(EBP-004) Wound Care During the Covid-19 Pandemic, the new reality.  This presentation focuses on Covid and Wound Care, how we are able to still provide continued care for our patients, as well as understanding what affects Covid has on the skin.

Unique Challenges with Covid-19 and Skin Manifestations, treatment and challenges with being able to see and treat patients.


Methods:

To say that these patients present challenges to our best and most evolved nosocomial wound prevention efforts would be an understatement:

- Most critical COVID-19 patients may be too unstable to be physically turned, major factor in unavoidable PIs.

- Nutritional status has been a greater challenge in severe COVID-19 cases than in any other disease process

- Coagulopathies are a key feature of severe COVID-19, with an as yet suspected, but poorly defined link to skin vulnerabilities.

- Further complicating matters, during surges, censuses have often been at an all-time high, and use of agency nursing staff as well

 

 

Results:

Understanding the patients and the increased risk for co-morbid conditions plays a critical role in caring for these patients.

Track NPIAP guidance closely

Implement best practices for skin protection in proned and supine patients

Empower staff with guidance to protect them from occupational Pis

Minimize In-Room time with telemedicine where applicable

Use digital collaborative tools to leverage the expertise of the entire organization. We have a strong and diverse team.

Finally, we must make certain our teams know the many skin manifestations of COVID-19, and that these may mimic PI 

Skin discoloration/injury on non-loaded locations are likely not Pis

Discussion:

PI on anatomical locations under pressure and/or sheer may be considered unavoidable if:

Microvascular occlusions increase non-modifiable risk, superceding preventative interventions 

Multi-system organ dysfunction prevents normal skin resilience to injury and trauma

And/Or evidence-based preventative care is limited by extrinsic factors when our healthcare system is at crisis capacity

Trademarked Items:

References: • Sachdeva, M., Gianotti, R., Shah, M., Lucia, B., Tosi, D., Veraldi, S., ... & Dodiuk-
• Alves, P., Gefen, A., Moura, A., Vaz, A., Ferreira, A., & Beeckman, D. (2020). PRPPE| COVID 19–UPDATE. Prevention of skin lesions caused by personal protective equipment (face masks, respirators, visors, and protection glasses). Associação Portuguesa de Tratamento de Feridas.
• Athtiala et al. Wound Int. 2018 EPUAP, NPIAP, PPPIA: 2019
• EPUAP.org
• Gad, R. P. (2020). Cutaneous manifestations of COVID-19: Report of three cases and a review of literature. Journal of dermatological science.
• Griffiths, M.J.D., et al., Guidelines on the management of acute respiratory distress syndrome. BMJ Open Respir Res, 2019. 6(1): p. e000420. Available from: https://spiral.imperial.ac.uk:8443/bitstream/10044/1/74593/2/Guidelines%20on%20the%20management%20of%20acute%20respiratory%20distress%20syndrome.pdf 3. Papazian, L., et al., Formal guidelines: management of acute respiratory di
• Perrillat, A., Foletti, J. M., Lacagne, A. S., Guyot, L., & Graillon, N. (2020). Facial pressure ulcers in COVID-19 patients undergoing prone positioning: How to prevent an underestimated epidemic?. Journal of stomatology, oral and maxillofacial surgery, 121(4), 42-444.
• Skin Manifestations with COVID-19: The Purple Skin and Toes that you are seeing may not be Deep Tissue Pressure Injury. An NPIAP White Paper
• https://cdn.ymaws.com/npiap.com/resource/resmgr/white_papers/COVID_Skin_Manifestations_An.pdf
• https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19-issues-related-to-wound-care-and-telehealth-management?csi=d5eef537-6c5c-4135-b92c-7df46a8f64de&source=contentShare
• Patient data and photos courtesy of Kersten Reider BSN, RN, CWOCN and Elizabeth McElroy, MSN, RN, CRNP, CWS, CWOCN-AP.
• Tang, J., Li, B., Gong, J., Li, W., & Yang, J. (2020). Challenges in the management of critical ill COVID-19 patients with pressure ulcer. International wound journal,17(5), 1523–1524. https://doi.org/10.1111/iwj.13399
• Tchero, H., Noubou, L., Becsangele, B., Mukisi-Mukaza, M., Retali, G. R., & Rusch, E. (2017). Telemedicine in Diabetic Foot Care: A Systematic Literature Review of Interventions and Meta-analysis of Controlled Trials. The international journal of lower extremity wounds, 16(4), 274–283.
• Kim, H. M., Lowery, J. C., Hamill, J. B., & Wilkins, E.
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• Dobke, M. K., Bhavsar, D., Gosman, A., De Neve, J., & De Neve, B. (2008). Pilot trial of telemedicine as a decision aid for patients with chronic wounds. Telemedicine journal and e-health: the official journal of the American Telemedicine Association, 14(3), 245–249. https://doi.org/10.1089/tmj.2007.0038
• National Pressure Injury Advisory Panel. (2020). Unavoidable Pressure Injury during COVID-19 Pandemic: A Position Paper from the National Pressure Injury Advisory Panel Accessed at: https://cdn.ymaws.com/npiap.com/resource/resmgr/white_papers/Unavoidable_in_COVID_Pandemi.pdf
• Black J, Cuddigan J. Skin Manifestations with COVID-19: The Purple Skin and Toes That You Are Seeing May Not Be Deep Tissue Injury. An NPIAP White Paper 2020. Accessed at: https://cdn.ymaws.com/npiap.com/resource/resmgr/white_papers/COVID_Skin_Manifestations_An.pdf
• European Pressure Ulcer Advisory Panel, National Pressure Injury Advisory Panel, and Pan Pacifc Pressure Injury Advisory Panel, Prevention and Treatment of Pressure Ulcers/Injuries: Clinical Practice Guideline. The International Guideline. Emily Haesler (Ed.). EPUAP-NPIAP-PPPIA: 2019.
• Janet Cuddigan, PhD, RN, FAAN Professor, University of Nebraska Medical Center President, National Pressure Injury Advisory Panel April 2, 2020
• British Journal of Dermatologists Bataille, V., Visconti, A., Murray, B., Bournot, A., Wolf, J., Ourselin, S., ... & Falchi, M. (2020). Diagnostic value of skin manifestation of SARS-CoV-2 infection. medRxiv.
• Young, S., & Fernandez, A. P. (2020). Skin manifestations of COVID-19. Cleveland Clinic journal of medicine.
• Galván Casas, C., Catala, A. C. H. G., Carretero Hernández, G., Rodríguez-Jiménez, P., Fernández-Nieto, D., Rodríguez-Villa Lario, A., ... & García-Gavín, J. (2020). Classification of the cutaneous manifestations of COVID-19: a rapid prospective nationwide consensus study in Spain with 375 cases. British Journal of Dermatology, 183(1), 71-77.
• Sachdeva, M., Gianotti, R., Shah, M., Lucia, B., Tosi, D., Veraldi, S., ... & Dodiuk- Gad, R. P. (2020). Cutaneous manifestations of COVID-19: Report of three cases and a review of literature. Journal of dermatological science.