The Effectiveness of Foam and Alginate Dressing in The

Treatment of Pressure Ulcer with Elderly Patients in

Intensive Care Unit: A Report of Two Cases

BACKGROUND Figure 2. The Type of Modern Wound Dressing

Pressure injury is local injury to the skin or subcutaneous soft tissue, manifested
as intact skin or an open ulcer, possibly accompanied by pain (Shi, et al., 2020).
Pressure injuries are localized areas of soft tissue damage that typically occur in a
people who are elderly, have limited mobility or are confined to bed or chair by an
acute or chronic health problem, injury or surgery and who have impaired
nutrition, as is often the case for patients who are frail and have fragility fractures
(Hommel & Tholimson, 2018).
Foam dressings for patients with incontinence protect the skin of the appendix
from infestation, maintain the skin dry, provide a good microenvironment, and
improve tissue tolerance. Many clinical studies show that foam dressings can
reduce the incidence of pressure ulcers. Alginate dressing which consists of
polysachharides from brown seaweed has excellent excudate absoption and good
hemostasis. It suits for infected and non-infected wounds with a large amount of DISCUSSION
excudate (Shi, et al. 2020). 1. Pressure ulcer formation is highly influenced by risk factors, including all
Some studies in Shi, et al (2020) showed the significant differences in the incidence conditions leading to immobility, elderly, and malnutrition. Extrinsic risk factors
of pressure injuries between the two groups (≤10%). Thus, the study concluded include being immobilized bed for prolonged periods of time, hospitalized in ICU.
that the application of multi-layered soft silicone foam dressings reduces the Intrinsic risk factors such as diabetes, malnutrition, also increase the overall risk
incidence in patients prior to transfer to the ICU. Chaiken et al. applied a silicone for pressure ulcers. Immobility is the major factor in an at risk patient to indicate
border foam dressing to the appendix of patients in the ICU to examine whether that a dressing to prevent pressure ulcers should be considered. Immobility may
the dressing reduces sacral pressure injury. The results showed that the incidence be the result of disease, severe illness or frailty, or sedation, paralysis or
of pressure ulcers decreased from 13.6 to 1.8% after application of the dressing, anaesthesia for surgery, investigations or treatments. (1,5)
indicating that this type of dressing effectively reduces the incidence of sacral 2. People who stay in bed for a long time or unable to move may suffer from
pressure injury in the ICU. Walsh et al. applied a silicone border foam dressing to pressure injury, especially the elderly with chronic disease and also hospitalized
the tibia region of patients in the ICU. The results showed that the incidence of in ICU. The patients who have pressure ulcer may have longer hospital stays, and
hospital-acquired pressure injury in the ICU decreased from 12.5% in 2009 to 7% it can cause more infectious or sometimes can increase the mortality rate and
in 2010, and the number of sacral pressure injury cases decreased from 50 to 13, higher rate of readmission. To decrease it, we can give the special dressings
respectively. which can utilize as the barrier bacteria, decreasing the pain in the process of
healing, absorbing the excess wound fluid, and keeping the moist wound. (6)
CASE PRESENTATION
3. Foam dressing which contained from polyurethane, have high exudates
1. We reported 2 patients with chronic diseases who had pressure ulcer in sacrum.
absorption and a high autolysis debridement capacity, can keep the wound on
All patients were reffered to out-patient clinics in Intensive Care Unit of Gatot
moist condition, and do not cause traumas during removal. They are well suited
Soebroto Indonesia Army Central Hospital, Jakarta, Indonesia. Pressure ulcer was
for wounds that have minimal to moderate drainage and are often used on Stage
diagnosed by the endocrinologist, plastic surgery and referred to registered ET
II and Stage III pressure ulcers. Alginate is a very absorbent material that is ideal
Nurse for wound management.
for use in wounds with moderate to high discharge. They can absorb several
2. All patients underwent with foam dressings, alginate, transparant film dressing
times their weight in exudate and can conform well to irregular or tunneled
and hydrocolloid.
wounds. Transparent film dressings are used primarily to provide a barrier to
Table 1.1 Characteristics of Patients
urine, stool, and other bodily fluids, which can macerate the skin. Because they
are transparent and allow for observation of the wound, they can be applied and
left in place for days. (1, 3, 4)

CONCLUSION
Wound dressing treatment with foam dressing and combine with alginate dressing
can improve the pressure ulcer getting better, especially in elderly patient with
Figure 1. Transformation of Wound After Three Times Intervention of Foam Dressing
critical condition. At the same time, the effectiveness for using foam dressing with
Treatment
pressure ulcer grade II-III can keep the moisture balance, promote oxygen exchange,
prevent infection, facilitate autolytic debridement, and promote the production of
granulation tissue and re-epithelialization. However, with various dressing that we
applied to the patient, it helps for increase the quality of life the patient for getting
better.

1. Boyko, T. V., Longaker, M. T., & Yang, G. P. (2018). Review of the Current Management of Pressure Ulcers. Advances in Wound Care, 7(2), 57–67. https://doi.org/10.1089/wound.2016.0697
2. Hommel, A., & Santy-Tomlinson, J. (2018). Pressure Injury Prevention and Wound Management, 85–94. https://doi.org/10.1007/978-3-319-76681-2_7
3. Jin, Y., Li, J., Wu, S., & Zhou, F. (2021). Comparison of polyurethane foam dressing and hydrocolloid dressing in patients with pressure ulcers: A randomized controlled trial protocol. Medicine, 100(2), e24165. https://doi.org/10.1097/MD.0000000000024165
4. Shi, C., Wang, C., Liu, H., Li, Q., Li, R., Zhang, Y., … Wang, J. (2020). Selection of Appropriate Wound Dressing for Various Wounds. Frontiers in Bioengineering and Biotechnology, 8(March), 1–17. https://doi.org/10.3389/fbioe.2020.00182
5. World Union of Wound Healing Societies (WUWHS). (2016). Role of dressings in pressure ulcer prevention: a consensus document, (October). Retrieved from
https://www.researchgate.net/publication/308868272_Role_of_dressings_in_pressure_ulcer_prevention%0Ahttp://www.woundsinternational.com/wuwhs/view/consensus-document-role-of-dressings-in-pressure-ulcer-prevention%0Ahttp://www.wuwhs2016.com/files/WUWHS_PUP_cons
6. Zhao, N., Tian, Z., Li, Y., Yu, H., & Yang, Y. (2021). Virtual Reality-Based Analysis of Pressure Ulcer Care Information Related to Medical Equipment for the Prevention of Pressure Ulcer Skin Foam Dressings in the Elderly. Journal of Healthcare Engineering, 2021.
https://doi.org/10.1155/2021/6389001

Copyright 2022 Rima Hanifati, Gatot Soebroto, Indonesia Army Central Hospital, Jakarta, Indonesia. Email: hanifatirima@gmail.com. Telp: +6281280581391