Addressing the Challenge of Pressure Injuries Editorial Summary This article provides a concise overview of the significant problem of pressure ulcers and how the prevalence of this avoidable public health issue can be reduced. The various factors that increase risk of pressure ulcers are explored, as well as some of the standards and guidelines that can help healthcare practitioners identify symptoms early and prevent pressure ulcers from developing.
Introduction
P
ressure injury (PI) is a significantly under recognised public health issue. The approximate total cost of pressure injury in the United States is $26.8 billion per year.1 In Australia, this number is approximately $1.8 billion.2 Clearly, we have a significant issue; we also know that in the United States around 60,000 patients will die every year specifically related to a pressure injury.3 At Wounds Australia we think it is a lot higher than that, but since we don’t actually collect data in Australia, it’s very difficult to make an estimation. When answering these questions it is vital to review the latest evidence based practice.
Understanding the Skin In order to treat a pressure injury, or prevent them, it really starts in understanding the skin. When it comes to understanding the skin in relation to wound healing, there are two principle layers: The epidermis, which functions to resurface wounds and restore the barrier against bacteria; and the dermis, which functions to restore structural integrity, collagen and physical properties of the skin.
Ms Hayley Ryan Director, WoundRescue Pty Ltd. Wound Clinical Nurse Consultant
When it comes to pressure injury, it is crucial to know where it affects to skin, since this is the part which helps us diagnose the correct stage.
Newcastle NSW, Australia
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Wound Masterclass - Vol 1 - December 2022
Stages of Pressure Injury • • • •
Stage 1: Quite superficial; top layer of skin Stage 2: Visible breaks in the skin Stage 3: Visible fatty tissue Stage 4: Visible bone, tendon or muscle
Importance of Skin Ph We know that skin pH tends to be between 4 and 6.5. Optimal skin pH, however, is 5.5; this is because the acid mantle, which protects the skin against microorganisms, is protected. One focus for maintaining skin integrity is to consider things like soap-free cleansers, and pH neutral emollients; no matter what area of healthcare you are working in, you should always encourage patients to use emollients and soaps which are soap-free, fragrance-free, and pH neutral; this is key to preventing the skin from breaking down.
Nutrition In wound management, nutrition is pivotal. Changes in nutritional status can alter skin structure and function if there is a wound present. It is important to screen people for nutritional status. There is debate over whether to focus on prealbumin or serum albumin levels. I request serum albumin levels when I’m considering someone who may be malnourished; if results are <30g/L, this will delay healing. This tells us that the focus we need to have is on high
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