The Effect of a Pressure Ulcer Prevention Program and the Bowel Management System in Reducing Pressure Ulcer Prevalence in an ICU Setting

Abstract

The Braden score is a reliable predictor of a patient's potential for developing pressure ulcers. Moisture is 1 of 6 indicators considered when calculating a Braden score. Efforts to reduce the effects of moisture and enzymatic activity on skin from incontinent diarrhea have employed various types of nonstandardized and nonapproved approaches. Rigid rectal tubes and catheters designed for other purposes are among the devices being utilized. These devices may put the patient at risk for rectal necrosis and loss of sphincter tone, and their use has produced no demonstrable positive outcomes. Additionally, their use is limited to those patients who are experiencing active diarrhea. The Zassitrade mark Bowel Management System (BMS) developed by Zassi Medical Evolutions, Inc., has produced promising outcomes. While the BMS is useful in managing patients with diarrhea, it can also be used to modify formed stool in patients who have wounds that are likely to become contaminated with incontinent feces, or who are too hemodynamically unstable to turn for lengthy or frequent incontinence care.

Evidence-Based Prevention of Pressure Ulcers in the Intensive Care Unit

“…Indwelling fecal containment devices include products such as the FlexiSeal (ConvaTec Inc), Actiflo (Hollister Global), and Zassi application and use of these devices may prevent pressure ulcers from developing by preventing skin contact with fecal enzymes and moisture. 29 …”

“…5,29 Enzymes in and the pH of fecal matter may act in conjunction with moisture to promote skin maceration and epidermal erosion. Topical skin barriers assist in providing a barrier between moisture and skin; however, frequent cleansing because of diarrhea reduces the effectiveness of the skin barrier.…”

Predictors of Pressure Ulcers in Adult Critical Care Patients

“…Bowel management systems, also called fecal containment devices, were introduced to the clinical market in 2004, after the aforementioned studies were published. In a study by Benoit and Watts, 41 use of these devices in combination with strategies to prevent pressure ulcers decreased the prevalence of pressure ulcers for patients exposed to high levels of moisture from liquid stool incontinence.…”

Massive Gastrointestinal Hemorrhage as a Complication of the Flexi-Seal Fecal Management System

“…20,21 An increasing number of ICUs are using protocols for management of fecal incontinence and are using prediction scores to identify patients at risk for devicerelated pressure ulcers. [22][23][24] Current international pressure guidelines for ulcer prevention acknowledge that use of medical devices is a risk factor but provide no guidance on prevention. The National Pressure Ulcer Advisory Panel states that pressure ulcers are often device related, are unstageable, and should not be classified as partial or full-thickness skin wounds.…”