Stop the Pressure Day

This year, Stop the Pressure Day is being held on 17th November. It’s an event launched by the European Pressure Ulcer Advisory Panel (EPUAP), and held on the third Thursday of November every year.

So what’s it all about?

Stop the Pressure day is an initiative designed to bring the problem of pressure ulcers to the attention of healthcare professionals, the general public and policy makers.  

Organisations across Europe highlight this day in a bid to spread awareness, hosting educational activities on the prevention and treatment of pressure ulcers and sending out educational materials.

So we thought it only fitting that we follow suit.

In this article, we’ll look at both pressure ulcers and moisture-associated skin damage (MASD) — including the causes, symptoms and treatment options for these two distinct conditions

MASD and Pressure ulcers: what's the difference?

What is MASD?

MASD involves the inflammation and erosion of the skin due to extended contact with a source of moisture. That might be urine, faeces, sweat, wound exudate, ostomy effluent, mucus or saliva and others.

There are four different categories of MASD:

• Incontinence-associated dermatitis (IAD): This is MASD caused by exposure to urine and or faeces.
• Intertriginous dermatitis: This is MASD caused by skin to skin, or skin to device irritation. Causes include perspiration, friction, and a bacterial or fungal bioburden.
• Periwound moisture-associated dermatitis: This type of wound is caused by fluid leaking from a wound.
• Peristomal moisture-associated dermatitis: MASD around a stoma, due to skin exposure to urine or faeces.

What is a pressure ulcer?

A pressure ulcer involves damage to both the skin and the deeper layer of tissue underneath. Severe pressure ulcers can affect the muscle or bone underneath the skin.

A pressure ulcer is sometimes referred to in layman’s terms as a bedsore or a pressure sore.

What causes MASD and what causes pressure ulcers?Causes of MASD

When skin is exposed to moisture for an extended period of time, the integrity of the skin barrier is compromised. This leads to skin damage, which can quickly worsen as the damaged skin is more susceptible to irritant penetration and further damage from friction.

As we saw above, the source of moisture depends upon the type of MASD a patient has.

Patients most at risk of MASD include individuals with an elevated temperature, abnormal skin pH, a history of atopy and deep body folds; incontinent patients and those with an ostomy are also more susceptible.  

Causes of pressure ulcers

Capillaries transport blood and oxygen to different parts of the body. A pressure ulcer occurs when capillaries are compressed.

Patients most at risk of pressure ulcers include those who are immobile or limited in their movement. You’re also more likely to see it when a patient is thin and frail. And if medical equipment — such as an ankle brace or an oxygen tube — is poorly fitted.

Diagnosing MASD and pressure ulcers correctly

MASD is often misdiagnosed as a pressure ulcer and vice versa. This leads to suboptimal patient care.  So it’s really important to know which signs of skin damage are most associated with one condition or the other.

The location of the skin damage is often a big clue.

Pressure ulcers are most often seen in areas of the body where there’s a bony prominence — a place where there is little or no soft tissue between the skin and the underlying bone.

For example, pressure ulcers may be found at the sacrum, the shoulder blade, the heels, the knees, elbows, the back of the head, the outward curvature of the spine and behind the ears.

In contrast, MASD is most often located around a leaking wound or stoma, around the buttocks (if a patient is incontinent), and in the folds of skin where perspiration tends to gather.

There are other differences you can look out for, as listed here:

How to treat pressure ulcers and how to treat MASD?

Once you’ve determined whether your patient has MASD or a pressure ulcer, you can treat the patient accordingly.

How to prevent and treat pressure ulcers

Here’s what you need to do if you discover that your patient has a pressure ulcer, along with the preventative measures you can take to avoid pressure ulcers from occurring in the first place.

• Regularly inspect the skin of at-risk patients so that any pressure ulcers can be treated quickly
• Regularly reposition patients (at least once every two hours) to prevent pressure build-up
• Use protective pads to cushion bony areas of the body
• Apply appropriate dressings to protect the pressure ulcer and speed up the healing process

How to prevent and treat MASD

Barrier cream should be the first port of call for mild cases of MASD. This helps to protect the skin from moisture and from irritants. Barrier cream can also be used as a preventative treatment.