7. Waring M, Butcher M. An investigation into the conformability of wound dressings. Wounds UK 2011; 7(3): 14–24.
8. Dillon JM, Clarke JV, Deakin AH, et al. Correlation of total knee replacement wound dynamic morphology and dressing material properties. J Biomech 2007; 40(Suppl 2): S61.
9. White R. Evidence for atraumatic soft silicone wound dressing use. Wounds UK 2005; 4(1): 14–22.
to wound characteristics that can be implemented in any healthcare setting and which are freely available (www. woundcare.thehealthline.ca
). Pressure ulcer prevention has been identified by
North American innovations in skin integrity
his short report looks at innovative developments in skin integrity in Canada and
the US. Skin integrity performs two crucial roles in the field of wound management. The first is optimising the quality of the skin so that it is well-hydrated, supple, and has the
best tensile strength possible — important in the prevention of pressure ulcers, skin tears and incontinence-associated dermatitis. The second role is preventing the extension of existing wounds due to maceration or dermatitis, or erosion of the periwound skin in any exuding lesion. Education that focuses on both of these areas is important
for all care providers, from the support worker who provides skin and continence care, to the nurse who supervises and carries out treatment, through to the wound care specialist.
Periwound skin Sibbald et al
mention the periwound skin briefly in
their 2011 wound bed preparation update, stating that assessing clinicians should classify the wound edge as being hyperkeratotic, macerated or normal. No specific directives are given, however, other than achieving moisture balance through the careful selection of an appropriate dressing. Dressing manufacturers need to continue to develop new
products that manage large or copious amounts of exudate while preserving the integrity of the periwound skin.
Prevention The choice of skin care products can have a major impact on preventing breakdown, as recently demonstrated by Beeckman et al
, who compared a three-in-one perineal washcloth,
impregnated with 3% dimethicone formula with standard care using water and pH neutral soap. Researchers found the washcloth had a statistically significant effect in preventing incontinence-associated dermatitis (P=.003) (although the severity between the two groups was not significant [P=.006]). Improving skin integrity through 'responsible bathing', as defined by LeBlanc et al
, and by the appropriate selection
of dressing products, has been highlighted in a project based in Ontario, Canada. A toolkit developed by the project provides educational materials on prevention of pressure ulcers, skin tears, pre-tibial injuries and matching dressings
17 Wounds International Vol 3 | Issue 1 | ©Wounds International 2012
1. Sibbald RG, Goodman L, Woo KY et al. Special Considerations in Wound Bed Preparation 2011: An Update. Adv Skin Wound Care 2011; 24(9): 415–36.
2. Beeckman D, Verhaeghe S, Defloor T, Schoonhoven L, Vanderwee K. A 3-in-1 perineal case washcloth impregnated with dimethicone 3% versus water and pH neutral soap to prevent and treat incontinence-associated dermatitis. A randomized, controlled clinical trial. J Wound Ostomy Cont 2011; 38(6): 627–34.
3. LeBlanc K, Christensen D, Orsted HL, Keast DH. Best practice recommendations for the prevention and treatment of skin tears. Wound Care Can 2008; 6(1): 14–32.
4. RNAO. Risk Assessment & Prevention of Pressure Ulcers. RNAO, 2011. Available at: http://www.rnao.org/Storage/83/7749_PRESSURE-ULCERS_
Supplement_2011.pdf (accessed 24 January, 2012)
Accreditation Canada as a Required Organisational Practice (ROP) — an essential area of practice requiring healthcare centres to have strategic plans in place to enhance patient safety and minimise risk. Compliance necessitates the use of validated risk assessment forms, integrated policies and procedures around interventions, education of staff and monitoring. An organisation's quality and services are examined against national standards of excellence An update of the Registered Nurses of Ontario (RNAO)
best practice guideline, Risk Assessment and Prevention of Pressure Ulcers, was published in 2011
and includes several
additional recommendations, which reflect current research findings such as the use of two hourly re-positioning when using a standardised mattress, emergency stretcher or operating table surface. These guidelines form the basis of many best practice initiatives across Canada. Other North American initiatives include the ongoing
consensus on skin tears. Started in 2010, and led by Kimberly LeBlanc from Ottawa, Canada, and co-chair Sharon Baranoski, from Chicago, USA, representatives from five countries have participated in a three-step Delphi procedure to develop 12 consensus statements around the definition of a skin tear. The next step is a new classification system consisting of three different types of skin tears that will comprise an international standard. A second Delphi will validate these classifications using photographs and will be used to test inter- and intra-rater reliability. Future goals include a validated international risk assessment tool and a care pathway. All of this work should help to advance best practice in skin
and periwound care to the point that they become standard practice. They need to become integral to the education of future clinicians and be supported in written policies for all health organisations. In the US and Canada these advances are proving that when it comes to skin integrity, Benjamin Franklin’s maxim that an ounce of prevention is worth a pound of cure, has never been more apt. Connie Harris is Senior Clinical Specialist Wound and Ostomy, CarePartners ET NOW; and Project Lead-South West Regional Wound Care Framework Initiative, London, Ontario, Canada
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