Research Study On Knowledge of Interns Regarding Wound Care

University of Santo Tomas Hospital
Department of Medical Education and Research

Espaa, Manila
February 10, 2015
Wilson Tan De Guzman, MD
Chair, Institutional Review Board
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 Hospital
In 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 Reyes

Sabido
Principal Investigator
Investigator
Ana Katrina Rubin
Jessica Nicole
Principal
Madeleine Ann Salazar

Investigator
Maxinne Arielle Sampang

Laurice San Jose

Principal
Demie Dane Sanoria

Investigator
Britten Norman Santiago

Madelyn Sevilla
Principal
Michelle Sim

Protocol/ICF Version 2 dated 16 March 2015

Espaa, Manila
February 10, 2015
Wilson Tan De Guzman, MD
Chair, Institutional Review Board
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.
Sincerely,
Clarissa Mendoza, MD
Training Officer of Postgraduate Interns
Noted by:
Marcellus Francis Ramirez, MD
Chair, 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 the

In partial fulfillment of the Requirements for the

Postgraduate Internship
Reyes, Rachel Ann

Rubin, Ana Katrina
Sabido, Jessica Nicole
Salazar, Madeleine Ann
Sampang, Maxinne Arielle
San Jose, Laurice
Sanoria, Demie Dane
Santiago, Britten Norman
Sevilla, Madelyn
Sim, Michelle
February 2015

Table of Contents
Title Page
Table of Contents
Chapter I: Introduction
Chapter II: Review of Related Literature
Chapter III: Methodology
12
Chapter IV: Results, Discussion, and Conclusions
REFERENCES
17
Appendix A: Time Table (Gannt Chart)
18
Appendix B: Budget
19
Appendix C: Informed Consent
20
Appendix D: Questionnaire
22
Appendix E: Curriculum Vitae and Good Clinical Practice
28
Appendix 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 PROBLEM
1 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?
OBJECTIVES
This 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 LITERATURE
The 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
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
10
in wound care. In the their study 162 medical students, 45 General Practitioner and
47 surgical registrars completed their questionnaires. The overall median (25 th75th
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)
11
CHAPTER III: METHODOLOGY

Study 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 postoperatively. 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 STUDY
The study would be limited to the University of Santo Tomas Hospital working staff
consisting of nurses, junior interns, postgraduate interns.
STUDY SUBJECT
Includes 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
12
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 CRITERIA
1 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 CRITERIA
1 Excludes other University of Santo Tomas Hospital healthcare staffs such as
residents, consultants, radiation and medical technologist and nurse aids.
WITHDRAWAL CRITERIA
In 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 SIZE
The 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.
13
SAMPLING TECHNIQUE
Random sampling would be used as a means of obtaining a sample.
Questionnaire
The 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
14
asked in the questionnaire. An alpha value of 0.05 will be accepted as indicating a

significant result.
ETHICAL CONSIDERATIONS
Privacy and Confidentiality
The 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.
Recruitment
The 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.
Benefits
This 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.
Risk
Since 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 expenses
No 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.
15
Informed consent process

Informed 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 interest
There 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.
16
REFERENCES
1. 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 Chandler
3. Factors Affecting Wound Healing. S. Guo, L.A. DiPietro. J Dent Res. 2010 March;
89(3): 219229. doi: 10.1177/0022034509359125
4. 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: 185-206
5. Wound Care Essentials - Practice Principles 3rd ed. - S. Baranoski, et. al.,
(Lippincott, 2012) BBS
6. David Keast MSc, MD, CCFP Heather Orsted RN, BN, ET. The Basic Principles
of Wound Healing. 2004.
17
APPENDIX A
GANNT CHART
2015
January
Finalizing the research
paper before
submission to IRB
February
Submission to the IRB
March
Data Collection
Data Collection
Finalizing the Research

Paper
April
Finalizing the research
paper
Research paper
presentation
18
APPENDIX B
STUDY BUDGET
Bond papers, Folders --------------------------------------------------------------------------------------- Php 300

Printing --------------------------------------------------------------------------------------------------------- Php 500
TOTAL --------------------------------------------------------------------------------------------------------- Php 800
19
APPENDIX C
Informed Consent
This 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 9

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.
20
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 survey
The research takes over for about 3-4 months. During that time we will allot 1
people answer our survey.
month
to
have
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
21
APPENDIX D
Questionnaire
Wound 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 years
41- 50 years
51- 60 years
> 60 years
Gender
Female
Male
Current academic activities

None
NURSE
Junior Intern
Senior Intern
Other
........................
Your wound care interest

Not
Interested, but
Interested and
Very
Very
Very interested
Interested
do not read
I have read
interested,
interested,
I want to do
about it.
about it.
send me
send me on
research in this
reading
a course.
area.
material.
Please indicate the correct option by writing an X on the correct answer.

22
Each question has only one correct answer.
1. The ideal dressing for a wound with dry necrotic tissue is:
a. Foam dressing (e.g. Allevyn or Biatan )
X b. Hydrocolloid gel and covering (e.g. Comfeel)

c.
Alginate dressing (e.g. Kaltostat)
d. Dry gauze
e. All of the above
2. The ideal dressing for a wound with slough (wet necrotic tissue) is:
X a.
Honey and paraffin gauze
b. Mercurochrome
c.
Vacuum dressing
d. Dry gauze
e. All of the above
3. The ideal dressing for a granulating wound is:
a. Maggots
X b. Hydrocolloid gel and paraffin gauze (e.g. Nu-gel)

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

c.
d. Dry gauze
e. All of the above
5. The ideal dressing for an ulcer producing excessive exudate is:
a. Hydrocortisone cream and gauze
b. Hydrocolloid gel (e.g. Intracyte or Nu-gel) )
X c. Alginate dressing (e.g. Kaltostat)

d. Dry gauze
e. Peanut butter and gauze (e.g. Black Cat)
Please indicate the correct option by writing an x on the correct answer.
23
6. Diabetic foot ulceration at the metatarsal joint of the big toe is best treated by:
a. Weight loss (diet and exercise)
X b. Pressure offloading (plaster cast or adaptation of shoe)

c.
Antibiotic cream and gauze
d. Dry gauze
e. Amputation
7. Chronic diabetic foot ulceration is often complicated by:
X a. Deep soft tissue infection

b. Superficial soft tissue infection
c.
Myocardial infarction
d. 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.
Is harmful and should be avoided.
X 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. Hydrogen peroxide
X c. Normal Saline
d. 10% Acetic acid
e. Sodium Hypochlorite
10. Goals of management for infected diabetic foot ulceration includes
all of the options below except:
a. Thorough wound cleansing
b. Debridement of callus and necrotic tissue
c.
Use of systemic antibiotics
d. Offloading of pressure
X e. Application of biological wound dressings (e.g. Derma-graft)

11. A grade 3 pressure ulcer is characterized by:
24
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.
X d. Involvement 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 wound
c.
Increase the local inflammatory response
d. Dry up the wound environment
X e. Create a moist wound environment

13. Optimal treatment options for pressure ulcers include all of the option below except :
a. Foam dressing + Hydro gel
b. Hydrocolloid paste and hydrocolloid dressing
c.
X 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. Daily
X b. Weekly
c.
Monthly
d. Every 3 months
e. Every 6 months
15. Indications for systemic antibiotics include all of below except :
a. All grade 4 pressure ulcers
b. Septicemia
c.
Osteomyelitis
d. Advancing cellulitis
X e. Non-healing pressure ulcers

16. Which of the following is correct concerning venous stasis ulcers:
X a. Antibiotics 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.
25
c.
Lanolin should be used to cleanse the ulcer
d. Topical antibiotics seldom cause skin sensitivity

e. Saline should not be used to cleanse the wound
17. Applying a four layer compression system for a leg ulcer:
X a. Is ideal therapy for venous stasis ulcers

b. Contraindicated for all ulcers
c.
Best for arterial ulcers
d. Requires a duplex Doppler before it is safe

e. Is expensive and does not work
18. Compression therapy for venous ulcers include all of the below
except:
a. Elastic compression bandages
X b. Multi-layer compression bandages

c.
Elastic hose (e.g. Tubi-grip)
d. Class three compression stockings

e. 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 gel
d. Should not be achieved by means of enzymes.
X e. Can be achieved by surgery or applying a desloughing cream.

(E.g. Aserbine)
26
20. The following should be considered for first line of treatment for
venous stasis ulcers:
a. Bed rest
b. Amputation
c.
Oral antibiotics
d. Topical antiseptics
X e. A graduated multilayer high compression system
21. Do you consider your pre graduate training in wound care to be?
a. Totally inadequate
b. Too Basic
c. Appropriate
d. Advanced
e. Unnecessary
Thank you for your participation
APPENDIX E
Curriculum Vitae and Good Clinical Practice Certificate of Investigators
RACHEL ANN TUAZON REYES
Cellphone No. 09178112973/09228843979
Email Add: rachelreyes_53189@yahoo.com
OBJECTIVE
To be able to practice and enhance my skills in any available setting.
EDUCATIONAL ATTAINMENT
27
2014 to 2015
2010 to 2014
2006 to 2010
2002 to 2006
1996 to 2002
Postgraduate Intern, University of Santo Tomas Hospital

Graduated Doctor of Medicine, UST Faculty of Medicine and Surgery
Graduated BS Biology, University of Santo Tomas College of Science
Graduated Secondary Education at St. Paul College Bocaue
Graduated Primary Education at St. Paul College Bocaue
ACHIEVEMENTS/POSITIONS HELD
Organizations
Medical Missions Incorporated, Alumni Committee Head (A.Y. 2011-2012)
Biology Society - Outreach and Spiritual Committee Head (2009-2010)
School
Most Outstanding Student CWTS (2007-2008)
Academic excellence Awardee, Leadership Silver (H.S Graduation 2006)
SEMINARS ATTENDED
2011
Leadership Training Seminar (Medical Missions Inc)
2008 and 2009
Leadership Training Seminar (Biology Society)
PERSONAL DATA
Address
2188 La Trinidad Subdivison Lolomboy, Bocaue, Bulacan
Citizenship
Filipino
Date of Birth
May 31, 1989
Place of Birth
Bunducan, Bocaue, Bulacan
Civil Status
Single
Tel. No.
09178112973/09178843979
_________________________________________________________________________________
___
SKILLS
Proficient in all MS-Office applications and Internet Explorer
Fluent in spoken English and Filipino
REFERENCES
Thesis Adviser, Department of Medical Education and Research
Mr. Ernesto Guillermo
Academic Chairman, St. Paul College of Bocaue
09175170016
Ana Katrina Rubin

26 Kyoto St. BF Homes, Paranaque
Mobile:
Email:
09228473175
rubinana@yahoo.com
Professional Profile
28
A 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 Qualifications
Graduated 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 Details

Interests include:
Jessica Nicole Sabido

3910K Sociego St. Sta. Mesa, Manila
Mobile:
Email:
09328899224
jessica_sabido@yahoo.com
29
A 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.
Graduated at St. Jude Catholic School (2002-2006)
Graduated Cum Laude BS Medical Technology at University of Santo Tomas (2006 - 2010)
Key I.T. Skills
Microsoft Office

Interests include:
Reading books
Madeleine Ann Salazar

215 P. Burgos St. Poblacion Bocaue, Bulacan
Mobile:
Email:
09223159396
madeleineann721@yahoo.com
30
A 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.
Graduated at St. Paul College of Bocaue (2002-2006)
BS Medical Technology Graduate of University of Santo Tomas (2006 - 2010)
Key I.T. Skills
Microsoft Office

Interests include:
Maxinne Arielle Sampang

98 Wakas St. Capitangan, Abucay, Bataan
Mobile:
Email:
09229480468
maxinne.arielle@gmail.com
31
A Postgraduate Intern of University of Santo Tomas Hospital able to maintain positive attitude and
productive work environament.
Graduated 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)
Key I.T. Skills
Microsoft Office

Interests include:
Playing Lawn Tennis
Laurice San Jose

3 Santol St. Meadowood Subdivision, Panapaan, Bacoor, Cavite
Mobile:
Email:
09433111472
lauricesanjose@yahoo.com
32
A Postgraduate Intern of University of Santo Tomas Hospital with demonstrable ability to establish
trust, emote genuine patient caring and manage crisis situations.
Graduated at Elizabeth Seton School (2002 2006)
Key I.T. Skills
Microsoft Office
Adobe Photo Shop

Interests include:
Singing, Impersonation, Interior designing
Demie Dane C. Sanoria

1220 Santander St. Pacific Grand Tower 1 Sampaloc, Manila
Mobile:
09226927689/09166398646
Email:
demz_sanoria@yahoo.com
33
A proud Postgraduate Intern of University of Santo Tomas Hospital dedicated to provide safe, efficient
and patient centered care.
Graduated 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
Epi Info
Microsoft Excel
Microsoft Powerpoint
Adobe Photoshop

Interests 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

168 A. Mabini St. Sabang, Baliuag, Bulacan
Mobile:
Email:
09256215574/09175136615
brittensantiago@yahoo.com
34
A proud Postgraduate Intern of University of Santo Tomas Hospital dedicated to provide safe, efficient
and patient centered care.
2014 2015
2010 2014
July 2010
2006 2010
2002 2006
Post Graduate Intern University Of Santo Tomas Hospital

Graduated Doctor of Medicine, Faculty of Medicine and Surgery UST
Philippine Nursing Licensure Examination Board Passer
Graduate Bachelor of Science in Nursing, College of Nursing UST
Graduated as the First Honorable Mention, Secondary Education at Saint Paul College San
Rafael
Graduated Primary education at Saint Paul College San Rafael
1996 2002
Key I.T. Skills
Microsoft Office
Epi Info
Microsoft Excel
Microsoft Powerpoint

Interests include:
Language:
References:
Playing Card games, reading books, plastic arts modeling.

Proficient in both English and Tagalog
Dr. Carina F. Concepcion Pediatrician Cel. No. 09228193991
Madelyn Sevilla
45 Daniel St. Centerville Subdivision, Tandang Sora, Q.C.
Mobile:
09177215228/09228289094
Email:
madsevilla@gmail.com
35
A proud Postgraduate Intern of University of Santo Tomas Hospital dedicated to provide quality patient
care, assess patient and implement proper treatment plans.
Graduated at Miriam College High School (2006)
BS Nursing Graduate of University of Santo Tomas (2006 - 2010)
Passes the Nursing Licensure Examination (July 2010)
Key I.T. Skills
Microsoft Office
Microsoft Power Point
Microsoft Excel

Interests include:
Reading Books
Michelle Sim
818 Gandara St. La Granda Mansion, Sta. Cruz, Manila
Mobile:
Email:
09255770988
mdsim821@yahoo.com
36
A Postgraduate Intern of University of Santo Tomas Hospital dedicated to provide appropriate care
and get involved in patient treatment plan as needed
Graduated at Uno High School (2002 2006)
Key I.T. Skills
Microsoft Office

Interests include:
Reading books
APPENDIX F
Espaa, Manila
March 16, 2015
Eduardo Vicente Caguioa, MD
37
Medical Director
Dear Sir:
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.
Sincerely,
Rachel Ann Reyes

Group 9 PGI Representative

Noted by:
Approved by:
Eduardo Vicente Caguioa, MD
Medical Director

Espaa, Manila
March 16, 2015
38
Dear Sir:
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.
Sincerely,
Rachel Ann Reyes


Noted by:
Approved by:

Espaa, Manila
March 16, 2015
Jesus Valencia, MD
Dean
Faculty of Medicine and Surgery
Dear Doctor:
39
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.
Sincerely,
Rachel Ann Reyes


Noted by:
Approved by:
Jesus Valencia, MD
Dean
Faculty of Medicine and Surgery

Espaa, Manila
March 16, 2015
Emilio Alvarez, Ph D, RN
Chief, Department of Nursing Services
Dear Sir:
40
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.
Sincerely,
Rachel Ann Reyes


Noted by:
Approved by:
Emilio Alvarez, Ph D, RN
Chief, Department of Nursing Services
41

Research Study On Knowledge of Interns Regarding Wound Care

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University of Santo Tomas Hospital

Department of Medical Education and Research

Rachel Ann Reyes

Ana Katrina Rubin

Madeleine Ann Salazar

Maxinne Arielle Sampang

Laurice San Jose

Demie Dane Sanoria

Britten Norman Santiago

University of Santo Tomas Hospital

Department of Medical Education and Research

A SURVEY OF WOUND CARE KNOWLEDGE AMONG HEALTH CARE WORKERS

A Research Paper Submitted to the

In partial fulfillment of the Requirements for the

Reyes, Rachel Ann

University of Santo Tomas Hospital

Chapter II: Review of Related Literature

Chapter III: Methodology

Chapter IV: Results, Discussion, and Conclusions

Appendix A: Time Table (Gannt Chart)

Appendix C: Informed Consent

Appendix E: Curriculum Vitae and Good Clinical Practice

Appendix F: Approval Letter (Medical director, DMER Chair,

Hence, this study aims (i) to

Protocol/ICF Version 2 dated 16 March 2015

CHAPTER II: REVIEW OF RELATED LITERATURE

Protocol/ICF Version 2 dated 16 March 2015

Protocol/ICF Version 2 dated 16 March 2015

(polymorphonucleocytes). The inflammatory response causes the blood vessels to

Protocol/ICF Version 2 dated 16 March 2015

collagen framework on which further dermal regeneration occurs. Specialized

undergraduates. They have stated that it is clear that improvement in education

Protocol/ICF Version 2 dated 16 March 2015

CHAPTER III: METHODOLOGY

Protocol/ICF Version 2 dated 16 March 2015

Protocol/ICF Version 2 dated 16 March 2015

asked in the questionnaire. An alpha value of 0.05 will be accepted as indicating a

Protocol/ICF Version 2 dated 16 March 2015

Informed consent process

Protocol/ICF Version 2 dated 16 March 2015

Protocol/ICF Version 2 dated 16 March 2015

Finalizing the Research

Protocol/ICF Version 2 dated 16 March 2015

Bond papers, Folders --------------------------------------------------------------------------------------- Php 300

Protocol/ICF Version 2 dated 16 March 2015

UST Post Graduate Interns Group 9

Researcher Contact Information: Britten Norman Santiago et al,

Part I: Information Sheet

Protocol/ICF Version 2 dated 16 March 2015

Part II: Certificate of Consent

Protocol/ICF Version 2 dated 16 March 2015

Current academic activities

Your wound care interest

Please indicate the correct option by writing an X on the correct answer.

Each question has only one correct answer.

X b. Hydrocolloid gel and covering (e.g. Comfeel)

Alginate dressing (e.g. Kaltostat)

Honey and paraffin gauze

X b. Hydrocolloid gel and paraffin gauze (e.g. Nu-gel)

Alginate dressing (e.g. Kaltostat)

X b. Hydrocolloid gel and paraffin gauze (e.g Intracyte)

Alginate dressing (e.g. Kaltostat)

X c. Alginate dressing (e.g. Kaltostat)