The SILKIE (Skin graftIng Low friKtIon Environment) study: A non-randomised proof-of-concept and feasibility study on the impact of low-friction nursing environment on skin grafting success rates in adult and paediatric burns

Linda Hollén; Rosemary Greenwood; Rebecca Kandiyali; Jenny Ingram; Chris Foy; Susan George; Sandra Mulligan; Francesca Spickett-Jones; Simon Booth; Anthony Sack; Alan Emond; Ken Dunn; Amber Young

doi:10.1136/bmjopen-2018-021886

The SILKIE (Skin graftIng Low friKtIon Environment) study: A non-randomised proof-of-concept and feasibility study on the impact of low-friction nursing environment on skin grafting success rates in adult and paediatric burns

Linda Hollén, Rosemary Greenwood, Rebecca Kandiyali, Jenny Ingram, Chris Foy, Susan George, Sandra Mulligan, Francesca Spickett-Jones, Simon Booth, Anthony Sack, Alan Emond, Ken Dunn, Amber Young

Research output: Contribution to journal › Article › peer-review

Abstract

Objectives To evaluate the impact of low-friction (LF) bedding on graft loss in an acute burn care setting, and to examine the feasibility and costs of using LF bedding compared with standard care. Design Proof of concept before and after study with feasibility of delivering the intervention. Setting Three burns services within two UK hospital trusts. Participants Inclusion criteria were patients older than 4 weeks, who received a skin graft after burn injury and were admitted overnight. The comparator cohort were eligible patients admitted in a 12-month period before the intervention. Intervention Introduction of LF sheets and pillowcases during a 15-month period. Outcome measures For proof of concept, the LF and comparator cohorts were compared in terms of number of regrafting operations (primary), percentage graft loss, hospital length of stay (LoS) and LoS cost (secondary). Feasibility outcomes were practicality and safety of using LF bedding. Results 131 patients were eligible for the LF cohort and 90 patients for the comparator cohort. Although the primary outcome of the proportion needing regrafting was halved in the LF cohort, the confidence interval (CI) crossed 1 (OR (95% CI): 0.56 (0.16 to 1.88)). Partial graft loss (any loss) was significantly reduced in the LF cohort (OR (95% CI): 0.27 (0.14, 0.51)). Inpatient LoS was no different between the two cohorts (difference in median days (95% CI): 0 (-2 to 1)), and the estimated difference in LoS cost was $-1139 (-4829 to 2551). Practical issues were easily resolved, and no safety incidents occurred while patients were nursed on LF bedding. Conclusions LF bedding is safe to use in burned patients with skin grafts and we have shown proof of concept for the intervention. Further economic modelling is required to see if an appropriately powered randomised control trial would be worthwhile or if roll out across the National Health Service is justified.

Original language	English
Article number	e021886
Journal	BMJ Open
Volume	8
Issue number	6
DOIs	https://doi.org/10.1136/bmjopen-2018-021886
Publication status	Published - 14 Jun 2018

Bibliographical note

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

Keywords

burn injuries
burns
graft loss
low friction
skin grafting

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Hollén, L., Greenwood, R., Kandiyali, R., Ingram, J., Foy, C., George, S., Mulligan, S., Spickett-Jones, F., Booth, S., Sack, A., Emond, A., Dunn, K., & Young, A. (2018). The SILKIE (Skin graftIng Low friKtIon Environment) study: A non-randomised proof-of-concept and feasibility study on the impact of low-friction nursing environment on skin grafting success rates in adult and paediatric burns. BMJ Open, 8(6), Article e021886. https://doi.org/10.1136/bmjopen-2018-021886

@article{ba0a49b1d83a4da3a964b79d3f2b570d,

title = "The SILKIE (Skin graftIng Low friKtIon Environment) study: A non-randomised proof-of-concept and feasibility study on the impact of low-friction nursing environment on skin grafting success rates in adult and paediatric burns",

abstract = "Objectives To evaluate the impact of low-friction (LF) bedding on graft loss in an acute burn care setting, and to examine the feasibility and costs of using LF bedding compared with standard care. Design Proof of concept before and after study with feasibility of delivering the intervention. Setting Three burns services within two UK hospital trusts. Participants Inclusion criteria were patients older than 4 weeks, who received a skin graft after burn injury and were admitted overnight. The comparator cohort were eligible patients admitted in a 12-month period before the intervention. Intervention Introduction of LF sheets and pillowcases during a 15-month period. Outcome measures For proof of concept, the LF and comparator cohorts were compared in terms of number of regrafting operations (primary), percentage graft loss, hospital length of stay (LoS) and LoS cost (secondary). Feasibility outcomes were practicality and safety of using LF bedding. Results 131 patients were eligible for the LF cohort and 90 patients for the comparator cohort. Although the primary outcome of the proportion needing regrafting was halved in the LF cohort, the confidence interval (CI) crossed 1 (OR (95% CI): 0.56 (0.16 to 1.88)). Partial graft loss (any loss) was significantly reduced in the LF cohort (OR (95% CI): 0.27 (0.14, 0.51)). Inpatient LoS was no different between the two cohorts (difference in median days (95% CI): 0 (-2 to 1)), and the estimated difference in LoS cost was $-1139 (-4829 to 2551). Practical issues were easily resolved, and no safety incidents occurred while patients were nursed on LF bedding. Conclusions LF bedding is safe to use in burned patients with skin grafts and we have shown proof of concept for the intervention. Further economic modelling is required to see if an appropriately powered randomised control trial would be worthwhile or if roll out across the National Health Service is justified.",

keywords = "burn injuries, burns, graft loss, low friction, skin grafting",

author = "Linda Holl{\'e}n and Rosemary Greenwood and Rebecca Kandiyali and Jenny Ingram and Chris Foy and Susan George and Sandra Mulligan and Francesca Spickett-Jones and Simon Booth and Anthony Sack and Alan Emond and Ken Dunn and Amber Young",

note = "{\textcopyright} Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/",

year = "2018",

month = jun,

day = "14",

doi = "10.1136/bmjopen-2018-021886",

language = "English",

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Hollén, L, Greenwood, R, Kandiyali, R, Ingram, J, Foy, C, George, S, Mulligan, S, Spickett-Jones, F, Booth, S, Sack, A, Emond, A, Dunn, K & Young, A 2018, 'The SILKIE (Skin graftIng Low friKtIon Environment) study: A non-randomised proof-of-concept and feasibility study on the impact of low-friction nursing environment on skin grafting success rates in adult and paediatric burns', BMJ Open, vol. 8, no. 6, e021886. https://doi.org/10.1136/bmjopen-2018-021886

The SILKIE (Skin graftIng Low friKtIon Environment) study: A non-randomised proof-of-concept and feasibility study on the impact of low-friction nursing environment on skin grafting success rates in adult and paediatric burns. / Hollén, Linda; Greenwood, Rosemary; Kandiyali, Rebecca et al.
In: BMJ Open, Vol. 8, No. 6, e021886, 14.06.2018.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The SILKIE (Skin graftIng Low friKtIon Environment) study

T2 - A non-randomised proof-of-concept and feasibility study on the impact of low-friction nursing environment on skin grafting success rates in adult and paediatric burns

AU - Hollén, Linda

AU - Greenwood, Rosemary

AU - Kandiyali, Rebecca

AU - Ingram, Jenny

AU - Foy, Chris

AU - George, Susan

AU - Mulligan, Sandra

AU - Spickett-Jones, Francesca

AU - Booth, Simon

AU - Sack, Anthony

AU - Emond, Alan

AU - Dunn, Ken

AU - Young, Amber

N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

PY - 2018/6/14

Y1 - 2018/6/14

N2 - Objectives To evaluate the impact of low-friction (LF) bedding on graft loss in an acute burn care setting, and to examine the feasibility and costs of using LF bedding compared with standard care. Design Proof of concept before and after study with feasibility of delivering the intervention. Setting Three burns services within two UK hospital trusts. Participants Inclusion criteria were patients older than 4 weeks, who received a skin graft after burn injury and were admitted overnight. The comparator cohort were eligible patients admitted in a 12-month period before the intervention. Intervention Introduction of LF sheets and pillowcases during a 15-month period. Outcome measures For proof of concept, the LF and comparator cohorts were compared in terms of number of regrafting operations (primary), percentage graft loss, hospital length of stay (LoS) and LoS cost (secondary). Feasibility outcomes were practicality and safety of using LF bedding. Results 131 patients were eligible for the LF cohort and 90 patients for the comparator cohort. Although the primary outcome of the proportion needing regrafting was halved in the LF cohort, the confidence interval (CI) crossed 1 (OR (95% CI): 0.56 (0.16 to 1.88)). Partial graft loss (any loss) was significantly reduced in the LF cohort (OR (95% CI): 0.27 (0.14, 0.51)). Inpatient LoS was no different between the two cohorts (difference in median days (95% CI): 0 (-2 to 1)), and the estimated difference in LoS cost was $-1139 (-4829 to 2551). Practical issues were easily resolved, and no safety incidents occurred while patients were nursed on LF bedding. Conclusions LF bedding is safe to use in burned patients with skin grafts and we have shown proof of concept for the intervention. Further economic modelling is required to see if an appropriately powered randomised control trial would be worthwhile or if roll out across the National Health Service is justified.

AB - Objectives To evaluate the impact of low-friction (LF) bedding on graft loss in an acute burn care setting, and to examine the feasibility and costs of using LF bedding compared with standard care. Design Proof of concept before and after study with feasibility of delivering the intervention. Setting Three burns services within two UK hospital trusts. Participants Inclusion criteria were patients older than 4 weeks, who received a skin graft after burn injury and were admitted overnight. The comparator cohort were eligible patients admitted in a 12-month period before the intervention. Intervention Introduction of LF sheets and pillowcases during a 15-month period. Outcome measures For proof of concept, the LF and comparator cohorts were compared in terms of number of regrafting operations (primary), percentage graft loss, hospital length of stay (LoS) and LoS cost (secondary). Feasibility outcomes were practicality and safety of using LF bedding. Results 131 patients were eligible for the LF cohort and 90 patients for the comparator cohort. Although the primary outcome of the proportion needing regrafting was halved in the LF cohort, the confidence interval (CI) crossed 1 (OR (95% CI): 0.56 (0.16 to 1.88)). Partial graft loss (any loss) was significantly reduced in the LF cohort (OR (95% CI): 0.27 (0.14, 0.51)). Inpatient LoS was no different between the two cohorts (difference in median days (95% CI): 0 (-2 to 1)), and the estimated difference in LoS cost was $-1139 (-4829 to 2551). Practical issues were easily resolved, and no safety incidents occurred while patients were nursed on LF bedding. Conclusions LF bedding is safe to use in burned patients with skin grafts and we have shown proof of concept for the intervention. Further economic modelling is required to see if an appropriately powered randomised control trial would be worthwhile or if roll out across the National Health Service is justified.

KW - burn injuries

KW - burns

KW - graft loss

KW - low friction

KW - skin grafting

UR - http://www.scopus.com/inward/record.url?scp=85053141980&partnerID=8YFLogxK

U2 - 10.1136/bmjopen-2018-021886

DO - 10.1136/bmjopen-2018-021886

M3 - Article

AN - SCOPUS:85053141980

SN - 2044-6055

VL - 8

JO - BMJ Open

JF - BMJ Open

IS - 6

M1 - e021886

ER -

The SILKIE (Skin graftIng Low friKtIon Environment) study: A non-randomised proof-of-concept and feasibility study on the impact of low-friction nursing environment on skin grafting success rates in adult and paediatric burns

Abstract

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Keywords

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