Wounds on the Sacrum: Is it Pressure or Moisture?

Wounds on the Sacrum: Is it
Pressure or Moisture?
Janet M. Davis
MSN, RN, GNP, CWOCN
Disclosure Statement
Janet M. Davis is an employee of
3M™
As a Clinical Wound Care Specialist
in the
Critical and Chronic Care Solutions Division
Objective
The learner will be able to identify the
differences between pressure ulcers
and moisture lesions.
Pressure vs. Moisture
A pressure ulcer is localized injury to
the skin and/or underlying tissue
usually over a bony prominence, as
a result of pressure, or pressure in
combination with shear. A number
of contributing or confounding
factors are also associated
with pressure ulcers; the
significance of these factors is yet
to be elucidated. 2013
Inflammation associated with exposure to
some form(s) of moisture, chemical
irritants, friction
–
Urine
–
Stool
–
Weeping edema (serous or lymph)
–
Febrile episodes
–
Perspiration
–
Exudate
–
Solutions
(with or without erosion and/or secondary
infection)
Moisture Effects
•
•
•
•
↑ permeability sub-q tissue
Inflammation
pH changes
Stratum corneum changes
Friction & Its Effects
• Rubbing against another
• Force resisting motion
between two bodies in
contact as they are moving
relative to one another
(sliding)
Moisture & Friction
• Friction exists at skin surface
• Hydration level of skin-increases friction &
sticking to surface
– High humidity
– Liquid moisture
• Friction may lead to harmful shear stress
IAD
Color
Location
Shape/Border
Appearance
Bright red
erythemalighter tones
Skin folds
-buttocks
-inner thighs
-groin
Poorly demarcated
Glistening due
to serous
exudate
Subtle reddarker tones
Underneath
containment
devices
Irregular
Skin erosions;
secondary
infection
Bright red erythema
Skin folds--buttocks
Poorly demarcated
Glistening due to serous
exudate
Secondary infection
“Mild to Moderate” IAD
Subtle red-darker tones
Skin folds--buttocks
Poorly demarcated
Glistening due to serous
exudate
Secondary infection
“Severe” IAD
Secondary Fungal Infection
Moisture Lesions:
believed to be the
result of top-down
damage caused by
moisture and
associated irritants
(friction) resulting in
partial thickness
injury
Pressure Ulcers:
believed to be the
result of bottom-up
damage caused by
pressure, shear and
associated factors
resulting in partial full thickness injury
Pressure
Ulcer Stages
I
IV
II
Unstageable
III
DTI
Shear
• External force acting on
object or surface parallel
to the slope or to cause
to move along the plane
of contact
Moisture vs.
Pressure
Characteristic
Moisture
Pressure
Frictional forces
++
+/-
Pathophysiology
Top down
Bottom up
Location
BIG, folds
Bony
Color
Red-bright red,
glistening
Maroon – Pink Black
Depth
PT
PT or FT
-
FT +
Pain & itching
Pain & itching
Necrosis
Symptoms
• Cleanse
• Wound cleanser
• Protect
• Alcohol free barrier
film
• Dry - add moisture
• Hydrogel and/or Film
• Wet- contain it
• Absorbent, alginate,
foams, hydrocolloids
• Painful-protect it
• Contact layer, hydrogel
• Infected - treat it
• Silver
•Necrotic - debride it (If appropriate)
•Hydrogel + film
Prevention
• Treat source of moisture
– Urinary v. Fecal incontinence
– Patterns, timing
• Protect skin from exposure
– No-rinse, pH balanced cleanser
– Alcohol-free barrier film or barrier
cream/ointment
– Containment
Treatment
• Treat source of moisture
• Protect skin from exposure
• Denuded/eroded skin
–
–
–
–
Wound cleanser
Alcohol-free barrier film
Containment
AWC dressings
• Secondary infection
– Antifungal-fungus
– Antimicrobial-bacterial
The Bottom Line
References
• Beekman D, Schoonhoven L, Verhaeghe S, Heyneman A, Defloor T. Prevention
and treatment of incontinence-associated dermatitis: literature review. J Adv
Nurs. 2009; 65: 1141-1154.
• Fletcher J. Understanding the differences between moisture lesions and
pressure ulcers. Nurs Times. 2008; 104: 38-41.
• Gray M, Bohacek L, Weir D, Zdanuk J. Moisture vs Pressure: Making sense out
of perineal wounds. JWOCN. 2007; 34:134-142.
• Guy H. The difference between moisture lesions and pressure ulcers. Wounds
Essentials. 2012; 1: 36-44.
• Yates S. Differentiation of moisture lesions and pressure ulcers. Poster
available at: http://www.wounds-uk.com/pdf/cases_10239_82.pdf. Accessed
February 24, 2014.
• Pressure ulcer of moisture-relation skin damage? 2012; February/March.
Monthly spotlight available at:
http://www.mdqio.org/docs/newsletters/spotlight/Monthly_Spotlight_Feb_
March_2012.pdf. Accessed February 24, 2014.