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facilitate that care. Part of that risk assessment is to undertake a skin inspection documenting skin status, recording areas of skin damage and vulnerability, and formulating a care plan that corrects and treats damage and reduces risk of pressure injury. This process of regular skin


Figure 2: Hyperkeratosis on a lower limb.


assessment also forms part of the management strategy of the diabetic foot where neuropathy, structural abnormalities and ischaemia can result in a reduced protective response,


altered foot loading and an increased risk of skin damage[8] .


Peter Vowden is Professor of Wound Healing Research, Bradford Teaching Hospitals NHS Foundation Trust and the University of Bradford, UK.


1. Farage MA, Miller KW, Berardesca E, Maibach HI. Clinical implications of aging skin: cutaneous disorders in the elderly.Am J Clin Dermatol 2009; 10(2): 73–86.


2. Nakanishi M, Niida H, Murakami H, Shimada M. DNA damage responses in skin biology — implications in tumor prevention and aging acceleration. J Dermatol Sci 2009; 56(2): 76–81.


3. Cox NH. Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg: a series with community follow-up. Br J Dermatol 2006; 155(5): 947–50.


4. Koutkia P, Mylonakis E, Boyce J. Cellulitis: evaluation of possible predisposing factors in hospitalized patients.Diagn Microbiol Infect Dis 1999; 34(4): 325–7.


5. Guest JF, Greener MJ, Vowden K, Vowden P. Clinical and economic evidence supporting a transparent barrier film dressing in incontinence-associated dermatitis and peri-wound skin protection. J Wound Care 2011; 20(2): 76–84.


6. Aye M, Masson EA. Dermatological care of the diabetic foot. Am J Clin Dermatol 2002; 3(7): 463–74.


7. Bahr S, Mustafi N, Hattig P, et al. Clinical efficacy of a new monofilament fibre- containing wound debridement product. J Wound Care. 2011; 20(5): 242–8.


8. National Institute for Health and Clinical Excellence (NICE). Clinical Guidelines CG10: Type 2 diabetes – footcare. 2004; Available at: http://guidance.nice. org.uk/CG10/NICEGuidance/pdf/English (accessed December 6, 2011)


n Fat storage n Sebum secretion n Sweat secretion n Vitamin D formation n Pigment production.


All of these functions are vital for a healthy functioning


body. However, the skin is vulnerable to two main types of threat — natural or induced. Natural threats include the aging process and drying out, whereas induced threats include soaps, conventional bathing, pressure injuries, incontinence-associated dermatitis and skin tears. Pressure injuries are now identified in the top three causes


of global preventable harm and are recognised as being harmful, preventable, painful and costly. There are many costs involved in pressure injury prevention and management, such as equipment and maintenance, wound treatment and length of hospital stay. Investing in pressure injury prevention not only saves money, but also minimises hidden costs through reduction of patient pain, reduced readmission rates and cancellations, and reduced litigation. In 1997, Young estimated the cost of managing a stage 4 pressure injury at $61,230AUD[1]


, whereas a Queensland University of


Technology study indicated that a pressure injury increased the length of stay in hospital by four days per patient[2]


.


Prevention in Australia Many strategies have been implemented to reduce the development of pressure injuries. However, they continue to be a significant problem, consuming a large percentage of healthcare resources. Most facilities throughout Australia perform annual pressure injury prevalence studies, which measure the percentage of patients in hospital against those who have a pressure injury (hospital-acquired and present on admission). Although most healthcare facilities attempt to educate staff and provide the right equipment, wound treatment and risk assessment, nonetheless there is an acceptance that in certain circumstances a pressure injury is inevitable. However, the author's team at the Prince Charles Hospital


Preventing pressure injury in Australia


T 13


his paper describes how the introduction of skin care protocols such as the


use of skin wipes instead of soap and water, protective silicone sacral dressings and tackling malnutrition, have improved the management of skin integrity in an Australian hospital.


Skin is an organ that is often overlooked by clinicians as long


as it remains intact. The skin has seven main functions: n Protection n Sensation


Wounds International Vol 3 | Issue 1 | ©Wounds International 2012


in Brisbane (a 640-bed referral hospital specialising in cardiac and thoracic medicine) were frustrated by the attitude that skin damage could not be avoided and felt it was time to go beyond simply placing patients on pressure- relieving devices and checking for broken areas of skin. It was decided that there was a definite need to move out of crisis management and into prevention. After many years of implementing risk assessments, using


pressure redistribution equipment and providing copious staff education, the team's pressure injury prevalence studies still indicated that moderate numbers of stage 1 pressure injuries were developing at the hospital. The team felt it was time to look broadly at causative influences and focus more attention on nutrition and continence management. Research indicates a strong correlation between malnutrition and pressure injury. If the patient is malnourished, the risk of a pressure injury is doubled — if he or she is severely malnourished this risk is increased


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