Understanding Deep Tissue Injury

A deep tissue injury (DTI) is commonly mistaken for a stage 1 pressure ulcer or a bruise. This is a serious error and can have a profound impact on patient outcomes, liability, and reimbursement.

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What is a deep tissue injury (DTI)?

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Deeper, full-thickness damage to underlying tissue which may appear as purple areas or dark necrotic tissue should not be confused with Stage 1 pressure ulcers. The National Pressure Ulcer Advisory Panel has defined wounds such as these as;

A pressure-related injury to subcutaneous tissue under intact skin. Initially, these lesions have the appearance of a deep bruise (NPUAP, 2002).

DTI's require rapid identification, as they may quickly progress to Stage 3 and 4 pressure ulcers despite aggressive and optimal treatment.

How do DTI's form?

Fleck (2007) explains that DTI's form over areas of bony prominence and occur from the inside out. Superficial damage is not seen until later, when tissue undergoes necrosis, reaching the outer layer of skin and resulting in the formation of an external wound. She further stresses that DTI's can be differentiated from Stage 1 ulcers by their rapid deterioration despite proper care.

What are the legal implications of DTI's?

DTI's that are not recognized for what they are can have legal implications due to their ability to deteriorate despite stringent wound management practices. They result in increased costs and hospitalization, not to mention pain and suffering for the patient who develops one of these wounds, putting the health care practitioner and the facility at risk for litigation.

Salcido (2008) discusses the current Medicare changes that are scheduled to take effect October 1, 2008. These changes will have a huge impact on how hospitals are reimbursed. In regards to wound care, pressure ulcers will be considered hospital acquired (and therefore not reimbursed) unless these wounds are documented within 48 hours of admission. The onus is now on us, as healthcare professionals, to ensure that these wounds never develop, and if they do, they should be well documented and aggressively treated. This new policy is forcing us to examine our wound care management practices.

Documentation of DTI's

Wounds that are suspected as being a DTI should be afforded a full description and the word -DTI- should be mentioned. For those practitioners who work in long-term care with the Minimum Data Set (MDS) documentation system, the word -unstageable- should be used to describe those wounds that are suspicious for DTI. Thorough and ongoing documentation is crucial in respect to DTI's, as their rapid deterioration may make these wounds particularly tempting targets for litigation.

Education is the key to recognition and management of DTI's

Understanding the etiology of DTI's and learning how to differentiate these wounds from bruises, hematomas, and other closed wounds that may have a similar appearance is the key to prevention and treatment of these wounds, which have the potential for significant morbidity for patients, as well as being potentially litigious.

Understanding Deep Tissue Injury

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Understanding The Purpose Of The Water Softener System

More and more people are choosing to install home water softeners in their homes and offices but what are the benefits and how do they work?

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Water softeners are designed to remove calcium and magnesium from the water supply where it enters the house, by a process of reverse osmosis, sometimes referred to as ion exchange. The hard water enters a series of resin filters in the water softener system containing tiny polymeric beads which are specially formulated to enable them to be charged with sodium ions. As the hard water filters through the water softener the ions of calcium and magnesium are exchanged for sodium ions. Sodium, better known of course as salt, is highly soluble, unlike calcium, and is able to remain in solution whilst in your home water system and not be deposited in the form of lime scale and scum as is the case with untreated hard water. Once the resin filters have exchanged all their sodium charged ions for calcium and magnesium ions it is a simple matter to recharge the water filter by flushing it through with a salt water solution. Home water softeners come in a variety of sizes so it is a simple process to obtain one which is the correct capacity for your needs.

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An alternative to a home water softener are the various water conditioners. These are usually electrostatic or electromagnetic devices which work by introducing an electric charge to the water supply as it enters the house. This encourages the formation of crystals within the water to which, when heated, the calcium particles will attach themselves instead of to the pipe work or other metalwork. Whilst generally low in price and easy to install they are not as efficient as a water softener system and have fewer health benefits.

One of the more popular choices of water filter in the U.S is the Fleck 5600 electronic on demand water softener system. Costing between 0 and 0, according to capacity, they typically come with free shipping and will recoup their cost within a few years.

One of the first things most people notice after fitting a water softening system is the reduction in cleaning time spent on taps, showers, basins, just about everywhere that is touched by water. Not only will you spend a fraction of your previous amount on cleaning products and other harsh chemicals but your new soft water will 'lather up' much more than before allowing you to also save on household soaps, shampoo and even clothes washing products. By eliminating the build up of lime scale in your pipe work, radiators and central heating boiler, enabling them to operate more efficiently, you will not only save money on heating bills but you will prolong the lifespan of these units.

Water treatment can also have health benefits. By using less soaps and shampoo you will notice how much softer your skin and hair will feel without the need for expensive moisturizers and conditioners. Water softeners also have beneficial effects for Eczema and Psoriasis sufferers. In addition to greatly reducing the amount of harsh, drying, soaps and shampoos used, studies in the U.K, Japan and Spain suggest that the incidence of Eczema and Psoriasis in hard water areas can be as much as 50% higher than in soft water areas.

Less obvious is the beneficial effects the fitting of a home water softener system can have on the environment. By drastically reducing the amount of chemicals you use in both personal hygiene and cleaning products you will not only save yourself money but you will be producing far less waste water containing such harmful materials.

Whilst there are no limits set in the national primary or secondary drinking water regulations on sodium levels in drinking water some people may wish to have a separate supply of non softened water for use should they be on a low sodium diet. However this should not stop them from enjoying the overwhelming benefits of home water softeners.

Easy to install and maintain, the many health and financial benefits of a good water softener system will quickly repay the initial outlay, making this one of the most cost-effective improvements you can make to your home.

Understanding The Purpose Of The Water Softener System

FLECK WATER SOFTENER