Managing Pressure Injury and Incontinence

associated dermatitis (IAD)

Current updates and recommendations from the 2019 Guideline

Delivered in
National Webinar Pedis Care Malang
2020

Ns. Ahmad Hasyim W, M.Kep, MNg

 Ahmad Hasyim Wibisono
Malang 1 Juli 1986
085646333305 / ahasyimw@gmail.com
Pendidikan
 Sarjana keperawatan Universitas Brawijaya Malang (2009)
 Magister keperawatan medical bedah Universitas Indonesia
(2013)
 Master of nursing in diabetes management and education,
Flinders University Australia (2015)
Pelatihan
 Certified wound care clinician (2012)
 Certified stoma therapist (2012)
Pekerjaan
PROFILE  Dosen program studi ilmu keperawatan FK UB
 Ketua komite keperawatan RS UB (2016-2017)
 Penanggung jawab pedis care center (rumah perawatan luka,
stoma dan edukasi diabetes)
 Trainer nasional program sertifikasi perawatan luka
Organisasi
 Waka Bid Riset Infokom DPD PPNI Kota Malang
 Active member of
ADEA - Australian Diabetes Educators Association
WCET - World Council of Enterosthomal Therapist
InWCCA – Indonesia Wound Care Clinician Association
CONTENTS

Understanding
PI Skin damage
PI: the From concepts
management: Case studies due to PPE/
fundamental to prevention
wound care APD
concepts
UNDERSTANDING PI
 Common terms: pressure ulcer, pressure sore, pressure area, bedsore, decubitus  the latest term:
pressure injury (2016)
 Kerusakan yang terjadi pada kulit atau jaringan di bawahnya yang diakibatkan oleh penekanan terus
menerus, terutama pada area dengan tonjolan tulang
 Complete definition at http://www.npuap.org/national-pressure-ulcer-advisory-panel-npuap-announces-a-change-in-terminology-from-pressure-ulcer-to-pressure-
injury-and-updates-the-stages-of-pressure-injury/
 Correlations between pressure and tissue injury

INTRA-CAPILLARY PRESSURE
TISSUE TOLERANCE-PRESSURE CORRELATION

The extent to which pressure is concentrated over small areas will determine the degree of
ISCHEMIA and STRUCTURAL DAMAGE due to mechanical pressure
RISK FACTORS AND ETIOLOGY
Diseases, nutrition, hydration, age,
Comorbid
perfusion, vascular, incontinence,
conditions
immunity, BMI

Host factors Hematologic Protein, Hb,

(Internal) parameters Leukopenia

Disease-related &
Mobility level
treatment related

Risk factors

Pressure and
surface

Inappropriate
External factors Friction & shear material and
methods

Moisture,
temperature,
hygiene
RECOGNIZING PI

Stage 1 Stage 2 Stage 3 Stage 4 Unstageable Deep Tissue

pressure injury: Pressure Injury: Pressure Injury: Pressure Injury: Pressure Injury: Pressure Injury
Eritema yang kerusakan kulit kerusakan pada sampai penuh tertutup Luka warna gelap
tidak memucat pada lapisan lapisan kedalaman otot, jaringan mati pada jaringan
jika ditekan, epidermis- epidermis- tulang, tendon
pada kulit yg dermis dermis dan dalam tetapi kulit
utuh subkutan masih utuh
P.I STATISTICS
Prevalence study

PI: 6-26% DFU: 11% Venous ulcer: 2,5% Arterial ulcer: 1%

(grade I-IV)

 ASEAN incidence range up to 31,3%, Indonesian:

up to 33,3%
 Darker skin color tend to have higher prevalence
 Emerging contributing factor: increased life
expectancy
 STRATEGIES TO PREVENT P.I
Fundamental principle:
Pressure distribution, and alternation
Skin Care
Routine Monitoring
 Reposition all individuals at risk of, or with existing pressure ulcers, unless contra-
indicated
 Recommended freq: every 2-4 hours,
 Recommended angle: 300-400 lateral, prone if possible
 Avoid positioning the individual on bony prominences with existing Grade 1 PI
 Avoid positioning the individual directly onto medical devices, such as tubes,
drainage systems or other foreign objects

Reposi Support
tioning surface  “Specialized devices for pressure redistribution designed for management of
tissue loads”
 Produces alternating pressure through mechanical means and has the ability to
change its load distribution properties
 Two types: active and reactive
RECOMMENDED POSITIONING

PROBLEM
ACTIVE SUPPORT SURFACE
PRESSURE INJURY + IAD MANAGEMENT
Consists of 3 primary measures

Wound management

●
TIME, or the new DIMES concept
●
Cleansing  Assessment  Wound Bed Preparation
●
Modern Wound Dressing, Adjunctive treatment (topical oxygen, infra red, NPWT, electrical stimulation, etc)

Pressure management  Mechanical offloading & support surface

●
Support surface
●
Position turning schedule
●
Offloading pads

Skin care

●
Skin barriers
●
Moisture management
The DIMES Concept © Ayello 2015

D Devitalized tissue
●
Fokus : membersihkan jaringan mati Action: Debridement
●
Outcome: warna dasar luka merah
I Infection & inflammation control
• Fokus: Pengendalian infeksi, mengurangi inflamasi Action: Antimikrobial
• Outcome: infeksi (-), biofilm (-)

M Moisture balance
• Fokus: Menjaga kelembaban luka Action: Kontrol eksudat, dressing
• Outcome: pertumbuhan jaringan baru (++)

E Epithelial advancement + environment

• Fokus: Menumbuhkan kulit baru Action: Proteksi, wound edge, dressing
• Outcome: Terbentuk kulit baru dari tepi luka
S Support
• Fokus: Support sistemik, knowledge Action: Education, nutrition, fixation
• Outcome: support system +
MODERN WOUND DRESSINGS CAPABILITIES

Wound moisture
Dead tissue removal management Odor control Proliferation enhancement
 CASE STUDY

M Gra Epi
P
1

4
nul thel
ec
atio
ha n
ial
adv r
nic
al
sup
por
anc
em ot
+ t
Epi
ent
Per
e
au
tol
thel
ial
iwo
un
ct
ysi
s
adv
anc
d
ski
io
de
em
ent
n
Bio
n
bri
de
Ed
ge
film S
ma
m car
e
na ki
en ge
t
Per
iwo me n
nt
Inf und
ski Moi c
ect stu
ion
n
Bio re a
co ma
ntr
film
ma na r
ol nag
em
ge
me e
ent nt

Pressure management
 CASE STUDY

Me Gra Epi
P
1

4
ch nul thel
atio
ani
cal n
ial
adv r
+
aut
sup
por
anc
em ot
oly
sis
t
Epi
ent
Per
e
de
thel
ial
iwo
un
ct
bri
de
adv
anc
d
ski
io
me
nt
em
ent
n
Bio
n
Inf
ecti
Ed
ge
film S
ma
on
co
car
e
na ki
ge
ntr
ol
Per
iwo me n
nt
Ex
ud
und
ski Hy c
per
ate n
Bio gra a
ma nul
na
film
ma atio r
ge
me
nag
em
n
con e
nt ent trol

Pressure management
SUMMARY
Optimal healing requirements

Controlled Adequate moisture balance (skin & Systemic support and psychosocial
infection No dead tissue Well managed risk factors wound) well being
 PERSONAL PROTECTIVE EQUIPMENT – skin problem
CRUCIAL POINTS
 Identifying areas at risk: high pressure, low pressure, high moisture, skin friction

1 2 3
PERSONAL PROTECTIVE EQUIPMENT – skin care
1. Applying skin barrier
1 2

Low pressure area High pressure area

Skin barrier : Hydrocolloid atau transparan film
Skin barrier film: swab/spray
PERSONAL PROTECTIVE EQUIPMENT – skin care
2. Removal of skin barrier
Use non alcohol material: water/ tepid water, adhesive remover

3. Skin care after working hours

 Moisturizing & nourishing lotions: Zinc oxide, Hyaluronan, antioxidants
 Skin care supplements: Vit E, Vit C
 Maintain skin pH
Follow up webinar
1. Materi akan dishare di grup WA webinar IAD
2. Sertifikat akan dishare secara bertahap di grup WA webinar IAD
3. Informasi next webinar akan dishare di grup WA webinar IAD
4. Informasi produk dapat request via grup di grup WA webinar IAD, atau kontak
admin grup
Pedis Care Products
Kategori Spesifikasi Contact person
Jasa Perawatan luka modern, perawatan stoma Tubagus +62 813-3377-6889
Oyek +62 822-3213-2136
Foot Screening, foot spa, foot reflexiology, bekam Nurul +62 823-3047-4407
Intan +62 823-0186-6243
Perawat care giver 24 jam, fisioterapi, bidan home care Fistin +62 813-3316-9557
Rental alat kesehatan Rosi +62 815-5599-4688
Intan +62 823-0186-6243
Robby +62 852-3056-0423
Barang Modern wound dressing berbagai merk Rizkha +62 858-8400-4568
Sandal, sepatu diabetes Pandu +62 899-9917-931
Davi +62 822-4444-3565
Manekin luka Suci +62 822-6460-0960
Terapi penunjang wound care: Ozone disinfector, infrared, vascular
doppler
THANK YOU 
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