Diabetic Foot Ulcer Infection Prevention - Essay Example

Diabetic Foot Ulcer Infection Prevention Diabetic foot ulcers continue to be a pervading health dilemma that predominantly leads to amputation (Lavery, Peters, & Armstrong, 2008; Schaper, Apelqvist, & Bakker, 2012). Ulceration was likewise pinpointed as among the most prevalent health conditions that afflicts people reportedly diagnosed with diabetes mellitus (Dorresteijn, Kriegsman, Assendelft, & Valk, 2012). The need to apply the most effective and appropriate intervention continues to be a challenge to health care professionals and seem to stall improvements in diabetic foot care management. Various studies have actually aimed to determine whether increased education for diabetic patients on foot care management would actually contribute to decreased diabetic foot ulcers (Gershater, Pilhammar, Apelqvist, & Alm-Roijer, 2011). In this regard, the aim of the current discourse is to present a review of literature on diabetic foot ulcer infection prevention, specifically aiming to answer this question - does increasing the knowledge about diabetic foot care help decrease the incidence of foot ulcer? - through evaluating the findings of six authoritative secondary sources written on the subject. The study written by Lavery, Peters, & Armstrong (2008) has initially identified risk factors: both systemic and local, which increases preponderance for the development of foot ulcers. Specifically, seven variables were noted to be directly associated with the development of foot ulcers, to wit: “neuropathy, callus, deformity, elevated peak pressure, vascular disease, ill-fitting footwear and penetrating trauma” (Lavery, Peters, & Armstrong, 2008, p. 427). The outcome of foot-ulcers were likewise revealed to be influenced by other factors that included “extent of tissue loss, infection, peripheral arterial disease (PAD) and co-morbidity” (Schaper, Apelqvist, & Bakker, 2012, p. 1869). The role that education plays in preventing foot ulcers have been emphasized in a comprehensive study written by the European Wound Management Association (EWMA) (2010). Their report evaluated and compared diverse studies which focused on non-healing wounds, or initially termed chronic wounds (European Wound Management Association (EWMA), 2010). The paper thereby defined non-healing or chronic wound as “a wound that has not healed for at least 4–6 weeks from its first observation at a trial screening visit” (European Wound Management Association (EWMA), 2010, p. 264). Since there were different types of wound that were apparently identified (diabetic ulcers, venous ulcers, as well as pressure ulcers), the focus of the current review is clearly on diabetic ulcers. Concurrently, relevant issues and concerns regarding providing relevant information to patients, management, diagnostic and therapeutic protocol, as well as factors influencing the outcome of suggested interventions were revealed (European Wound Management Association (EWMA), 2010; Faglia, et al., 2002; Schaper, Apelqvist, & Bakker, 2012). The main concern among the articles evaluated on the subject emphasized that management of diabetic foot ulcers actually require a multi-disciplinary approach (Schaper, Apelqvist, & Bakker, 2012; Lavery, Peters, & Armstrong, 2008). For instance, merely understanding the risk factors or variables associated with the development of foot ulcers was deemed insufficient and virtually ineffective in addressing the dilemma. Most of the interventions that were expounded were reactionary; as opposed to preventive – where education plays a relevant role. Only in the studies written by Dorresteijn, Kriegsman, Assendelft, & Valk (2012) and Lavery, Peters, & Armstrong (2008) did the authors emphasize education as one of the interventions for preventing diabetic ulcers. Accordingly, the authors asserted that “educating people with diabetes about foot care (would potentially) help reduce foot ulcers and amputations” (Dorresteijn, Kriegsman, Assendelft, & Valk, 2012, p. 2). This was corroborated in the study by Lavery, Peters, & Armstrong (2008) who contended that “the importance of foot puncture injuries as pivotal factors in ulcer development suggest that simple preventative and patient education measures may be very effective in reducing this specific pathway” (p.430). The interventions that were proposed in European Wound Management Association (EWMA) (2010) were explicitly disclosed as follows: “the standard treatment of diabetic foot ulcers focuses on offloading and control of infection and ischaemia” (p. 249). On the other hand, the use of percutaneous transluminal angioplasty (PTA), particularly infrapopliteal, in diabetic subjects with ischaemic foot ulcer was deemed effective in preventing amputation and in assisting towards foot revascularization (Faglia, et al., 2002, p. 226). As could be deduced, these interventions were evidently reactionary; meaning, these presupposed that diabetic foot ulcers have already ensued. In fact, statistics revealed by Lavery, Peters, & Armstrong (2008) in their discourse: “recent reports suggest that the incidence of amputation has not significantly changed and, in some regions, may have increased” (p. 425). It could likewise be perceived that since the trend for amputation has allegedly increased, it could therefore be an indication that preventive measures through education have not been totally effective. From the research of Dorresteijn, Kriegsman, Assendelft, & Valk (2012), their assertion that could potentially assist in reducing diabetic foot ulcers and eventual amputation were more closely evaluated since this is study eventually affirmed that there has been insufficient evidence and support that education alone could reduce the indicidence of foot ulcers in diabetic patients. To quote: “this review of high-level studies found that educating people with diabetes about the need to look after their feet seems to improve people’s foot care knowledge and behaviour in the short term. There is insufficient evidence that education alone, without any additional preventive measures, will effectively reduce the occurrence of ulcers and amputations” (Dorresteijn, Kriegsman, Assendelft, & Valk, 2012, p. 2). Therefore, this could be the reason why most health care professionals in this endeavor focus on determining other more effective interventions that should be implemented in conjunction with education, per se. As clearly noted, the education facet would only be beneficial for diabetic patients in the short term. This could be due to the fact that there have been diverse factors which were identified to be contributory to diabetic foot ulcers.Likewise, it was emphasized that “the underlying causes of foot ulcers are usually irreversible and chronically progressive” (Dorresteijn, Kriegsman, Assendelft, & Valk, 2012, p. 2). Even if the patient has been aptly provided with crucial information regarding the nature and extent of the problem for wound management (European Wound Management Association (EWMA), 2010); or the guidelines and tips in foot care, avoiding risks, and proper management, the nature of the disease itself (diabetes mellitus) creates various internal changes that still increase the preponderance for the development of foot ulcers – despite being aptly knowledgeable. In conclusion, the answer to question: does increasing the knowledge about diabetic foot care help decrease the incidence of foot ulcer? – is yes, only in the short term (Dorresteijn, Kriegsman, Assendelft, & Valk, 2012). Education would only provide enough amount of knowledge for foot care management and prevention of incidences for foot ulcers within a short time frame. Increasing education would not effectively assist in preventing diabetic foot ulcers especially when the risk factors or identified variables for the development of foot ulcers evidently exist. Thus, as confirmed in various studies, a more multi-dimensional approach in management and intervention of diabetic foot ulcers are needed for its continued prevention and possibly earmark non-recurrence in the long-run. References Dorresteijn, J., Kriegsman, D., Assendelft, W., & Valk, G. (2012). Patient education for preventing diabetic foot ulceration (Review). The Cochrane Collaboration, 1-50. European Wound Management Association (EWMA). (2010). Outcomes in controlled and comparative studies on nonhealing wounds: recommendations to improve the quality of evidence in wound management. Journal of Wound Care, 19(6), 239-268. Faglia, E., Mantero, M., C. M., Caravaggi, C., De Giglio, R., Pritelli, C., . . . Graziani, L. (2002). Extensive use of peripheral angioplasty, particularly infrapopliteal, in the treatment of ischaemic diabetic foot ulcers: clinical results of a multicentric study of 221 consecutive diabetic subjects. Journal of Internal Medicine, 252, 225–232. Gershater, M., Pilhammar, E., Apelqvist, J., & Alm-Roijer, C. (2011). Patient education for the prevention of diabetic foot ulcers. European Diabetes Nursing, 8(3), 102–107. Lavery, L., Peters, E., & Armstrong, D. (2008). What are the most effective interventions in preventing diabetic foot ulcers? International Wound Journal, 5(3), 425-433. Schaper, N., Apelqvist, J., & Bakker, K. (2012). Reducing lower leg amputations in diabetes: a challenge for patients, healthcare providers and the healthcare system. Diabetologia, 55(7), 1869–1872. Read More