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H - Skin Integrity

Skin Integrity | Body Structure and Function J Hsieh, MSc; DL Wolfe, PhD; E Nussbaum, PhD; H Flett, MSc; C Craven, MD; and the E-Scan Investigative Team Maintaining skin integrity after spinal cord injury (SCI) involves the prevention and management of pressure ulcers in areas of the body where sensation is often diminished or absent. A pressure ulcer is a localized injury to the skin and/or underlying tissue (e.g., deep tissue), typically over a bony prominence (Figure 1.0). It is caused by pressure, or pressure in combination with shear and/or friction, moisture and a variety of other contributing factors. Pressure ulcers often result in functional limitations and disruption of an individual’s life. In addition, re-hospitalization, significant fluid and protein loss and, in severe cases, osteomyelitis, myonecrosis, necrotizing fascitis, sepsis and death can result from untreated pressure ulcers. As there is a 95% lifelong pressure ulcer prevalence rate for individuals with SCI, rehabilitation plays a critical role in maintaining skin integrity and overall health. Figure 1.0 Comon Presure Ulcer Risk Areas. Used with permision from the Spinal Cord Injury University (SCI-U) Website.1 Although prevention and implementation of evidence-based best practices can reduce costs associated with treating pressure ulcers by 90%,2,3 annual incidence and prevalence rates among individuals with SCI remain high at 30%.4,5 Current Practice: Prevention and Management of Pressure Ulcers Post-SCI Facilitating skin integrity in a rehabilitation setting requires coordinated interprofessional care by assistive device authorized personnel - case coordinators/managers, dietitians, doctors (family, hospitalist, physiatrist, plastic surgeon, infectious disease specialist), nurses (registered, registered nursing assistant/registered practical, advanced practice), occupational therapists (OTs), physiotherapists (PTs), pharmacists, social workers, peer support workers and wheelchair vendors - provided in a variety of settings including inpatient and outpatient, transition, rehabilitation and community (Figure 2.0, next page). Although all SCI rehabilitation facilities across Canada provide skin and wound management services, the extent of the services provided varies due to diversity in the interprofessional team makeup, the spectrum of treatments provided, the seven published guidelines and variety of unpublished care pathways. There is a ‘disconnect’ between the available evidence, and the challenges of interprofessional care delivery that often results in care providers reverting to solo practice. Shoulder blades Elbows Tail bone Sit bones Ankles Heels Hips SKIN INTEGRITY | BODY STRUCTURE AND FNUCTION 85


H - Skin Integrity
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