A 14-Year Audit and Analysis of Human Skin Allograft Discards

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.