Spradbrow Jordan, Etchells Matthew, Cartotto Robert, Halliday Alison, Lin Yulia, Simor Andrew, Visvalingam Raj, Callum Jeannie
From the *Department of Clinical Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; †Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ‡Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; and §Department of Microbiology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
J Burn Care Res. 2017 Sep/Oct;38(5):e786-e795. doi: 10.1097/BCR.0000000000000485.
The objective of this study was to review the incidence of skin allograft discard and bacterial contamination due to donor bioburden at the Ontario Professional Firefighters Skin Bank over a 14-year period. We sought to determine whether modifications to our prerecovery donor preparation process have been effective in reducing skin bioburden and identify other potential risk factors of allograft contamination. A retrospective review of all skin donors (n = 259) processed from 2002 to 2015 was performed. Multivariate logistic regression was used to determine whether donor-related factors and procurement-related factors were significantly associated with microbial contamination predisinfection and discard secondary to contamination. Eighty-one donor recoveries were discarded (81/259; 31%) or 694 grafts (694/2636; 26%), with bacterial contamination being the most common reason for discard (29/81; 36%) followed by positive viral serology (21/81; 26%) primarily for hepatitis B core antibodies. Bacterial contamination predisinfection was detected in 46% of donors (49% of grafts). Analysis of risk factors showed that only donor preparation using a 70% alcohol spray significantly reduced odds of both bacterial contamination predisinfection (P < .0001) and discard secondary to bacterial contamination (P = .0233). Our results suggest that selective screening of donors to reduce risk of microbial contamination is unlikely to alter the rate of allograft contamination. However, use of a 70% alcohol spray during donor preparation may minimize bacterial contamination and subsequent bacterial-related discards. Given that detailed guidelines for donor preparation do not exist, use of an alcohol spray may be of value for tissue banks experiencing allograft loss due to bacterial contamination.
本研究的目的是回顾安大略省职业消防员皮肤库在14年期间因供体生物负荷导致的皮肤同种异体移植物丢弃和细菌污染的发生率。我们试图确定对我们的术前供体制备过程所做的修改是否有效地降低了皮肤生物负荷，并确定同种异体移植物污染的其他潜在风险因素。对2002年至2015年处理的所有皮肤供体（n = 259）进行了回顾性研究。采用多因素逻辑回归分析来确定供体相关因素和获取相关因素是否与消毒前的微生物污染以及因污染导致的丢弃显著相关。81例供体获取物被丢弃（81/259；31%）或694块移植物（694/2636；26%），细菌污染是丢弃的最常见原因（29/81；36%），其次是病毒血清学阳性（21/81；26%），主要是乙肝核心抗体阳性。46%的供体（49%的移植物）检测到消毒前细菌污染。风险因素分析表明，只有使用70%酒精喷雾进行供体制备才能显著降低消毒前细菌污染（P <.0001）和因细菌污染导致的丢弃的几率（P =.0233）。我们的结果表明，选择性筛查供体以降低微生物污染风险不太可能改变同种异体移植物污染率。然而，在供体制备过程中使用70%酒精喷雾可能会将细菌污染及随后因细菌导致的丢弃降至最低。鉴于不存在供体制备的详细指南，对于因细菌污染而出现同种异体移植物损失的组织库，使用酒精喷雾可能有价值。
