The effectiveness of dalethyne dressings for reducing bacteria in diabetic foot ulcers

Objective: This study evaluates the effectiveness of a dalethyne dressing for decreasing bacteria in diabetic patients with infected foot ulcers. Methods: This study was conducted from March to September 2018 with a sample of 30 par ticipants from the outpatient Kitamura Wound Clinic in Pontianak City, Indonesia. A quasi-experimental non-equivalent pretest–posttest control group design was used for the study. Participants were divided into two groups: an intervention group (treated with a dalethyne dressing) and a control group (treated with a standard dressing). Two trained research assistants collected the data using the Wagner wound classification system and a bacteria counter. The assistants swabbed each wound surface with sterile cotton, and the swabs were used to conduct a bacteria culture and count. Results: The study population was 50％ female and 50％ male with no significant differences between each other in age, HbA1c, blood pressure, or ankle-brachial index (ABI; P > 0.05). Both groups had a significant reduction in the number of bacteria from the pretest to posttest (P < 0.05). Mann–Whitney analysis of posttest data indicated a significant difference in bacteria reduction between the control group (median = 2.25) and the intervention group (median = 7.6; P = 0.018). It was noted that Staphylococcus aureus was found in the control group at posttest, but not in the intervention group. Conclusions: This study provides evidence that a dalethyne dressing is effective for killing S. aureus in the infected foot ulcers of diabetic patients.     

Prevalence and risk factors for herpes simplex virus type 2 antibodies among low- and high-risk populations in Indonesia

OBJECTIVES/GOAL: Data on prevalence of herpes simplex virus type 2 (HSV-2) infections are limited in Asia. This study investigated the seroprevalence of, and risk factors for, antibodies to HSV-2 among low- and high-risk, predominantly asymptomatic populations in Indonesia. STUDY DESIGN: We screened women attending maternal and child health, obstetric, gynecology, and sexually transmitted infection (STI) clinics; men attending STI clinics; and female sex workers (FSWs) for type-specific HSV-2 antibodies using the HerpesSelect 2 enzyme-linked immunosorbent assay IgG and Western blot. RESULTS: HSV-2 antibodies were detected in 153 of 176 FSWs (86.9%; 95% confidence interval [CI], 81.0-91.5); increasing age was the only significant independent risk factor (odds ratio [OR], 1.15; 95% CI, 1.06-1.24; P = 0.001). Among non-sex worker females, HSV-2 antibodies were detected in 78 of 418 (18.7%; 95% CI, 15.0-22.7); significant independent associations were any contraceptive use (OR, 2.24, 95% CI = 1.33-3.85, P = 0.003), symptoms or signs of genital ulcer (OR, 2.69; 95% CI, 1.27-5.70; P = 0.01) and younger age of sexual debut (OR, 0.92; 95% CI, 0.86-0.99; P = 0.03). HSV-2 antibodies were detected in 25 of 116 men (21.6%; 95% CI, 14.5-30.1). CONCLUSIONS: HSV-2 seroprevalence reported here is in the upper range of that reported in nearby regions. Health promotion is needed to encourage affected individuals to recognize symptoms of genital herpes and seek care and advice on reducing transmission. The high seroprevalence among FSWs has potentially serious implications for the HIV epidemic in Indonesia.     

Risk factors in the development of pressure ulcers in an intensive care unit in Pontianak, Indonesia

The purpose of this study was to identify risk factors associated with the presence of pressure ulcer development in adult patients at an intensive care unit hospital in Indonesia. The prospective cohort design was conducted in this study. A total of 105 patients participated and a pressure ulcer developed in 35 patients. The initial analysis identified several variables as significant risk factors for pressure ulcer development (interface pressure, fecal incontinence, skin moisture, diastolic blood pressure, smoking and body temperature). However, when entered into a final multivariate analysis, four factors, interface pressure [odds ratio (OR) 17.6, 95% confidence interval (CI) 4.1, 74.3], skin moisture (OR 8.2, 95% CI 2.2, 30.9), smoking (12.7, 95% CI 2.8, 56.7) and body temperature (OR 102.0, 95% CI 7.7, 98.8) were found to be significant. The results suggest that interface pressure measured using a multipad pressure evaluator, skin moisture measured by a moisture checker, thermometer for body temperature and smoking status are adequate instruments for the prediction of pressure ulcer development.     

Evaluation of validity of the new diabetic foot ulcer assessment scale in Indonesia

We developed a new assessment tool for diabetic foot ulcers because no such tool specifically for diabetic foot ulcer exists. The diabetic foot ulcer assessment scale (DFUAS) has 11 domain items. The minimum and maximum scores on this scale are 0 and 98, respectively; higher scores indicate more severe wounds. The aim of this study was to evaluate the concurrent validity, construct validity and predictive validity of DFUAS in Indonesia. A prospective cohort study was conducted on patients with diabetic foot ulcer at Kitamura wound clinic in Indonesia. A total of 62 patients with 70 diabetic foot ulcers were assessed with DFUAS tool, Bates‐Jensen wound assessment tool (BWAT), and pressure ulcer scale for healing (PUSH). Concurrent validity was determined by correlation of the DFUAS total score with the external criterion (BWAT, PUSH, and wound surface area). A comparison between the total DFUAS score and chronic wound status was made to determine construct validity. We also analyzed 41 wounds that were followed for 4 weeks to evaluate predictive validity. The correlation coefficient total scores of the DFUAS against the BWAT, PUSH, and wound surface area were 0.92, 0.87, and 0.82, respectively. The comparison of the total DFUAS score with chronic wound status was p < 0.001. The predictive validity test indicated that a DFUAS cutoff score of 12 produced the best balance of sensitivity, specificity, positive predictive value, and negative predictive value (89%, 71%, 86%, and 77%, respectively). In conclusion, the newly developed DFUAS is a valid tool for assessing diabetic foot ulcers.     

Relationship between maceration and wound healing on diabetic foot ulcers in Indonesia: a prospective study

The aim of this study was to clarify the relationship between maceration and wound healing. A prospective longitudinal design was used in this study. The wound condition determined the type of dressings used and the dressing change frequency. A total of 62 participants with diabetic foot ulcers (70 wounds) were divided into two groups: non‐macerated (n = 52) and macerated wounds (n = 18). Each group was evaluated weekly using the Bates–Jensen Wound Assessment Tool, with follow‐ups until week 4. The Mann–Whitney U test showed that the changes in the wound area in week 1 were faster in the non‐macerated group than the macerated group (P = 0·02). The Pearson correlation analysis showed a moderate correlation between maceration and wound healing from enrolment until week 4 (P = 0·002). After week 4, the Kaplan–Meier analysis showed that the non‐macerated wounds healed significantly faster than the macerated wounds (log‐rank test = 19·378, P = 0·000). The Cox regression analysis confirmed that maceration was a significant and independent predictor of wound healing in this study (adjusted hazard ratio, 0·324; 95% CI, 0·131–0·799; P = 0·014). The results of this study demonstrated that there is a relationship between maceration and wound healing. Changes in the wound area can help predict the healing of wounds with maceration in clinical settings.     

Validity of DMIST for monitoring healing of diabetic foot ulcers

A new diabetic foot evaluation scale was proposed, using the seven domains of depth, maceration, inflammation/infection, size, tissue type of the wound bed, type of wound edge, and tunneling/undermining. This scale was named “DMIST” as an acronym from the initials of the domains. The purpose of this study was to evaluate the validity of DMIST. Secondary analysis was conducted in three investigations performed using the diabetic foot ulcer assessment scale (DFUAS) in Japan and Indonesia. Secondary analysis was assessed using DMIST, PUSH, and DESIGN for 4 weeks based on DFUAS score and photographs of diabetic foot ulcers by researchers. Concurrent validity was determined from the correlation of total DMIST scores with PUSH and DESIGN scores. Construct validity was determined by comparisons between total DMIST score and grade of the Wagner classification. Predictive validity was determined by receiver operating characteristic curve analysis for wound non‐healing 4 weeks later. Subjects comprised 35 Japanese patients and 118 Indonesian patients. Correlations of total DMIST score with PUSH and DESIGN scores were 0.831 and 0.822, respectively. Comparison of total DMIST scores with grade of the Wagner classification (Grade I vs. Grade II/III vs. Grade IV/V) was p < 0.001. Based on an area under the curve of 0.872, a DMIST score of 9 was selected as a cut‐off, offering sensitivity of 0.855 and specificity of 0.786 for wound non‐healing 4 weeks later. Our findings suggest that DMIST offers high validity.     

Relationship between items of DMIST and healing of diabetic foot ulcers

A monitoring tool for the wound-healing process of diabetic foot ulcers (DFUs) was developed. It comprises seven domains, namely, depth, maceration, inflammation/infection, size, tissue type of the wound bed, type of wound edge, and tunnelling/undermining. It was named “DMIST” based on the initials of its domains. Although DMIST is useful for assessing wound-healing processes, the monitoring items related to wound healing remain unclear, thereby making the selection of optimal care based on the assessment difficult. We identified the relationship between the DMIST items and wound healing. This study was a secondary analysis of five previous investigations and was conducted using DMIST based on the diabetic foot ulcer assessment scale score and DFU images. Multivariate logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (95% CIs) after simultaneously controlling for potential confounders. The examined DFU healing status revealed that some DFUs healed at 4 weeks from baseline, whereas some DFUs did not. Variables considered in the models were the scores of each DMIST domain. The study population comprised 146 Indonesian patients and 33 Japanese patients. Depth, maceration, and size were associated with DFU healing at 4 weeks from baseline [depth: OR = 0.317 (95% CI: 0.145-0.693, P = 0.004); maceration: OR = 0.445 (95% CI: 0.221-0.896, P = 0.023); size: OR = 0.623 (95% CI: 0.451-0.862, P = 0.004)]. Our findings suggest that appropriate management of maceration promotes DFU healing.     

Development of a new risk assessment scale for predicting pressure ulcers in an intensive care unit

Aims and objectives: The study aimed to evaluate the predictive validity and accuracy of a new pressure ulcer risk assessment scale in two Indonesia intensive care units (ICUs). Background: Several risk assessment scales have been designed to identify patients at risk of developing pressure ulcers in ICU. However, the relative weight of each variable that contributes to pressure ulcer development in these scales is not described to enable designing of a risk assessment scale. Currently, the risk factors contributing to pressure ulcer development include interface pressure, body temperature and cigarette smoking. Design: A prospective cohort study was conducted in two ICUs in Pontianak, Indonesia. Methods: A total of 253 patients were recruited to the study from both hospitals. Data collection included new risk assessment scale [i.e. the Suriadi and Sanada (S.S.) scale] scoring, demographic, pressure ulcer severity scores (based on the National Pressure Ulcer Advisory Panel) and skin condition measures. Using the S.S. scale, trained data collectors scored patients once and assessed the body temperature daily until patients were discharged. Additionally, daily data were also collected in relation to the patient‘s skin condition and stage of pressure ulcer. Results: Out of the 253 patients, 72 (28·4%) developed pressure ulcers. In ICU A, the incidence was 27%; pressure ulcers developed into stage I (41·7%), stage II (45·8%), stage III (10·4%) and stage IV (2·1%). In ICU B, the incidence was 31·6%; the development of pressure ulcers was 48% in stage I and 52% in stage II. Using the predictive validity test, the S.S. scale balanced sensitivity (81%) and specificity (83%) at a cut‐off score of 4. The area under the receiver‐operating characteristic curve was 0·888 (confidence interval: 0·84–0·93). Conclusion: The S.S. scale was found to be a valid risk assessment tool to identify the patients at risk of developing pressure ulcers in Indonesia ICU.     

A new instrument for predicting pressure ulcer risk in an intensive care unit

The purpose of this study was to assess the utility of two instruments (the Braden scale and a multi-pad pressure evaluator) for predicting pressure ulcer development. A prospective cohort design was used and 105 intensive care unit patients participated in this study. The result was a 33% incidence of pressure ulcers. Both the Braden score and the multi-pad pressure evaluator instruments gave significant differences between patients who did and did not develop pressure ulcers. The predictive validity of these tools was calculated. The results indicated that the multi-pad pressure evaluator provided the best balance between sensitivity and specificity. We suggest that the multi-pad pressure evaluator may be better suited for assessing the risk of pressure ulcers in intensive care units.