Simple Solutions for the Rapid Healing of Pressure Injuries

Introduction: Pressure injury is a worldwide problem commonly seen with patients who have limited mobility, incontinence, poor nutrition, and/or limited sensation. In spite of education, prevention, and early interventions, the incidence remains 6% -18.5%.

Prolonged immobility with unrelieved pressure results in pressure injuries. The cost and efficacy of treatments vary widely. Treating a single pressure injury can cost as much as $70,000 USD. This study evaluates the benefit of a simple, low-cost treatment using a modified collagen/glycerine gel (MCG) and a sodium polyacrylate powder (SPP) added to the standard of care.

Methodology: This case series includes ten patients with Stage 2 - 4 pressure injuries (Pan Pacific Pressure Injury Alliance Classification). Management was standardized with the Hospital Kuala Lumpur Pressure Injury Prevention Skin Bundle (PIPSB 2016 2nd Edition) Assessment was done within 8 hours of admission. Wound bed preparation using the TIME concept was initiated with cleansing, desloughing, and debridement. Sodium Polyacrylate 3g packet was mixed with 30cc of sterile water and modified collagen/ glycerine gel was added to the wound bed. Polyurethane foam was used as a secondary dressing. Barrier creams were used on the periwound area when appropriate. The treatment was repeated every 2-3 days. The protocol included frequent repositioning and specialty mattresses. Objective assessment was wound measurement and time to closure.

Results: All 10 cases of pressure injury showed marked improvement with decreased size. The synergistic efficacy of these two products, sodium polyacrylate powder (SPP) and modified collagen/glycerin gel (MCG), initiated the inflammatory phase of healing, effectively controlled exudate, facilitated autolytic debridement, and promoted quality granulation tissue. There were no complications or worsening of the wounds.

Conclusion: The combination of these two products worked synergistically to promote rapid healing. This allowed patients to be discharged home where this same treatment could be continued. Finding an effective, affordable treatment for pressure injuries is significant because of the high morbidity and mortality with these wounds. This cost-effective strategy effectively healed pressure injuries at a faster rate than seen with more expensive and invasive therapies.

References:

• Harries RL, Bosanquet DC, Harding KG.Wound bed preparation: TIME for an update. Int Wound J 2016; 13 (suppl. S3):8–14
• Efficacy of dressings for heavily exuding chronic. Wiegand et al. Chronic Wound Care Management and Research 2015:2
• Elgharably H, Roy S, Khanna S, Abas M, DasGhatak P, Sen C K et al. A Modified Collagen Gel Enhances Healing Outcome in a Pre-Clinical Swine Model of Excisional Wounds. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society. 2013; 21(3):473-481.
• Elgharably H, Ganesh K, Dickerson J, Khanna S, Abas M, Sen CK et al. A Modified Collagen Gel Dressing Promotes Angiogenesis in a Pre-Clinical Swine Model of Chronic Ischemic Wounds. Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society. 2014; 22(6):720-729.
• Stout EI, McKessor A. Glycerin-Based Hydrogel for Infection Control. Advances in Wound Care. 2012; 1(1):48-51.
• Hospital Kuala Lumpur Pressure Injury Prevention Skin Bundle (PIPSB 2014 1st Ed, PIPSB 2016 2nd Ed).