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Sugardine Versus Povidine-Iodine in Management of Pressure Ulcers
Sugardine Versus Povidine-Iodine in Management of Pressure Ulcers
e-ISSN: 23201959.p- ISSN: 23201940 Volume 4, Issue 4 Ver. IV (Jul. - Aug. 2015), PP 84-93
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I.
Introduction
The terms decubitus ulcer, bedsore, and pressure ulcer are often used interchangeably. Decubitus,
means "to lie down." Decubitus ulcers therefore, occur at sites overlying bony structures that are prominent
when the person is lying in a recumbent position. These ulcers may occur on the scalp, back, tailbone, hip, heel,
or any other areas to which pressure is applied for long time. Because the common denominator of all such
ulcerations is pressure, the term that best describes this condition is pressure ulcer (Kirman&Vistnes, 2012). The
authors further pointed out that, the prevalence of pressure ulcers in hospitalized patients worldwide has been
reported to be from 14:21% over the last decade. The cost to heal a single full-thickness pressure sore may be as
high as 70,000 dollars every year in each country. The overall annual cost worldwide has recently been
estimated to be between 5 billion and 8.5 billion dollars, with the cost of hospital-acquired pressure ulcers
between 2.2 and 3.6 billion dollars.
Pressure ulcers (PUs) are an important aspect of geriatrics and palliative care that amplifies morbidity
of the chronically bed-ridden patients posing a threat to health-care economy and resources. Helvig, Ritter
&Heinsler(2011) indicated thatPUs can interfere with functional recovery, may be complicated by pain and
infection and can prolong hospital length of stay. Their presence may be a marker of poor overall prognosis and
premature mortality. In 1997, The National Pressure Ulcer Advisory Panel's defined PUs with different staging
system, stage I is an intact skin with non-blanchable redness of a localized area, stage II as shallow open ulcer
with a red pink wound bed without slough (representing partial thickness loss of dermis), stage III as fullthickness tissue loss with visible subcutaneous fat/slough, while stage IV is a full thickness loss with exposed
bone, tendon, or muscles that often includes undermining/tunneling with slough/eschar (Ruth & Bryant, 2012).
Several methods to heal pressure ulcers have been studied for the past four to five millennia. Surgery's
earliest known document on the care of wounds is The Edwin Smith Surgical Papyrus, dated around 1700 BC,
which describes the treatment of a number of difficult wounds encountered on the battlefields of Egypt. Since
then, our knowledge of the physiology of wound healing has been elucidated, but timely and efficient wound
healing has remained somewhat elusive, especially in areas where technology and modern wound care supplies
are limited. However, natural resources have been used extensively for wound care with acceptable results. The
use of sugar for wound healing is one of the earliest known methods. In pre-modern times, the idea that sugar
can facilitate the healing of wounds has been documented. In modern times, the use of sugar as a general
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II.
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Ethical Consideration
Permission to conduct the proposed study was obtained from the hospital authorities of the
governmental Hospital. Prior to the initial interview, the researchers introduced themselves to individual
members who met the inclusion criteria; each potential member was fully informed with the title, purpose and
nature of the study, and then an informed consent was taken from participants who accept to participate in the
study. Following their acceptance to take part, each question was addressed one by one, with the interviewer
explaining any difficulties along the way. The patients were assured about the confidentiality and ethical
principles that would be followed. The researchers emphasized that participation in the study is entirely
voluntary and withdrawal from the study doesn't affect provided care; anonymity and confidentiality were
assured through coding the data.
Procedure
Once the permission was granted to proceed with the proposed study, names of potential patients who
had pressure ulcers, as well as met the criteria for possible inclusion was approached from each involved ward.
Patients were assigned to a study and a control groups (75 patients in each group). Dressing for control group
was done utilizing povidine-iodone, on the other hand sugardine was applied for the study group. Sugardine is a
mix of white granulated sugar with povidine- iodine until a thick mixture have reached (about the consistency of
DOI: 10.9790/1959-04448493
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III.
Results
Table (1): Socio-demographic Characteristics and Medical Data among Total Study Sample (Total=150)
Socio-demographic characteristics
Age:
40-<50
50-<60
60- above
Sex:
Male
Female
Marital Status:
Married
Widow
Divorced
Education:
Illiterate
Read &Write
Primary Education
Secondary Education
University Education
Residence:
Rural
Urban
Income: (LE)
0-500
501-1000
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No
Study Group
%
No
24
33
18
32.0
44.0
24.0
25
33
17
33.4
44.0
22.6
43
32
57.3
42.7
39
36
52.0
48.0
55
16
4
73.3
21.3
5.4
53
17
5
70.7
22.7
6.6
17
14
26
16
2
22.7
18.7
34.7
21.3
2.7
26
22
17
8
2
34.7
29.3
22.7
10.7
2.6
49
26
65.3
34.7
44
31
58.7
41.3
52
23
69.3
30.7
57
18
76.0
24.0
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Control Group
%
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Study Group
%
No
Control Group
%
14
18
22
14
7
18.7
24.0
29.3
18.7
9.3
33
19
14
11
8
30.7
25.3
18.7
14.7
10.6
31
4
9
31
41.3
5.3
12.0
41.4
22
4
11
38
29.3
5.3
14.7
50.7
21
54
28.0
72.0
26
49
34.7
65.3
Study Group
%
No
Control Group
%
4
13
21
24
13
6.386
5.3
17.3
28.0
32.0
17.3
10
23
26
13
3
5.680
13.3
30.7
34.7
17.3
4.0
3
14
21
24
13
6.400
4.0
18.7
28.0
32.0
17.3
1
10
22
26
13
3
5.653
1.3
13.3
29.3
34.7
17.3
4.0
1
6
12
20
22
14
6.306
1.3
8.0
16.0
26.7
29.3
18.7
1
13
19
26
13
3
5.613
1.3
17.3
25.3
34.7
17.3
4.0
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Study Group
No
Control Group
No
3
52
20
2.226
4.0
69.3
26.7
36
39
2.520
48
52
7
65
3
9.3
86.7
4.0
1
35
39
1.3
46.7
52.0
1.946
6
12
50
7
1.853
2.506
8.0
16.0
66.7
9.3
3
33
39
2.480
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4.0
44.0
52.0
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Study Group
No
First Assessment:
Granulation tissues
Slough
Necrotic tissues
Mean
Second Assessment:
Granulation tissues
Slough
Necrotic tissues
Mean
Third Assessment:
Granulation tissues
Slough
Necrotic tissues
Mean
Control Group
No
63
12
3.160
84.0
16.0
52
23
3.306
69.3
30.7
3
59
13
3.133
4.0
78.7
17.3
1
51
23
3.293
1.3
68.0
30.7
12
49
14
3.026
16
65.3
18.7
4
48
23
3.253
5.3
64.0
30.7
Study Group
No
Control Group
No
17
58
22.7
77.3
28
47
37.4
62.6
18
57
24.0
76.0
29
46
38.7
61.3
26
49
34.7
65.3
29
46
38.7
61.3
Table (7): Pressure Ulcer Healing Assessment Data among Total Study Sample
Throughout the three assessments (Total=150)
Intervals of assessments
Woundsize:
First & Second
First & Third
Second & Third
Exudates amount:
First & Second
First & Third
Second & Third
Tissue type:
First & Second
First & Third
Second & Third
Study Group
xSD
T-test
Control Group
xSD
T-test
0.013
0.080
0.093
0.115
0.318
0.373
1.000
2.173
2.162
0.321
0.033*
0.034*
0.026
0.066
0.040
0.162
0.251
0.196
1.424
2.299
1.756
0.159
0.024*
0.083
0.280
0.373
0.093
0.508
0.631
0.681
4.770
5.117
1.186
0.000*
0.000*
0.239
0.013
0.040
0.026
0.115
0.197
0.162
1.000
1.756
1.424
0.321
0.083
0.159
0.026
0.133
0.106
0.230
0.413
0.351
1.000
2.791
2.628
0.321
0.007*
0.010*
0.013
0.053
0.040
0.115
0.226
0.197
1.000
2.042
1.756
0.321
0.045*
0.083
DOI: 10.9790/1959-04448493
x-
SD
T-test
0.706
0.746
0.693
1.522
1.507
1.651
4.019
4.289
3.635
0.000*
0.000*
0.001*
0.293
0.560
0.626
0.693
0.575
0.955
3.665
8.432
5.680
0.000*
0.000*
0.000*
0.146
0.160
0.226
0.537
0.593
0.669
2.363
2.334
2.933
0.021*
0.022*
0.004*
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IV.
Discussion
Pressure sores are complex wounds that result from one or more contributing factors. Stress, time,
spasticity, infection, edema, moisture, and poor nutrition are considered fundamental issues that result in or
contribute to pressure ulcer development. Debilitation and development of pressure ulcer poses a legal liability
risk to healthcare practitioners and hospital managers. In the present study, results regarding Socio-demographic
and related medical data revealed that the highest percentage in both study and control groups were males, aged
from 50 to less than 60 years, married, had low income, as well as residing in rural areas. The majority of them
were unconscious (had either cerebral hemorrhage or cerebro-vascular stroke). Sacrum and heels were the
commonest locations of pressure ulcers with a round or oval shapes. In this regards, Salcido & Lorenzo (2012)
pointed out that pressure ulcers commonly develop on the occiput of geriatric patients who spend extended
amounts of time lying supine. The same authors indicated that elderly patients often have pressure ulcers on the
heel. The incidence in hospitalized patients ranged from 2.7%to 29% respectively. Patients in critical care units
have an increased risk of pressure ulcers, as evidenced by a 33% incidence and 41% prevalence. Elderly patients
admitted to acute care hospitals for non-elective orthopedic procedures, such as hip replacement and treatment
of long bone fractures, are at even greater risk, with a 66% incidence rate.
The present study results were supported by Sarabahi & Tiwari (2012), who found that, more than
60% of pressure sores developed within the hospital wards. One probable source is the increasing geriatric
population requiring hospitalization in whom one third to one half experiences a functional decline. These
results might be due to prolonged contact between the human body and hard objects that result in ischemic
necrosis and pressure sore formation of the intervening tissues.
One study conducted in 2006 on 240
paraplegic patients denoted that more than 50% of pressure sores form at the ischium and sacrum. The same
study also documented the heel, external malleoli, tibial crest, and costal margin as non-pelvic sites susceptible
to pressure sore formation. Such information was virtually duplicated by another study on 2000 paraplegics with
pressure sores, adding only the high incidence of trochanteric sore. Another study from Denmark in 2006,
showed that almost two thirds of pressure sores occurred when patients are in the hospital. Fifty-three percent of
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V.
Conclusion
The present study concluded a significant positive improvement in the total pressure ulcer healing
scores in the study group compared to the total scores in the control group was evident indicating that the
research hypothesis of the current study was supported. In addition, no statistically significant difference was
observed between first and second assessments in the study group in relation to wound size and tissue type.
Moreover, no statistically significant differences were found between the second and third assessments
regarding exudates amount. In the control group, statistically significant differences were found only between
the first and third assessments regarding wound size and tissue type.
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Recommendations
Replication of the study on a larger sample for longer period in different settings as well as on different
patients with various types of ulcers. Further studies comparing sugardine to other evidence-based dressing
modalities to assess its effectiveness and provide a high standard of care.
Health care professionals should provide updated wound care and pressure ulcer management that is
based on scientific guidelines and best practice information. Individuals and organizations who invest in
education in evidence-based management of wounds should reap the benefits of lower financial cost as well as
the satisfaction of knowing that they are providing their patients with the most current, up-to-date management
practices available
References
[1].
[2].
[3].
[4].
[5].
[6].
[7].
[8].
[9].
[10].
[11].
[12].
[13].
[14].
[15].
[16].
[17].
[18].
[19].
Bames, J & Segelman, A., (2008).Sugar treats bedsores better than any antibiotic. Time Magazine/CNN. Life With ALS.com.
Biswas, A., Bharara, M., Hurst, C., Gruessner, R., Armstrong, D., &Rilo, H. (2010). Use of Sugar on the Healing of Diabetic
Ulcers: A Review. Journal of Diabetes Science and Technology. 2010 September; 4(5): 11391145.
Cauble, D. (2010). A Critical Appraisal of Two Measures for Pressure Ulcer Assessment . Southern Online Journal of Nursing
Research, Vol 10 (4). December 2010.
Cohen, P.,R. (2011).Cochrane Database Syst Rev. 2010;1:CD003557). (153-08)
Fitzgerald, K. (2013). Sugar May Help Heal Wounds, Small Trial Underway. Dermatology. 15 Feb 2013 4:00 PST.
Goldsmith, L., (2008). Sugardine as a thrush treatmentOctober 31, 2008 . (EQUEN Ink. COM).
Helvig E, Ritter M, & Heinsler C. (2011).Management of pressure ulcers - What is new? Journal of Mid-life Health. 2011 Jul-Dec;
2(2): 9192
Issue of Clinical Advisor, (2011). www.clinicaladvisor.com/issues. From the July 2011
Kirman, N. &Vistnes, M , (2012). Nonsurgical Treatment of Pressure Ulcers. Medscape References, Jan 11, 2012.
Murandu, M. &Dealey, C., (2012). The use of granulated sugar to treat two pressure ulcers. Wounds International, Vol 1; Issue 1
Case reports
National Pressure Ulcer Advisory Panel and European Pressure Ulcer Advisory Panel. Prevention and Treatment of pressure ulcer s:
Clinical practice guideline. Washington, DC: National Pressure Ulcer Advisory Panel; 2009
Romanelli, M., Clark, M., & Cherry, G. (2012). Science & Practice of Pressure Ulcer Management. (6th ed., .p:37). Springer-Verlag
London Limited Company.
Ruth, D. & Bryant, A. (2012). Acute & Chronic Wounds: Current Management Concepts. (4th ed., p:83). Mosby Company.
Salcido,R. & Lorenzo T. (2012). Pressure Ulcers and Wound Care. January 18, 2012. Cited in img.medscape.com
Sarabahi, S. & Tiwari, WK. (2012). Principles & Practice of Wound Care. (1 st ed., p:318). Ajanta Offset & Packagings Ltd.
Company.
Statistics by country for bedsores (2010). Cited at : www.right diagnosis.com.
Swezey, L. (2008). Evidence-Based Wound Care Vs Traditional Wound Care. August 28, 2008 EzineArticles.com .
The Cochrane Central Register OF Controlled Trials . The use of iodine in medicine Tue, 13.11.2012 02:56. Cited in
http://iodine.kz/en/in_medicine/http://www.yahoo.com/
Wiliam, M.K. (2008). Quasi-Experimental Design. Research Methods Knowledge Base., 2nd Edition. Atomic Dog Publishing,
Cincinnati, OH.
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