprised of 20 knowledge-related, multiple-choice questions that were grouped into four spheres about (a) dressings (b ) diabetic foot ulcers (c) stasis ulcers and (d) pressure ulcers. Each questionnaire has an information pamphlet attached which states out the aims of the study, consent that participants and their contributions were voluntary and anonymous.

DATA ANALYSIS From the questionnaire, mean scores of the three groups to be studied are to be compared using ANOVA. The scores of nurses, junior interns and senior interns would be compared to each other and would be compared on the 4 topics to be asked in the questionnaire. An alpha value of 0.05 will be accepted as indicating a significant result.

ETHICAL CONSIDERATIONSPrivacy and ConfidentialityThe identity will be withheld from the public. Only the principal investigator had access to the questionnaire. To ensure confidentiality, the healthcare workers will be given the option not to write their name or only their initials will be used.RecruitmentThe participants of this study will be obtained through random sampling. Informed consent will be signed before the questionnaire is answered. Any possible withdrawal to the study will be accepted. BenefitsThis study would help us identify whether the information the healthcare workers give/teach their patient is correct regarding daily wound care. This will likewise help improve the knowledge of the involved participants.RiskSince this study entails to review the knowledge of hospital staffs, their identity will not be disclosed so as to protect them from being misjudged in case their knowledge was not adequate.Compensation and expensesNo monetary incentives in cash or kind would be provided. Investigators would also not receive any compensation for the study. All financial expenses were shouldered by the investigators.

Informed consent processInformed consent would be obtained by the primary investigators from the heath care workers who will answer the questionnaire as well as approval by the Institutional Review Board.Conflict of interestThere would be no conflict of interest arising from financial, familial considerations, of the principal investigator and the study site. The investigators were compliant to Good Clinical Practice Guidelines to avoid any conflict of interest.

REFERENCES1. A survey of wound care knowledge in South Africa. Dec 2010. Dirk Hagemeister, et al. 2. Five Types of Wounds. Oct 27, 2013 | By Stephanie Chandler3. Factors Affecting Wound Healing. S. Guo, L.A. DiPietro. J Dent Res. 2010 March; 89(3): 219229. doi:10.1177/00220345093591254. Fonder MA, Lazarus GS, Cowan DA, Aronson-Cook B, Kohli AR, Mamelak AJ: Treating the chronic wound: A practical approach to the care of nonhealing wounds and wound care dressings. J Am.Acad.Dermatol. 2008; 58: 185-2065. Wound Care Essentials - Practice Principles 3rd ed. - S. Baranoski, et. al., (Lippincott, 2012) BBS6. David Keast MSc, MD, CCFP Heather Orsted RN, BN, ET. The Basic Principles of Wound Healing. 2004.

APPENDIX A

GANNT CHART

2015

JanuaryFebruaryMarchApril

Finalizing the research paper before submission to IRBSubmission to the IRB

Data CollectionData Collection

Finalizing the Research PaperFinalizing the research paper

Research paper presentation

APPENDIX B

STUDY BUDGET

Bond papers, Folders --------------------------------------------------------------------------------------- Php 300Printing --------------------------------------------------------------------------------------------------------- Php 500TOTAL --------------------------------------------------------------------------------------------------------- Php 800

APPENDIX CInformed ConsentThis informed consent is for health care workers including Junior interns, Post Graduate interns and nurses in the University of Santo Tomas Hospital who we are inviting to participate in the research entitled, A Survey of wound care knowledge among health care workers in the University of Santo Tomas Hospital.

UST Post Graduate Interns Group 9University of Santo Tomas HospitalDepartment of Medical Education and Research

Researcher Contact Information: Britten Norman Santiago et al, (09256215574)IRB Contact Information: Dr. Wilson Tan De Guzman (731 3001 Loc. 2610)

This Informed Consent Form has two parts: Information Sheet (to share information about the study with you) Certificate of Consent (for signatures if you choose to participate)

Part I: Information Sheet We are the members of Group 9 working as Postgraduate interns for the University of Santo Tomas Hospital doing research regarding wound care knowledge of health workers. We are going to give you information and invite you to be a part of this research. You do not have to decide today whether or not you will participate in the research. Before you decided, you can talk to anyone you feel comfortable with about the research. This consent form may contain words that you do not understand. Please ask to stop as we go through the information and we will take time to explain. If you have questions later, you can ask them to any members of our group. Wound care is an important part in the process of wound healing. With this information, we want to determine how much time do health care providers allot to teach patients and relatives regarding proper techniques in wound care and the degree of knowledge among the said people.The total number of participants were computed with a confidence interval set at 16 at a confidence level of 95%. The researchers would assume that 50% of the study groups total population would be competent on wound care. The total population for each group are 200 for USTH nurses, 540 for junior interns and 120 for senior interns. With these in mind, the computed sample sizes for each group are 35 for UST nurses, 40 for the Junior Interns and 32 for the Senior Interns.This research will involve your participation in answering a survey comprised of multiple choice questions that will take about 5 to 10 minutes.You are being invited to take part in this research because we feel that your experience as a health care worker can contribute to our understanding regarding practices and techniques of wound care.The choice that you make will have no bearing on your job or on any work-related evaluations or reports. You may change your mind later and stop participating even if you agreed earlier.We are asking you to help us learn more about your knowledge regarding wound care. We are inviting you to take part in this research project. If you accept, you will be asked to fill out a survey, which we will provide and collect. If you do not wish to answer any of the questions included in the survey, you may skip them and move on to the next question. The information recorded is confidential, your name is not being included on the forms, only a number will identify you, and no one else except the members of our group will have access to your surveyThe research takes over for about 3-4 months. During that time we will allot 1 month to have people answer our survey.There will be no direct benefit to you but your participation is likely to be helpful in order to find out more about wound care practices in our institution.The research being done may draw attention and if you participate you may be asked questions by other people. We will not be sharing information about you to anyone outside of the research team. The information that we collect from this research project will be kept private. Any information about you will have a number on it instead of your name. Only the researchers will know what your number is and we will lock that information up with a lock and key. It will not be shared with or given to anyone except for the members of our group.You do not have to take part in this research if you do not wish to do so, and choosing to participate will not affect your job or job-related evaluations in any way. You may stop answering the survey at any time that you wish without your job being affected. This proposal has been reviewed and approved by USTH IRB, which is a committee whose task it is to make sure that research participants are protected from harm.

Part II: Certificate of Consent I have been invited to participate in this research regarding wound care practices. I have read the foregoing information, or it has been read to me. I have had the opportunity to ask questions about it and any questions I have been asked have been answered to my satisfaction. I consent voluntarily to be a participant in this study Print Name/ Initials of Participant__________________Signature of Participant ___________________Date ___________________________Day/month/year

APPENDIX DQuestionnaireWound care management survey

This 5 page questionnaire should take only 5-10 minutes to complete.Please indicate the information applicable to you by marking an X in the appropriate box. If other is selected, please elaborate in the box with the dotted line.By completing this questionnaire it will be accepted that you have agreed to participate in this research. Anonymity and confidentiality will be maintained.

Age< 20 years

21- 30 years

31- 40 years41- 50 years51- 60 years> 60 years

GenderFemale

Male

Current academic activitiesNoneNURSE

Junior InternSenior InternOther

........................

Your wound care interestNotInterestedInterested, butdo not readabout it.Interested andI have readabout it.Veryinterested,send mereadingmaterial.Very interested,send me ona course.Very interestedI want to doresearch in thisarea.

Please indicate the correct option by writing an X on the correct answer.Each question has only one correct answer.

1. The ideal dressing for a wound with dry necrotic tissue is:a. XFoam dressing (e.g. Allevyn or Biatan )b. Hydrocolloid gel and covering (e.g. Comfeel)c. Alginate dressing (e.g. Kaltostat)d. Dry gauzee. All of the above

2. The ideal dressing for a wound with slough (wet necrotic tissue) is:a. X Honey and paraffin gauzeb. Mercurochrome c. Vacuum dressing d. Dry gauzee. All of the above

3. The ideal dressing for a granulating wound is:a. XMaggots b. Hydrocolloid gel and paraffin gauze (e.g. Nu-gel)c. Alginate dressing (e.g. Kaltostat)d. Dry gauzee. All of the above

4. The ideal dressing for a dry and epithelializing wound is:a. XFoam dressing (e.g. Allevyn or Biatan)b. Hydrocolloid gel and paraffin gauze (e.g Intracyte)c. Alginate dressing (e.g. Kaltostat)d. Dry gauzee. All of the above

5. The ideal dressing for an ulcer producing excessive exudate is:a. Hydrocortisone cream and gauzeb. XHydrocolloid gel (e.g. Intracyte or Nu-gel) ) c. Alginate dressing (e.g. Kaltostat)d. Dry gauzee. Peanut butter and gauze (e.g. Black Cat)Please indicate the correct option by writing an x on the correct answer.Each question has only one correct answer.

6. Diabetic foot ulceration at the metatarsal joint of the big toe is best treated by:a. XWeight loss (diet and exercise)b. Pressure offloading (plaster cast or adaptation of shoe)c. Antibiotic cream and gauzed. Dry gauzee. Amputation

7. XChronic diabetic foot ulceration is often complicated by:a. Deep soft tissue infectionb. Superficial soft tissue infectionc. Myocardial infarctiond. Extreme pain.e. Secondary cancer.

8. Removal of callus around a diabetic ulcer:a. Requires daily soaks in warm water and macerated skin.b. Can only be performed in a theatre.c. XIs harmful and should be avoided.d. Activates wound healing by release of intrinsic growth factors.e. Increases the pressure on the wound area.

9. The ideal wound cleansing solution for a diabetic foot ulcer is:a. Povidone-iodene (undiluted)b. XHydrogen peroxidec. Normal Salined. 10% Acetic acide. Sodium Hypochlorite

10. Goals of management for infected diabetic foot ulceration includes all of the options below except:a. Thorough wound cleansingb. Debridement of callus and necrotic tissuec. Use of systemic antibiotics d. XOffloading of pressuree. Application of biological wound dressings (e.g. Derma-graft)Please indicate the correct option by writing an X on the correct answer.Each question has only one correct answer.

11. A grade 3 pressure ulcer is characterized by:a. A red area with no break in the skin.b. Necrosis to the level of the bony structures.c. The need for urgent surgery.d. XInvolvement of subcutaneous tissues but not fascia.e. Healing within two weeks and does not cause pain.

12. Optimal treatment for pressure ulcers will :a. Increase pressure on other bony areas.b. Kill every bacterium in the woundc. Increase the local inflammatory responsed. XDry up the wound environmente. Create a moist wound environment

13. Optimal treatment options for pressure ulcers include all of the option below except :a. Foam dressing + Hydro gelb. Hydrocolloid paste and hydrocolloid dressingc. XAlginate dressing (e.g. Kaltostat)d. Gauze and iodine ointment (e.g. Betadine)e. Negative pressure wound therapy (a vacuum dressing)

14. Wound evaluation for the purpose of reevaluating treatment objectives should be done:a. XDailyb. Weeklyc. Monthlyd. Every 3 monthse. Every 6 months

15. Indications for systemic antibiotics include all of below except :a. All grade 4 pressure ulcersb. Septicemia c. Osteomyelitisd. Advancing cellulitise. XNon-healing pressure ulcersPlease indicate the correct option by writing an X on the correct answer. Each question has only one correct answer.

16. Which of the following is correct concerning venous stasis ulcers:a. XAntibiotics should be reserved for patients with cellulitis or those with active infection requiring a skin graft.b. Ulcer dimensions should be measured every second day.c. Lanolin should be used to cleanse the ulcerd. Topical antibiotics seldom cause skin sensitivitye. Saline should not be used to cleanse the wound

17. XApplying a four layer compression system for a leg ulcer:a. Is ideal therapy for venous stasis ulcersb. Contraindicated for all ulcersc. Best for arterial ulcersd. Requires a duplex Doppler before it is safee. Is expensive and does not work

18. Compression therapy for venous ulcers include all of the below except:a. XElastic compression bandagesb. Multi-layer compression bandagesc. Elastic hose (e.g. Tubi-grip)d. Class three compression stockingse. Class two compression stockings

19. Look at the picture of a patients leg and decide which is the correct option concerning debriding the dead tissue:a. Will not help with managing infection. b. Should only be done surgically.c. Cannot be achieved with applying a hydro geld. XShould not be achieved by means of enzymes.e. Can be achieved by surgery or applying a desloughing cream. (E.g. Aserbine)

20. The following should be considered for first line of treatment for venous stasis ulcers:a. Bed restb. Amputationc. Oral antibioticsd. XTopical antisepticse. A graduated multilayer high compression system

21. Do you consider your pre graduate training in wound care to be?a.Totally inadequateb.Too Basicc.Appropriated.Advancede.Unnecessary

Thank you for your participation

APPENDIX ECurriculum Vitae and Good Clinical Practice Certificate of Investigators

RACHEL ANN TUAZON REYESCellphone No. 09178112973/09228843979 Email Add: [email protected]

OBJECTIVETo be able to practice and enhance my skills in any available setting.

EDUCATIONAL ATTAINMENT2014 to 2015Postgraduate Intern, University of Santo Tomas Hospital2010 to 2014Graduated Doctor of Medicine, UST Faculty of Medicine and Surgery2006 to 2010Graduated BS Biology, University of Santo Tomas College of Science 2002 to 2006Graduated Secondary Education at St. Paul College Bocaue1996 to 2002Graduated Primary Education at St. Paul College Bocaue

ACHIEVEMENTS/POSITIONS HELDOrganizationsMedical Missions Incorporated, Alumni Committee Head (A.Y. 2011-2012)Biology Society - Outreach and Spiritual Committee Head (2009-2010)SchoolMost Outstanding Student CWTS (2007-2008)Academic excellence Awardee, Leadership Silver (H.S Graduation 2006)

SEMINARS ATTENDED2011Leadership Training Seminar (Medical Missions Inc)2008 and 2009Leadership Training Seminar (Biology Society)PERSONAL DATAAddress2188 La Trinidad Subdivison Lolomboy, Bocaue, BulacanCitizenshipFilipinoDate of BirthMay 31, 1989Place of BirthBunducan, Bocaue, BulacanCivil StatusSingleTel. No.09178112973/09178843979____________________________________________________________________________________SKILLSProficient in all MS-Office applications and Internet ExplorerFluent in spoken English and Filipino

REFERENCESClarissa Mendoza, MDThesis Adviser, Department of Medical Education and ResearchMr. Ernesto GuillermoAcademic Chairman, St. Paul College of Bocaue 09175170016

Ana Katrina Rubin26 Kyoto St. BF Homes, Paranaque

Mobile: 09228473175

Email:[email protected]

Professional ProfileA Postgraduate Intern of University of Santo Tomas Hospital with a clear logical mind and practical approach to problem and drive to see things through completion. Education and QualificationsGraduated at Elizabeth Seton School (2002 2006)BS Biology Graduate of University of Santo Tomas (2006 - 2010)Faculty of Medicine and Surgery Graduate (2010 - 2014)Post Graduate Intern University Of Santo Tomas Hospital (2014 present)

Key I.T. Skills Microsoft Office

Other / Personal DetailsInterests include:

Jessica Nicole Sabido 3910K Sociego St. Sta. Mesa, Manila

Mobile: 09328899224


Professional ProfileA Postgraduate Intern of University of Santo Tomas Hospital with an open-mind, strong technical skills as well as excellent interpersonal skills. Eager to be challenged in order to grow and improve my medical skills gained through experience. Education and QualificationsGraduated at St. Jude Catholic School (2002-2006)Graduated Cum Laude BS Medical Technology at University of Santo Tomas (2006 - 2010)Faculty of Medicine and Surgery Graduate (2010 - 2014)Post Graduate Intern University Of Santo Tomas Hospital (2014 present)


Other / Personal DetailsInterests include:Reading books

Madeleine Ann Salazar215 P. Burgos St. Poblacion Bocaue, Bulacan

Mobile: 09223159396


Professional ProfileA Postgraduate Intern of University of Santo Tomas Hospital with a genuine interest to the better welfare of my patients, providing quality and efficient care. Highly organized and able to efficiently prioritize multiple task. Education and QualificationsGraduated at St. Paul College of Bocaue (2002-2006)BS Medical Technology Graduate of University of Santo Tomas (2006 - 2010)Faculty of Medicine and Surgery Graduate (2010 - 2014)Post Graduate Intern University Of Santo Tomas Hospital (2014 present)


Other / Personal DetailsInterests include:

Maxinne Arielle Sampang98 Wakas St. Capitangan, Abucay, Bataan

Mobile: 09229480468


Professional ProfileA Postgraduate Intern of University of Santo Tomas Hospital able to maintain positive attitude and productive work environament. Education and QualificationsGraduated 2nd honorable mention at Special Science Class of Arellano HS (2002-2006)Graduated Cum Laude BS Medical Technology at University of Santo Tomas (2006 - 2010)Passed the Medical Technology Licensure Examination (September, 2011)Faculty of Medicine and Surgery Graduate (2010 - 2014)Post Graduate Intern University Of Santo Tomas Hospital (2014 present)


Other / Personal DetailsInterests include:Playing Lawn Tennis

Laurice San Jose3 Santol St. Meadowood Subdivision, Panapaan, Bacoor, Cavite

Mobile: 09433111472


Professional ProfileA Postgraduate Intern of University of Santo Tomas Hospital with demonstrable ability to establish trust, emote genuine patient caring and manage crisis situations.Education and QualificationsGraduated at Elizabeth Seton School (2002 2006)BS Biology Graduate of University of Santo Tomas (2006 - 2010)Faculty of Medicine and Surgery Graduate (2010 - 2014)Post Graduate Intern University Of Santo Tomas Hospital (2014 present)

Key I.T. Skills Microsoft Office Adobe Photo Shop

Other / Personal DetailsInterests include:Singing, Impersonation, Interior designing

Demie Dane C. Sanoria1220 Santander St. Pacific Grand Tower 1 Sampaloc, ManilaMobile: 09226927689/09166398646


Professional ProfileA proud Postgraduate Intern of University of Santo Tomas Hospital dedicated to provide safe, efficient and patient centered care.Education and QualificationsGraduated High School at Leyte National High School (2006)BS Nursing Graduate of the University of Santo Tomas (2006 - 2010)Nursing Licensure Examination Passer (July 2010)Graduated from the Faculty of Medicine and Surgery (2010 - 2014)Post Graduate Intern of the University Of Santo Tomas Hospital (2014 present)

Key I.T. Skills Microsoft Office Microsoft Excel

Epi Info Microsoft Powerpoint Adobe Photoshop

Other / Personal DetailsInterests include:Playing musical instruments (guitar, bass, drums, keyboards), sketching/painting, reading books (non-fiction), listening to music (classical, rock, blues, jazz,), architectural design, playing video games, jogging

Britten Norman Santiago168 A. Mabini St. Sabang, Baliuag, Bulacan

Mobile: 09256215574/09175136615


Professional ProfileA proud Postgraduate Intern of University of Santo Tomas Hospital dedicated to provide safe, efficient and patient centered care.Education and Qualifications2014 2015 Post Graduate Intern University Of Santo Tomas Hospital

2010 2014 Graduated Doctor of Medicine, Faculty of Medicine and Surgery UST

July 2010Philippine Nursing Licensure Examination Board Passer

2006 2010 Graduate Bachelor of Science in Nursing, College of Nursing UST

2002 2006 Graduated as the First Honorable Mention, Secondary Education at Saint Paul College San Rafael

1996 2002 Graduated Primary education at Saint Paul College San Rafael

Key I.T. Skills Microsoft Office Microsoft Excel

Epi Info Microsoft Powerpoint

Other / Personal DetailsInterests include:Playing Card games, reading books, plastic arts modeling.

Language:Proficient in both English and Tagalog

References:Dr. Carina F. Concepcion Pediatrician Cel. No. 09228193991

Madelyn Sevilla 45 Daniel St. Centerville Subdivision, Tandang Sora, Q.C.Mobile: 09177215228/09228289094


Professional ProfileA proud Postgraduate Intern of University of Santo Tomas Hospital dedicated to provide quality patient care, assess patient and implement proper treatment plans.Education and QualificationsGraduated at Miriam College High School (2006)BS Nursing Graduate of University of Santo Tomas (2006 - 2010)Passes the Nursing Licensure Examination (July 2010)Faculty of Medicine and Surgery Graduate (2010 - 2014)Post Graduate Intern University Of Santo Tomas Hospital (2014 present)

Key I.T. Skills Microsoft Office Microsoft Power Point Microsoft Excel

Other / Personal DetailsInterests include:Reading Books

Michelle Sim818 Gandara St. La Granda Mansion, Sta. Cruz, Manila

Mobile: 09255770988


Professional ProfileA Postgraduate Intern of University of Santo Tomas Hospital dedicated to provide appropriate care and get involved in patient treatment plan as neededEducation and QualificationsGraduated at Uno High School (2002 2006)BS Biology Graduate of University of Santo Tomas (2006 - 2010)Faculty of Medicine and Surgery Graduate (2010 - 2014)Post Graduate Intern University Of Santo Tomas Hospital (2014 present)


Other / Personal DetailsInterests include:Reading books

APPENDIX F


March 16, 2015

Eduardo Vicente Caguioa, MDMedical DirectorUniversity of Santo Tomas Hospital

Dear Sir: Greetings! We are the postgraduate interns in the Department of Medical Education and Research in the University of Santo Tomas Hospital. We are currently in the process of completing our research paper entitled: A Survey of Wound Care Knowledge Among Health Care Workers in the University of Santo Tomas Hospital which aims to ascertain how much time is devoted by the nurses, junior and senior interns in teaching their patients and relatives regarding proper wound care, and to determine the state of knowledge about wound care among health care workers in the University of Santo Tomas Hospital.In this regard, we would like to ask your good office to allow the postgraduate interns, junior interns, and nurses to answer our 21 item survey. The information regarding the study and the informed consent are included in the survey. The survey is likewise voluntary and the participants may withdraw anytime they want to. Attached to this letter is our research protocol and IRB approval. Your favorable response to this matter will highly be appreciated. Thank you very much for your consideration. Sincerely,

Rachel Ann ReyesBritten Norman SantiagoGroup 9 PGI RepresentativeGroup 9 PGI RepresentativeNoted by:Clarissa Mendoza, MDTraining Officer of Postgraduate InternsDepartment of Medical Education and Research


Approved by:

Eduardo Vicente Caguioa, MDMedical Director


March 16, 2015


Dear Sir: Greetings! We are the postgraduate interns in the Department of Medical Education and Research in the University of Santo Tomas Hospital. We are currently in the process of completing our research paper entitled: A Survey of Wound Care Knowledge Among Health Care Workers in the University of Santo Tomas Hospital which aims to ascertain how much time is devoted by the nurses, junior and senior interns in teaching their patients and relatives regarding proper wound care, and to determine the state of knowledge about wound care among health care workers in the University of Santo Tomas Hospital.In this regard, we would like to ask your good office to allow the postgraduate interns to answer our 21 item survey. The information regarding the study and the informed consent are included in the survey. The survey is likewise voluntary and the participants may withdraw anytime they want to. Attached to this letter is our research protocol and IRB approval. Your favorable response to this matter will highly be appreciated. Thank you very much for your consideration.Sincerely,


Approved by:Marcellus Francis Ramirez, MDChair, Department of Medical Education and Research


March 16, 2015

Jesus Valencia, MDDeanFaculty of Medicine and SurgeryDear Doctor:Greetings! We are the postgraduate interns in the Department of Medical Education and Research in the University of Santo Tomas Hospital. We are currently in the process of completing our research paper entitled: A Survey of Wound Care Knowledge Among Health Care Workers in the University of Santo Tomas Hospital which aims to ascertain how much time is devoted by the nurses, junior and senior interns in teaching their patients and relatives regarding proper wound care, and to determine the state of knowledge about wound care among health care workers in the University of Santo Tomas Hospital.In this regard, we would like to ask your good office to allow the junior interns to answer our 21 item survey. The information regarding the study and the informed consent are included in the survey. The survey is likewise voluntary and the participants may withdraw anytime they want to. . Attached to this letter is our research protocol and IRB approval. Your favorable response to this matter will highly be appreciated. Thank you very much for your consideration.Sincerely,


Marcellus Francis Ramirez, MDChair, Department of Medical Education and ResearchApproved by:Jesus Valencia, MDDeanFaculty of Medicine and Surgery


March 16, 2015

Emilio Alvarez, Ph D, RN Chief, Department of Nursing ServicesUniversity of Santo Tomas Hospital

Dear Sir: Greetings! We are the postgraduate interns in the Department of Medical Education and Research in the University of Santo Tomas Hospital. We are currently in the process of completing our research paper entitled: A Survey of Wound Care Knowledge Among Health Care Workers in the University of Santo Tomas Hospital which aims to ascertain how much time is devoted by the nurses, junior and senior interns in teaching their patients and relatives regarding proper wound care, and to determine the state of knowledge about wound care among health care workers in the University of Santo Tomas Hospital.In this regard, we would like to ask your good office to allow the nurses of both clinical and private division to answer our 21 item survey. The information regarding the study and the informed consent are included in the survey. The survey is likewise voluntary and the participants may withdraw anytime they want to. . Attached to this letter is our research protocol and IRB approval. Your favorable response to this matter will highly be appreciated. Thank you very much for your consideration.Sincerely,


Marcellus Francis Ramirez, MDChair, Department of Medical Education and ResearchApproved by:Emilio Alvarez, Ph D, RNChief, Department of Nursing Services

Protocol/ICF Version 2 dated 16 March 2015 40

research study on knowledge of interns regarding wound care

Documents

Transcript of research study on knowledge of interns regarding wound care