I have a patient who had a failed mesh placement and a panniculectomy and who has developed at least three separate fistulas with a very large amount of output (3-4 L/24 hrs). Any suggestions? I am using an Eakin wound management pouch hooked up to wall suction.
A Three-Year Multiphase Pressure Ulcer Prevalence/Incidence Study in a Regional Referral Hospital
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A pressure ulcer is any lesion caused by pressure resulting in damage of underlying tissue.1 At least 3 million adults in the US are reported to have pressure ulcers yearly.2 Pressure ulcers can have a devastating impact on health and care provision, ranging from patient discomfort to increased healthcare costs. Conservative cost estimates of caring for a patient with a pressure ulcer range from $500 to $50,000.3 The average hospital incurs $400,000 to $700,000 annually in direct costs to treat pressure ulcers.4
Nosocomial pressure ulcers in hospitals are one indicator for quality of care. The key to successful outcomes is early assessment and interventions to prevent or reduce their incidence.5 Baseline and ongoing prevalence and incidence studies can help achieve the desired outcomes and measure the effectiveness of interventions implemented in pursuit of those outcomes.
Prevalence is defined as the proportion of a group that has a pressure ulcer at a given time, which may be a single point in time or a time period during which the cases are counted. Incidence is the proportion of the group initially free of pressure ulcers that develop them during a specified period of study.6
The cornerstone of pressure ulcer prevention is identifying and minimizing risk factors with the use of a validated risk assessment tool such as the Braden Scale. The AHRQ Pressure Ulcer Prediction and Prevention Guidelines list several other recommendations related to maintaining tissue tolerance to pressure. Among these recommendations are the use of mild cleansing agents to minimize dryness and treating dry skin with moisturizers.5 Healthcare agencies that implement focused skin care protocols to prevent pressure ulcers and intervene as early as possible have been able to demonstrate reductions in the prevalence and incidence of pressure ulcers.7,8
Skin Physiology and Related Care
Determining who is at risk for pressure ulcer development requires some understanding of the physiology of the skin. The largest organ, the skin is the dividing line between an individual and the environment. The skin protects against infectious micro-organisms, ultraviolet light, noxious substances, and excess fluid electrolyte loss and is instrumental in thermoregulation, sensation, metabolism, and communication.9 The skin’s protective function is a complex process involving the acid mantle (pH 4.5 to 6), normal skin flora, and lipid barrier (sebum and extracellular lipids located in the cell layers of the stratum corneum). The stratum corneum (horny layer) is continuously exposed to the outside environment, providing the first line of protection, and is a vital part of the body’s immune system.10 The acidic environment and normal flora (resident micro-organisms) reduce the chance for pathogens to invade, contributing to the body’s immune response.
The pH and surfactant system of a skin cleanser may influence the skin’s pH and lipid barrier. Washing with an alkaline soap can increase the pH of the skin and reduce the lipid barrier; therefore, a product with a pH of 4 to 7 and gentle surfactant system is recommended for skin cleansing. This is particularly important for the elderly patient population, whose skin is dryer, more prone to cracking, and slower to recover from the effects of alkaline substances.11 In addition, the act of cleansing involves friction, which further insults the stratum corneum. Dry stratum corneum and friction are generally accepted as precursors to pressure ulcer development and can be partially offset by using moisturizers to facilitate stratum corneum hydration.5,12-14
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Very interesting article. I hope to carry out a research like this in Jamaica in the near future
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