My Response

Skin integrity is a fundamental aspect of infection prevention, with pressure injuries and

wound-related complications presenting as a major threat to quality care delivery and improved

patient outcomes. Most of the acute care providing health facilities is becoming increasingly

aware of the rate of their hospital-acquired pressure injury as a part of their general patient skin

integrity assessment. The main point for clinicians with respect to the importance of the skin

integrity of patients relating to the prevention of HAI is that pressure injuries can lead to life-

threatening consequences including osteomyelitis, sepsis, and septic shock. As a result,

prevention of pressure ulcers by strict monitoring of patients’ skin integrity is a priority. On a

normal circumstance, skin impairments in the form of wounds heal in 3 phases which are

inflammatory, a proliferative phase, and a remodeling phase. However, pressure ulcers do not

really get to progress past the stage of inflammation. Current practice for treating pressure ulcers

includes tackling the etiology, debridement for the removal of dead and contaminated tissues,

dressings to promote healing and manage exudates, and turning of patients periodically to

provide relief from pressure. These treatment measures are employed over a long period of time

depending on the severity and they involve a high level of contact with infectious agents in the

inflammatory exudates and wound environment. As a result, the chance of spreading these

nosocomial infections to other patients in the same care facility in the form of hospital-acquired

infections which is orchestrated by poor hygiene is increased. These unexpected infections

develop during the period of intensive care delivery mostly and result in patient additional

illnesses and even deaths. The duration of hospital stay in affected patients is prolonged,

necessitating additional diagnostic and treatment measures which imply additional healthcare

costs. As earlier stated in this response, prevention of consequences of pressure ulcers and
wounds is a priority. Health care providers can achieve this by monitoring the skin integrity of

patients at a higher risk of developing pressure ulcers such as immobile patients on long term

duration of care, patients on tubes and other invasive procedures on a long term basis and aged

patients.

Develop Three to Five Objectives that will help you Enhance your Knowledge about

providing Safe Care to Patients who may have Challenges to their Skin Integrity.

1. Improve my knowledge of the underlying physiology of PI formation.

A pressure ulcer is a skin impairment which presents as a localized injury to the skin or due to

unrelieved pressure, usually over a bony prominence. This skin impairment may be caused by

poor blood supply and resulting reperfusion injury when blood supply to the tissue is improved.

A simple, everyday example of an experience of mild pressure sore occurs when healthy

individuals sit in the same position for a prolonged period of time. The dull pain experienced in

this situation indicates impedance in blood flow to affected parts of the body. In about 2 hours,

this inadequate blood supply to the tissue, known as ischemia, may bring about tissue damage

and cell necrosis. Initially, the sore of pressure ulcers start as a red, painful area. The later stages

in its process of development are observed when pressure is high enough to bring about damage

and destruction to the cell membrane of muscle cells. Eventually, the muscle cells die as a result

and skin fed through blood vessels via the muscle die. This represents the deep tissue injury form

of pressure ulcers that starts up as purple coloration on an intact skin. Common sores of pressure

ulcer can be seen to occur on the heads of the long bones of the foot, over the sacrum, over the

shoulder, ischial tuberosity, over the buttocks, the heels of the feet and over the back of the head.
2. Recognize factors which contribute to PI’s and Identify High Risk patients.

A lot of risk factors for pressure ulcers have been identified. Most common factors that may

increase the chances of a patient having pressure ulcer include immobility, systemic diseases like

diabetes mellitus, peripheral vascular disease, cerebral vascular accident and low blood pressure.

Other factors include advancement in age like of 70 years and older, current history of cigarette

smoking, malignancy,, urinary and fecal incontinence, dry skin, physical restraints, being

underweight or having a low body mass index, and history of pressure ulcers. Assessing the

specific risk factors for pressure ulcer will help the care provider to determine the exert etiology

of the condition and develop more effective treatment: Even patients with an existing case

pressure ulcer are also at risk for further skin impairment, Nurses and other health care

professionals should consider all possible risk factors for the development of this condition for

improved care delivery. Patients of up to 70 years of age and above are at a higher risk of

developing pressure ulcers because they have less moisture, less padding, less elastic skin, and

have thinning of the epidermis, making them more susceptible to skin impairment.

3. Implement and document intervention and prevention strategies.

After identifying patients at high risk of developing pressure ulcers, the next objective to

consider is prevention strategies that can help protect the skin integrity and prevent these forms

of impairment. The most prevention strategy for a person at risk for pressure ulcers and those

already with bedsores is the redistribution of pressure so that zero pressure is applied to the any

part of the skin that is prone to developing ulcers. In the middle of the 20th century, Ludwig

Guttmann came up with a program of turning paraplegics every 120 minutes (two hours) in order
to allow bedsores to heal. Before this discovery, such patients had a life-expectancy of no more

than two years as it is the case that they come down with sepsis and skin infections.

Health care facilities like nursing homes and hospitals usually design and put certain programs in

place that can help in the prevention of the development of pressure ulcers in patients who are

bedridden. Such program includes using a routine period and duration frame for turning and

repositioning to reduce and eliminate pressure build-ups. The frequency of changing patient’s

lying position depends on the level of pressure ulcer risk of the patient. More recently, a 2015

Cochrane review revealed that individuals who make use of high density or high specification

foam mattresses has 40% likelihood of developing new pressure ulcers compared to individuals

who lay on regular foam mattresses. Other studies also discovered that sheepskin overlays on top

of mattresses can help prevent the formation of new pressure ulcer. The research on the

efficiency of alternating pressure mattresses on the prevention of pressure ulcers is not entirely

clear. It was also found that high values of pressure on prominent areas of the body can be

reduced by making use of Pressure-redistributive mattresses. Several important terms have been

used in the description of how these support surfaces work. Many of them redistribute pressure

by immersing the body of the patient into the surface while some support surfaces contain

multiple air chambers that are alternately pumped. Such support surfaces include antidecubitus

mattresses and cushions.

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