Wound Care in

Bahrain

Ms. Eman AlJahmi, RN, IIWCC

23 Feb 2020
 Aims
1 Provide an aerial view of disease in Bahrain
2 Establishing a thinking of excellence in care
3 Integration initiatives currently in action
4 Initiatives for future
5 How one unit can make a difference
2
 3

The way to look at things

 4

The way to look at things

 5

The way to look at things

Bahrain 2002

2001 – 600 000

Of which 400 000 Bahraini

2015 - 1.2 Million

of which 550 000 Bahraini
6
 2013
39%
Sample slide – section header

7
2014
53%

8
Diabetes mellitus prevalence in Bahrain in 1996
• DM 25.5% -
• Pre-diabetes 14.7%

Diabetic foot complication prevalence in 2007

• Neuropathy 36.6%
• Peripheral vascular disease 11.8%
•
(Alzurba and Algarf 1996)
Foot ulcer 5.9%
(Almahroos and Alroomi 2007)
 We know:

Diabetic foot ulcers affect 12% to 25% of persons with

diabetes mellitus throughout their lives.

Foot ulceration is the precursor to non-traumatic lower

extremity amputations in approximately 85% of cases.
(Singh, et al 2005) 10

(Frykberg, et al 2006)
A huge jump to the future
was made by
implementing advanced
wound care material ,
accurate diagnostic and
treatment modalities in
one tertiary setting.
11
It all started with EDUCATION…………
July 2012 – Stellenbosch University teaching
team to King Hamad University Hospital -
Bahrain
 What were the teaching
needs?
■ Hyperbaric oxygen therapy technical operations
■ Chamber maintenance
■ Chamber safety
■ Hyperbaric patient preparation
■ Transcutaneous oximetry
■ A bit of wound care…..
60 sec Diabetic foot
screening
In 2013 ……

March 2014
 KHUH HBO 2014
Baseline audit

Case series of 76 patients Diabetic Foot

Ulcers of different stages.
52 patients were included for analysis (68%)
25 (48%) were grade 3-4 Wagner Classification
44 (85%) males, 8 (15%) females.
Most in age group of 45-64 years.
All had at least 20 2ATA HBO sessions & standard
wound care
Full healing was achieved in 42 (80.8%) patients. 15

Four (8%) patients had major amputation procedure

- Management of Diabetic Foot Complications by utilizing Hyperbaric Oxygen Therapy(HBOT) within a structured Inter-professional Wound
Care Approach (Abdulaal, Hermosilla and Smart, 2014).
What happened in one wound care unit?
 How Wound Care IS.

Bahrain 2002Bahrain 2015

3

23 17
How Wound Care IS.

18
Dressings in Primary Care

19
Primary Care

20
Secondary Health centres

21
Dressings in Private health clinics

22
Most available dressing types

23
 Needs:
• More nationwide studies to identify
wound related burden as result of disease
• Comprehensive training of wound care
professionals in diabetic foot prevention
and care on all care levels
• Nationwide uptake of 60 sec Diabetic Foot
screening tool
• Integration of all levels of service into a
referral framework
• Interprofessional care teams with
communication network pathways
24
 If we look after
the toe well
this foot may be saved!

25
 RISK ASSESSMENT FOR FOOT
ULCER IN PATIENTS WITH TYPE
2 DIABETES PRESENTING TO
THE ENDOCRINE CLINIC: A
DESCRIPTIVE STUDY.

Eman AlJahmi. RN, MscN, OTT (UAE), IIWCC(ZA).

Research Supervisor: Prof. Seamus
cowman.
 Objective

■ Background & significance of the study.

■ Research aim.
■ Literature.
■ Research methodology (design, sample,
data collection method, data analysis).
■ Results of the study.
■ Implications & recommendations.
Background of the Study

■ Increasing in the referral cases of

Diabetic Foot Ulcer (DFU) to wound
care unit.

■ The ulcer healing process usually

takes a long period and/ or major
intervention such as amputation.

■ Patient centered care: Fear and

anxiety.
Significance of the Study

Contribute to improvement in diabetic foot

care initiatives and patient satisfaction by
early detection of diabetic foot complications
and improve quality of life.
 Aim

 The aim of this study is to determine

the potential for high risk of
developing foot ulcer among diabetic
patients attending an endocrine clinic.
 Literature
■ Diabetic foot ulcer (DFU) is a common complication of Diabetes
mellitus that has shown an increasing trend over previous years (Alavi
et al., 2014).

■ A systematic review study done by Mairghani et al. in 2017 for

prevalence and incidence of diabetic foot ulcers among Arab world
result shows the mean prevalence rates of DFU were highest in Saudi
Arabia and Bahrain and lowest in Iraq.

■ The high risk diabetic foot assessment tool is user friendly and time
efficient, facilitating adoption in routine clinical practice in all settings,
be they high, middle or low income (Woodbury et al., 2015).

■ Previous studies in cost-effective interventions to prevent and control

diabetes agree with estimates that comprehensive and
multidisciplinary foot care leads to cost-savings (Li et al., 2010 and
Ortegon et al., 2004).
 Methodology

■ Design:
A quantitative, descriptive, cross
sectional design.
■ Setting:
An outpatient endocrine clinic in one
major teaching hospital in the
Kingdom of Bahrain.
■ Sample Size:
First 250 participants who met the
inclusion criteria were recruited.
■ Sampling method:
Convenience sampling during their
visit to the clinic.
 Methodology

■Inclusion criteria:
All patients with diabetes type 2 attending
endocrine clinic.
Male and female.
English and Arabic speaker.
Bahraini and non-Bahraini patients.

■Exclusion criteria:
Patient with type 2 diabetes below 18 years
old.
 Methodology
Study Instrument:
The instrument was divided into two parts as
follows:
Part One: Demographic and personal
characteristics.
Part Two: Screening for high risk of developing
diabetic foot ulcer(60-second tool) (Woodbury et al,
2012).

Data Analysis:
■ Descriptive analysis (frequency, percentage,
mean).
■ Inferential statistics (Independent variables T-
test and Chi-Square test were utilized to determine
the statistical significant differences between
 Study Result

The Participants Gender Age of the Participants

(n=250) (n=250)
Mean 55.63
Gender Frequency %

Std. Deviation 12.441

Male 97 38.8

Minimum 23
Female 153 61.2
Maximum 93
 Study Result

History of Type 2 HbA1c Result

Diabetes Mellitus (DM)
Years Frequency % HbA1c % Frequency %
Below 1 19 7.6
year
1-5 48 19.2 6.5% and
Below 30 12.0
6-10 65 26.0
11-15 40 16.0
Above 220 88.0
16-20 40 16.0 6.6%
Above 20 38 15.2 Total 250 100.0
years

Total 250 100.0

Study Result
Risk of Diabetic Foot Ulcer
 Study Result

1- Association of Age with Screening Result

Pearso T.test
Screening
Variables  N Mean SD n Chi- (Sig. 2-
Result
Square tailed)

Negative
58 51.43 13.092
Screening
Age 0.173 0.003
Positive
192 56.90 11.986
Screening
 Study Result
2- Association of HbA1c with Screening Result

Association of HbA1c with Screening Result  

HbA1c Result  

Variables T.test
Media
N Mean SD (Sig. 2-
n
tailed)
Negative
58 7.72 7.50 1.56
Screenin Screening
0.005
g Result Positive
192 8.38 8.20 1.55
Screening
 Study Result

3- Association of HbA1c with Duration of Diabetes

Duration of Diabetes and HbA1c Chi-Square Tests for HbA1c and

Result Duration of Diabetes
HbA1c Result Asymptotic
Variables Controll Uncontro Tests Value DF Significance
ed lled (2-sided)
Below 1 Pearson 33.63
7 12 5 .000
year Chi-Square 7a
1-5 14 34 Likelihood 29.75
Duration 5 .000
6-10 3 62 Ratio 1
of Linear-by-
11-15 3 37 20.85
Diabetes Linear 1 .000
16-20 2 38 3
Association
Above
1 37 N of Valid
20 Years 250
Cases
a. 4 cells (33.3%) have expected
count less than 5. The minimum
 Study Result
Medical History Association with Screening Result
Screening Pearson Chi-
Variables Negative Positive Square p
Screening Screening value
History of No 49 138
Cardiovascular .053
Yes 9 54
Disease
History of No 55 156
.013
Nephropathy Yes 3 36
History of No 51 135
.007
4- Association of Medical Retinopathy Yes 7 57
History of Catheter No 56 182
History with Screening Angiography for No
Yes 34
2 47
10
.583
History
Legs of
Result Hypertension Yes 24 145
.000

History of No 26 53
.013
Dyslipidaemia Yes 32 139
No 56 178
History of Asthma .295
Yes 2 14
History of No 47 159
.755
Hypothyroidism Yes 11 33
History of No 55 190
.049
Hyperthyroidism Yes 3 2
No 54 186
History of Cancer .199
Yes 4 6
No 58 177
History of Obesity .028
Yes 0 15
Implication of Results

Implications for Practice

■ Provide a focus on early detection of any
foot complications. Nurses as a key patient
advocate and are the liaison between the
health services and the patient.

Implication for Education

■ These findings of the study support the
importance and the need to establish an
educational program for patients with
diabetes that address the component of
foot care and proper foot wear.
 Conclusion

■ This study is the first research of its type

conducted in the Kingdom of Bahrain to
determine the scale of high risk of developing
diabetic foot ulcer among patient with diabetes
type 2 in an endocrine clinic and address the
needs of regular screening of diabetic foot and
proper education about foot care.

■ Screening for diabetic foot ulcers in the primary

care setting can lead to good outcomes for
patient and prevent diabetic foot ulcers.
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