Deep Tissue Damage Research Articles

Accidental High Voltage Electrocution Leading To Abdominal Wall Blow Out With Omental Evisceration And Auto Amputation Of Right Upper Limb: An Unusual Presentation

Electricity is the backbone for modern industrialization, development and day to day needs. Electrical Injuries are among the most devastating of burn injuries. High voltage electrical injuries result in extensive deep tissue damage and are associated with multiple complications and a high mortality rate. The passage of electric current through the body, produces wide range of effects, varying from insignificant localised spasm, little or no contact burns, or extreme severe burns. We describe the case of a 6-year-old child who suffered high voltage electric injury leading to anterior abdominal wall blow out with omental evisceration and auto amputation of right forearm. He was initially resuscitated in emergency room followed by emergency exploratory laparotomy was done with primary repair of ileal perforation along with right arm 4 quadrant amputation. This paper also emphasizes the safety measures to be taken at work place pertaining to high voltage cable

The effect of traditional Chinese medicine soaking method on the healing of diabetic foot ulcers: A meta-analysis.

Foot infections, sores or deep tissue damage from diabetes can be a serious psychological and physical injury. This paper aims at making meta-analyses on the therapeutic effects of traditional Chinese medicine (TCM) on diabetic foot ulcers. The Chinese National Knowledge Infrastructure, VIP Database, Wanfang Database and so on, has conducted a randomized controlled trial to evaluate the clinical effect of TCM soaking method for diabetes patients with diabetes. Literature has been determined to be included by computer search and by hand rough checks. The search period was from the creation of the database to October 2023. Review Manager 5.3 was used to analyse the meta data and evaluate it systematically. Altogether, 479 research was conducted in China's data base and 20 of them were eventually collected for the final statistical analysis. In all, 1361 patients were enrolled in the trials. The results indicated that TCM immersion in diabetic foot resulted in significantly improved obvious wound healing (OR, 3.2; 95% CI, 2.5, 4.09, p < 0.0001); results showed that TCM immersion therapy significantly increased the efficiency of effective wound healing (OR, 4.55; 95% CI, 3.25, 6.37, p < 0.001). Statistical significance was found. Using Egger's approach to detect publishing bias suggests that there is no risk of publishing bias in terms of marked wound healing and effective healing. Traditional Chinese drug immersion can increase obviously the recovery ratio and the effective recovery ratio of diabetic foot.

Pain Assessment in Patients Undergoing Maggot Debridement Therapy in the Process of Local Treatment of Chronic Wounds

(1) Background: Developing and implementing strategies for local wound care focused on improving the quality of life related to health status and reducing treatment costs for this patient group poses a challenge to contemporary healthcare systems. The utilization of Maggot Debridement Therapy (MDT) is one potential form of local therapy for preparing wounds for the healing process. The debridement of the wound bed with medical maggots is highly precise, and the defensins produced by the larvae eliminate bacteria and stimulate tissue regeneration. However, the presence of larvae in the wound may lead to the occurrence of pain symptoms. The aim of the study was to assess the intensity of pain during larval therapy in patients with chronic wounds treated in outpatient settings. (2) Patients and Methods: The study employed a diagnostic survey and estimation; the tool consisted of a research protocol comprising three parts (questionnaires). Inclusion criteria for the study were voluntary consent to participate (completion of the MDT acceptance questionnaire), chronic wounds of vascular etiology or pressure injuries, full-thickness skin or deep tissue damage, and pain intensity not exceeding four on the NRS (Numerical Rating Scale: 0—no pain, 10—the most severe pain) at the time of the study. Patient observation during the 3-day treatment was conducted by a wound care clinic nurse, assessing pain intensity once every 24 h during the larval dressing changes. (3) Results: Out of 348 individuals who qualified for MDT during the study period, 215 individuals participated in the study: 94 women (43.7%) and 121 men (56.3%). The age of the participants ranged from 28 to 97 years (mean 69.87 ± 12.95). Each participant experienced mild pain (2.26 ± 1.60 on the NRS) on the day of qualification for the study. An increase in pain intensity, according to subjective assessments, was reported by 29.3% of participants (n = 63). On the third day of MDT therapy, an increase in pain intensity was observed, reaching a mean value of 4.79 ± 2.12 (p &lt; 0.0001). Participants with pressure injuries showed the lowest pain intensity, which increased in consecutive days for all types of wounds. Additionally, the increase in pain intensity in patients with vascular etiology wounds was greater compared to patients with pressure injuries (p &lt; 0.001). (4) Conclusions: Local wound therapy with Lucilia sericata larvae increases pain intensity in the consecutive days of treatment. The wound area and the time since its occurrence may determine pain symptoms.

Skin Care Experience of a Case of Multiple Organ Failure Caused by High-Voltage Electrical Injury

Background: High-voltage electrical burns are caused by the direct transmission of electric current through the body and the conversion of electric energy into heat energy, which directly heats the tissues and leads to organ function damage. Especially after high-voltage electric burns (more than 1000W), it can not only cause coagulation necrosis of the skin and even carbonization, but also cause serious deep tissue damage .The degree of tissue damage depends on the type of current, the magnitude of current, the frequency, the voltage, the resistance of the tissue, the skin humidity, the duration, the contact area, and other factors. Low voltage and low frequency electric shock mainly affect the heart and respiration, which can lead to insignificant soft tissue damage. High voltage electric shock mainly causes serious soft tissue damage, which can be accompanied by changes in the circulatory system and respiratory system.[1] Subject and Method: We collected the data of a case of multiple organ failure caused by high-voltage electricity that was successfully treated in July 2023.In the course of this patient's successful treatment, The main nursing measures were analyzed: The intake and output volume were actively controlled. Albumin supplementation, Debridement and dressing change were performed daily, Covered with nano-silver ion dressing, Try to ensure a sterile environment during operation, Maintain ambient temperature and humidity. Results: Twenty days later,the skin damage caused by electric burns was reduced from 30% to 1%. Conclusion: These are very important links: The intake and output volume were actively controlled, The balance of intake and output was maintained for 24 hours, and lactic acid was less than 2mmol/L. Albumin supplementation Controlled above 30g/L, Debridement and dressing change were performed daily, Covered with nano-silver ion dressing, Try to ensure a sterile environment during operation, Maintain ambient temperature 28~30℃ and humidity 40%~50%.

Clinical Analysis of 3D-Fluid Attenuated Inversion Recovery and T1volume interpolated body examination Sequences on Delayed Gadolinium-Enhanced Scanning in Ramsay Hunt Syndrome.

Through the clinical analysis of 4 clinically confirmed cases of delayed gadolinium enhancement of Ramsay Hunt syndrome 3D-Fluid Attenated Inversion Recovery'and 'T1volume interpolated body examination (3D-FLAIR and T1VIBE) sequences, the more suitable sequences and pathologically damaged tissue sites of deep tissues of Ramsay Hunt syndrome by magnetic resonance imaging gadolinium enhancement were preliminarily explored. From October 2020 to March 2021, 4 clinically confirmed patients with Ramsay Hunt syndrome, 2 males and 2 females, aged 27-63, were continuously collected in the hospital otology clinic. Siemens Avento 1.5T magnetic resonance imaging 3D-FLAIR and T1VIBE sequencedelayed gadolinium enhancement scans and serological laboratory tests were performed, respectively, and corresponding antiviral and antiinflammatory therapy was given. The magnetic resonance imaging gadolinium enhancement of 4 cases of Ramsay Hunt syndrome was as follows: 3D-FLAIR sequence delay of 4.5 hours scanning 4 patients labyrinthine and/or middle ear signal was enhanced at the same time as the healthy side; T1VIBE sequence scanning disease in 3 cases of vestibular nerve development was enhanced than the healthy side, 2 cases of facial nerve development was enhanced than the healthy side, and 2 cases of cochlear nerve development was enhanced than the healthy side. All 4 patients were cured with related treatment. Through the comparison of 3D-FAIR and T1VIBE sequence of 4.5 hours delay before intravenous gadolinium injection and 4.5 hours delay after intravenous gadolinium injection in 4 patients with Ramsay Hunt syndrome, it was found that (i) 3D-FLAIR sequence delay of 4.5 hours scan was more likely to show whether the inner ear labyrinth barrier permeability increased and (ii) Ramsay Hunt syndrome deep ear tissue damage can be manifested as labyrinthitis, vestibular cochlear neuritis, facial neuritis, and otitis media.

Shades of phototoxicity in fluorescent imaging agents (that are not supposed to be phototoxic).

This article is a highlight of the paper by Huang et al. in this issue of Photochemistry and Photobiology. It describes shades of phototoxicity in fluorescent imaging agents that are not intended to be phototoxic. Phototoxicity was assessed using a modified neutral red uptake (NRU) in vitro assay with mean photo-effects (MPE) for the fluorescent agents IRdye800, indocyanine green (ICG), proflavine, and methylene blue (MB), with comparisons to known phototoxic agents benzoporphyrin derivative (BPD) and rose bengal (RB). The experimental conditions were aimed to mimic clinical settings, using not only visible light, but also near-infrared light for insight to photosafety and deep tissue damage. Molecular mechanisms underlying the phototoxicities were not sought, but IRdye800 and ICG were mainly deemed to be safe, whereas proflavine and MB would require precautions since phototoxicity can overshadow their utility as fluorescent imaging agents.

Evidence-based nursing care of a patient treated with the Ilizarov method for lower limb length inequality

Abstract Aim. Presentation of selected elements of nursing care of a patient with lower limb length inequality treated with the Ilizarov method. Material and methods. A patient after surgical placement of an external fixator is presented in this work. An individual case study method was used in this work, whereas the research techniques were: interview, nursing observations, measurements, analysis of nursing records. The research tools included e.g. a guide to collecting patient data and numeric rating scale (NRS) for pain assessment. Nursing diagnoses were made in a traditional way. Results. The study presents nursing interventions based on EBN for 4 diagnoses, e.g.: post-operative wound pain associated with skin incision and deep tissue damage; low mood and sadness due to the perspective of long-term treatment and accompanying disability. Effective improvement of the patient’s health is achieved by implementing nursing care based on scientific evidence. Conclusions. Important aspects of the nursing care of a patient with Ilizarov apparatus include the awareness and knowledge of nursing and clinical problems resulting from skin, soft tissue and bone damage caused by the external fixator. A small number of publications in this field is a motivator to present the topic

Treatment of limb combat blast wounds using negative pressure

Blast injury (BI) is a combat multifactorial injury resulting from the impulse action of the complex traumatic factors by the mine munition explosion, characterized an interconnected and increasingly severe impact, massive deep tissue damage and the development of a general contusion-shock syndrome. For severe BI with large skin and soft tissue defects, it is advisable to use negative pressure wound therapy (NPWT). Objective. To analyze the effectiveness of using the NPWT system in patients with blast injuries. Methods. Publications were searched in electronic systems Google Scholar, PubMed, ScienceDirect, archives of specialized journals. The results of treatment using NPWT of 134 patients were analyzed: 130 (97 %) men and 4 (3 %) women, average age 36.6 years (22‒64). According to the types of injuries, the patients were distributed as follows: blast injury — 128 (95.5%), bullet injuries — 6 (4.5 %). The results. The goal of BI treatment by negative pressure is to improve wound healing through multiple mechanisms of action at the macroscopic and microscopic levels. The use of NPWT reduces the risk of infectious complications, prevents excessive progression necrosis of affected tissues, accelerates the growth of granulation tissues and reduces pain syndrome. The result of the treatment is the wound preparation for primary healing or, in the case of significant soft tissue damage, the creation of favorable conditions for performing plastic surgeries. In general, NPWT accelerates treatment times, reduces risks of complication level and improves functional results. This current own research coincides with the results of majority authors and allows us to continue work in this direction. Conclusions. Treatment of blast injury wounds with the use of vacuum bandages and devices for creating negative pressure is an effective approach that contributes to the reduction of infectious complications, the growth of granulation tissue, facilitates further skin plasticity of the defect, accelerates the recovery time of the wounded and his rehabilitation.

Modelling the cost-effectiveness of subepidermal moisture measurement as part of a process of assessment and intervention to prevent hospital-acquired pressure ulcers.

Skin tissue assessment is traditionally used to identify early signs of pressure damage from changes observed at the skin surface. However, the early onset of tissue damage induced by pressure and shear forces is likely to be on soft tissues beneath the surface of the skin. Subepidermal moisture (SEM) is a biophysical marker for the detection of early and deep pressure-induced tissue damage. Measurement of SEM can detect early pressure ulcers up to 5 days before visible skin changes occur. The aim of this study was to evaluate the cost-effectiveness of SEM measurement compared with visual skin assessment (VSA). A decision-tree model was developed. Outcomes are the incidence of hospital-acquired pressure ulcers, quality-adjusted life-years (QALYs) and costs to the UK National Health Service. Costs are at 2020/21 prices. The effects of parameter uncertainty are tested in univariate and probabilistic sensitivity analysis. In a representative NHS acute hospital, the incremental cost of SEM assessment as an adjunct to VSA is -£8.99 per admission, and SEM assessment is expected to reduce the incidence of hospital-acquired pressure ulcers by 21.1%, reduce NHS costs and lead to a gain of 3.634 QALYs. The probability of cost-effectiveness at a threshold of £30 000 per quality-adjusted life year is 61.84%. Pathways that include SEM assessment make it possible to implement early and anatomy-specific interventions which have the potential to improve the effectiveness of pressure ulcer prevention and reduce healthcare costs.

An uncommon case of high-pressure paint gun injury to the orbit with multimodality evaluation and literature review.

High-pressure paint injection injury to the orbit is a rare type of orbital trauma. We present an unfortunate case of high-pressure paint injury to the right orbit of a young patient. High-pressure injection injury presents with a unique injury mechanism and resultant deep tissue damage. The superficial appearance of the entry site injury is deceiving; therefore, a thorough evaluation is necessary. Debridement is usually required if foreign body material is present. Antibiotics and steroids are commonly used in such cases.

SURGICAL TREATMENT OF VICTIMS WITH MINE AND EXPLOSIVE INJURIES DURING MILITARY ACTIONS

Summary. Mine-explosive injury is a gunshot combined multiple injury that occurs in a person as a result of the impact of the impact factors of the explosion of engineering, mine ammunition and is accompanied by deep and widespread tissue damage and contusion.&#x0D; The purpose of the work is to analyze the methods of surgical treatment of patients with mine-explosive injuries in the conditions of martial law.&#x0D; Materials and methods. The results of surgical treatment of 64 patients with mine-explosive injuries were analyzed, 27 (42.2 %) were women, 37 (57.8 %) were men, who were being treated at Dergachiv Central Hospital. All victims underwent surgical interventions depending on the location of the injury, its nature, the severity of the patient, the development of traumatic or hemorrhagic shock.&#x0D; Results and their discussion. Given that the most frequent type of injuries were wounds of various localization, the most common type of surgical intervention was surgical treatment of wounds. The scope of the intervention depended on the depth and size of the wound, as well as the nature of tissue damage. Surgical manipulations on the chest were performed to eliminate pneumothorax (pneumohydrothorax), pleural puncture was performed or pleural drainage was established. If the Rouvilois-Gregoir test was positive, a thoracotomy was performed followed by suturing of the lung wound. Invasive diagnostic methods, laparocentesis and laparoscopy were performed for suspicion of damage to the organs of the abdominal cavity, with the help of which damage to the organs of the abdominal cavity was excluded. The use of laparocentesis in such situations, although its diagnostic value is lower than that of video laparoscopy, allows to determine the pathological content in the abdominal cavity, which is sufficient to detect life-threatening consequences of abdominal injuries, for example, such as intra-abdominal bleeding.&#x0D; Conclusions. Victims with explosive lesions require a large number of surgical interventions in various anatomical areas. When providing assistance to victims of an explosive injury, one should be guided by the principles of “damage control”, determining the amount of interventions that should be performed based on vital indications.

INDICATORS OF DENTAL HEALTH AND LOCAL IMMUNITY IN YOUNG ADULTS WHO HAVE SUFFERED FROM CORONAVIRUS INFECTION.

The aim: To determine the dental status and state of local immunity in young adults who have suffered from the coronavirus disease. Materials and methods: The main group consisted of 30 people aged 20-22 years, who suffered from the coronavirus infection Covid19 6.1±1.2 months ago. The comparison group included 20 people who did not have a coronavirus infection. The control group consisted of 35 people, randomized by age and sex, who did not have signs of caries and periodontal tissue disease and did not have coronavirus disease. All patients were examined for dental status and local immunity. Results: The analysis of indicators of dental status revealed the possibility of the existence of a relationship between the signs of acute SARS-Cov2 viral infection and the development of caries and periodontal tissue diseases. Significant changes in the local immunity of the oral cavity were found in the examined patients, which had a pathogenetic influence on the development and progression of caries and periodontal tissue diseases: a significant increase in the level of Ig G, as well as a probable decrease in the concentration of SIg A relative to the comparison group, a probably higher normative value of pathogenic small- and medium-molecular CICs with a significant decrease in the level of physiological large-sized CICs relative to the comparison group, a decrease in the content of anti-inflammatory IL-4, as well as increased concentration of pro-inflammatory cytokines. Conclusions: Young adults who have suffered a coronavirus infection during the last 6 months have significantly higher caries prevalence, bleeding index, PMA index and hygiene index, halitosis, which indicates deeper tissue damage and tooth pathology with the formation of dentition defects than in the comparison group. Indicators of local immunity of the oral fluid have a deep and specific character.

Determination of medical device-related pressure injury in COVID-19 patients: A prospective descriptive study

BackgroundCOVID-19 patients are at risk for the development of pressure injuries (PI). AimThe aim of this study was to determine the incidence of medical device-related pressure injury (MDRPI) in patients treated in the COVID-19 Intensive Care Unit (ICU)s. MethodsThe sample of the study consisted of 132 patients, and each with a maximum follow-up of 7 days. Data were collected in the COVID-19 ICU of a university hospital between January and May 2021 by using a Patient Characteristics Form, the MDRPI Follow-up Form, the Braden Pressure Ulcer Risk Assessment Scale, and the Pressure Ulcer Staging Form. ResultsOf the patients, 59.1% (n = 78) developed at least one MDRPI. MRDPI was observed in those with a mean age of 65.45 ± 2.462 years who were invasively ventilated (51.3%), enterally fed (46.2%), placed in the prone position (78.2%), and had a Braden score ≤12 (50%). The most common medical devices that caused MDRPIs included endotracheal tube (ET) (31.2% n = 44), non-invasive mechanical ventilation (NIVM) (23.4% n = 33), nasal high-flow (11.3% n = 16), nasogastric tube (10.6% n = 15), the ET connection (8.5% n = 12), respectively. The most common sites for pressure injuries were the nose (28.8% n = 34), mouth (25.8% n = 34), ear (12.9% n = 17), lip (9.1% n = 12), and cheek (8.3% n = 11). The most common gradings of MDRPIs were stage 2 (28.8% n = 38), stage 1 (19.7% n = 26), stage 3 (9.1% n = 12) mucous membrane injuries (12.9% n = 17) and suspected deep tissue injuries (9.1% n = 12), respectively. The time to PI was 3 days (25.7% n = 36). ConclusionsMDRPI was common among COVID-19 patients. It was found that the most common cause of pressure injury was ventilators, and PI developed in the mouth and lip sites most frequently in patients in prone position, stage 2 and suspected deep tissue damage was the most common grade. It is important to evaluate the skin in contact with medical devices in COVID-19 patients and to take the necessary interventions to prevent PI.

Pressure ulcers in patients with COVID-19 acute respiratory distress syndrome undergoing prone positioning in the intensive care unit: A pre- and post-intervention study.

Prone positioning has been widely used to improve oxygenation and reduce ventilator-induced lung injury in patients with severe COVID-19 acute respiratory distress syndrome (ARDS). One major complication associated with prone positioning is the development of pressure ulcers (PUs). This study aimed to determine the impact of a prevention care bundle on the incidence of PUs in patients with COVID-19 ARDS undergoing prone positioning in the intensive care unit. This was a single-centre pre and post-test intervention study which adheres to the Standards for Reporting Implementation Studies (StaRI) guidelines. The intervention included a care bundle addressing the following: increasing frequency of head turns, use of an open gel head ring, application of prophylactic dressings to bony prominences, use of a pressure redistribution air mattress, education of staff in the early identification of evolving PUs through regular and rigorous skin inspection and engaging in bedside training sessions with nursing and medical staff. The primary outcome of interest was the incidence of PU development. The secondary outcomes of interest were severity of PU development and the anatomical location of the PUs. In the pre-intervention study, 20 patients were included and 80% (n= 16) of these patients developed PUs, comprising 34 ulcers in total. In the post-intervention study, a further 20 patients were included and 60% (n= 12) of these patients developed PUs, comprising 32 ulcers in total. This marks a 25% reduction in the number of patients developing a PU, and a 6% decrease in the total number of PUs observed. Grade II PUs were the most prevalent in both study groups (65%, n= 22; 88%, n= 28, respectively). In the post-intervention study, there was a reduction in the incidence of grade III and deep tissue injuries (pre-intervention 6%, n= 2 grade III, 6% n= 2 deep tissue injuries; post-intervention no grade III ulcers, grade IV ulcers, or deep tissues injuries were recorded). However, there was an increase in the number of unstageable PUs in the post-intervention group with 6% (n= 2) of PUs being classified as unstageable, meanwhile there were no unstageable PUs in the pre-intervention group. This is an important finding to consider as unstageable PUs can indicate deep tissue damage and therefore need to be considered alongside PUs of a more severe grade (grade III, grade IV, and deep tissue injuries). The use of a new evidence-based care bundle for the prevention of PUs in the management of patients in the prone position has the potential to reduce the incidence of PU development. Although improvements were observed following alterations to standard practice, further research is needed to validate these findings. The use of a new, evidence-based care bundle in the management of patients in the prone position has the potential to reduce the incidence of PUs.

Concentration-associated pathology of alkali burn in a mouse model using anterior segment optical coherence tomography with angiography

Pathological features of alkali concentration-associated burn were studied using non-invasive anterior segment optical coherence tomography (AS-OCT) and OCT angiography (OCTA). Alkali burn was induced in C57BL/6J mice (n = 20) by placing filter paper soaked in 0.1, 0.25, 0.5, and 1 M NaOH for 30s on the right eye (left eye control). Longitudinal imaging was performed with AS-OCT/OCTA and fluorescein angiography over 14 days, after which eyes were enucleated at 7 and 14 days for histology and immunofluorescence. Concentration-associated corneal swelling was maximal at 0.5M, increasing linearly in a concentration-dependent fashion at 0.1, 0.25, and 0.5 M NaOH, to levels of 50%, 100%, and 175% of control, respectively. At 0.1M, corneal swelling and surface erosions were prominent, while at 0.25M, deep tissue damage, limbal neovascularization, and stromal haze were evident at 7 days. At 0.5M and 1M, severe exacerbation of the corneal swelling, angle closure, Descemet's membrane detachment, hyphema, and profuse central neovascularization were noted as early as day 3, which further progressed to inflammation, fibrosis, and opacity by day 7. We conclude that alkali concentration-dependent burn intensity biomarkers can be assessed by non-invasive AS-OCT/OCTA, distinguishing between mild, moderate, and severe ocular injury, with potential relevance toward clinical utilization in human eyes.

Cost Comparison of Pressure Sores in the Last 4 Years and Evaluation of the Status of Patients Diagnosed with COVID: Acıbadem Healthcare Group Example

It was designed as a retrospective study. Between January 2018 and June 2021, 590 patients who developed pressure ulcers from 16 hospitals affiliated with Acıbadem Healthcare Group (AHG) were identified and classified as Stage 1, Stage 2, Stage 3, Stage 4 and Unstageable pressure ulcer, suspected of deep tissue damage. The cost of treatment was calculated in each category and the total cost per patient for the company was determined.&#x0D; There are two main ways to get data for analysis; 1- Sentinel Event System Reports (for determining the number of patients with pressure ulcers) and 2- Patient Services Pricing Department (for defining the cost of treatment). Costs and costing given by the pricing department with a bottom-up approach are calculated from the patient perspective.&#x0D; Pressure sore cost calculation for COVID-19 patients covers the period from March 2020 to June 2021.&#x0D; Data analysis: Two main ways were used to collect data for analysis; 1- Sentinel Event Notification System Reports (for determining the number of patients with pressure ulcers) and 2- Patient Services Pricing Department (for defining the cost of treatment).&#x0D; Population: All patients who developed pressure ulcers in 16 hospitals affiliated to Acıbadem Healthcare Group since 2018

Device-related pressure ulcers: SECURE prevention. Second edition.

Device-related pressure ulcers: SECURE prevention. Second edition.

The Past, Present, and Future of Deep-Tissue (Pressure) Injury.

The Past, Present, and Future of Deep-Tissue (Pressure) Injury.

Evaluating the impact on hospital acquired pressure injury/ulcer incidence in a United Kingdom NHS Acute Trust from use of sub-epidermal scanning technology.

The incidence of pressure injury/ulcers is persistent despite multiple prevention strategies in hospitals across the globe. Current standard of pressure injury/ulcer care supported by subjective skin tissue assessments, risk assessment tools and clinical judgement is ineffective in consistent pressure injury/ulcer prevention. A pragmatic study, aligning with SQUIRE guidelines, was conducted at Chelsea and Westminster hospitals to measure the impact of adding scanning technology to the prevailing standard of care pathway on the incidence of category 2-4 hospital-acquired pressure injury/ulcers. Six hundred and ninety-seven mixed-population patients at risk for pressure injuries/ulcers with a Waterlow score of ≥10 and a mean age ≥65years were enrolled across four wards over a 6-month period. Scanning technology was added to the prevailing standard of care as a device adjunctive to clinical judgement for the detection of deep and early-stage pressure-induced tissue damage. Ward staff completed comprehensive device training by the device manufacturer. Clinical interventions were initiated by clinical judgement informed by injury/ulcer risk assessments, skin and tissue assessments and scanner readings. Incidence of reportable category 2-4 pressure injuries/ulcers from the prior 12-month period from the same wards were used as a control comparator population. All diagnosed category 2-4 pressure injuries/ulcers, unstageable and deep-tissue injuries were recorded. Prior study 12-month pressure injury/ulcer incidence was 0.6% (5/892 patients) in ward A, 4.4% (9/206 patients) in Ward B, 1.1% (12/1,123 patients) in Ward C and 2.6% (16/625 patients) in Ward D. Two pressure injury/ulcers in Ward B were recorded during the study. Zero pressure injuries/ulcers were recorded in the remaining three wards resulting in an 81% incidence reduction across all four wards. Improved clinical decisions from clinical judgement based on Sub-Epidermal Moisture (SEM) Scanner data were reported in 83% patients (n=578/697). Implementing scanning technology into routine clinical practice achieves consistent reductions in pressure injury/ulcer incidence.

Association between Antibiotic Resistance with Duration of Hospitalisation in Diabetic Foot Ulcer Inpatient at Internal Ward in Dr. Soetomo General Hospital

Introduction: Diabetic Foot Ulcer (DFU) are microvascular and macrovascular complications fromdiabetes and has potential pathological risks including infection, ulceration, and deep tissue damage andis associated with neurological abnormalities, peripheral arterial disease, and metabolic complications inthe lower extremities. Diabetic foot injury is an infection of several pathogenic microorganisms that causetissue damage, if the infection is not handled properly then the wound will worsen and have an impact onamputation. Those pathogenic microorganisms could be a mono-microbial infection or a poly-microbialinfection and those infections could be multi-drug resistant organisms (MDRO).Objective: To analyse the association between antibiotic resistance and the duration of the hospitalisation indiabetic foot ulcer patient at Dr. Soetomo General Hospital.Method: This study is a cohort retrospective study that reviews medical records of all diabetic patients withdiabetic ulcer that was admitted into Dr. Soetomo General Hospital.Result: In Dr. Soetomo General Hospital the average duration of hospitalisation is 11.48 days. The species thatcaused the most infection under the category of gram-positive organisms are Enterococcus faecalis (7.8%),Staphylococcus aureus (5.2%) and Staphylococcus haemolyticus (3.9%). In the gram-negative category ofbacterial species, Proteus mirabilis (10.5%), Acinetobacter baumannii (9.8%) and Escherichia coli ESBL(8.5%) Patients had a high resistance towards is Cephazolin with a rate of 85.5% followed by Ampicillinwith 83.2% and Tetracyclin with 82.0%. Piperacillin-tazobactam (p-value 0.045) and Ceftazidime (p-value0.046) showed an association between antibiotic resistance and duration of hospitalisation. All patientspresented with MDRO and 35 (29.7%) were poly-microbial infectionConclusion: There is an association between antibiotic resistance and duration of hospitalisation forPiperacillin-tazobactam and Ceftazidime as well as 100% of patient presented with Multi-drug resistantorganism. Clinicians should refer to the periodic report from the internal ward on dominant species foundand antibiotic resistance more.