Given our commitment to the prevention of pressure injuries, at Action Products we took note of an important case study from the Rehabilitation Hospital of Indiana (as reported in Wound Care Advisor.)

The case study, authored by Todd Zortman, RN, WCC, and James Malec, PhD, of Rehabilitation Hospital of Indiana, demonstrates how two new technologies (infrared scanning and noncontact low-frequency ultrasound) can be used to identify and resolve deep tissue injuries (DTI) even in high-risk patients. Below is a brief summary of the case study.

Part 1: Detection using infrared scanning. During the inpatient rehabilitation admission assessment of patient, the clinician, in addition to inspecting J’s skin closely, used a digital infrared scanner on high-risk areas (heels, ischial tuberosities, sacrum, hips). The imaging revealed a “cold” spot (compared to adjacent tissue) on the right upper buttock (although no visible changes on the skin surface were apparent to the naked eye).

Part 2: Stimulation with noncontact, low-frequency ultrasound (NLFU) and simultaneous application of a saline mist (to disrupt biofilm, reduce bacteria and inflammation, enhance blood flow, and stimulate release of growth factors.) Mist therapy was repeated twice per day, with each treatment lasing six minutes.

Findings: After three days, repeat infrared imaging found no signs of DTI.

“At Rehabilitation Hospital of Indiana, we are in the process of developing a protocol for routine infrared scanning of high-risk areas in patients with mobility impairments,” authors Todd Zortman, RN, WCC, and James Malec, PhD explain.  “This type of protocol should also help determine the frequency of occult DTIs and whether, with early intervention, rates of pressure ulcers and re-hospitalization due to DTI can be reduced over a consecutive series of patients.”

An advanced deep tissue injury (DTI), is defined by the National Pressure Ulcer Advisory Panel as “a pressure-related injury to subcutaneous tissues under intact skin.” These injuries can happen beforehand and are not always apparent upon a patient’s admission to the hospital, pre-existing DTIs can be blamed on the health care facility.

In the perioperative setting, with prolonged immobilization of the patient, moisture, pressure, friction and shearing force, a DTI can be exacerbated, as researchers report in the Journal of Long-Term Effects of Medical Implants.   

Many complications caused by pressure injuries occur with injuries in stage III and IV, Wound Care Advisor points out.