Dimitri Beeckman

1. Prof. dr. Dimitri Beeckman PhD
University Centre for Nursing and Midwifery
Ghent University, Belgium
European Pressure Ulcer Advisory Panel
Chair of the Scientific Committee
The PuClas3 Project
Progetto PUCLAS III

2. PUCLAS 3 – PROF. D. BEECKMAN, 2014
Category I : Non- blanchable erythema
Category II : Partial thickness skin loss
Category III : Full thickness skin loss
Category IV : Full thickness tissue loss
Cat. 1
Cat. 2
Cat. 3
Cat. 4
INTRODUCTION

3. PUCLAS 3 – PROF. D. BEECKMAN, 2014
T.Defloor - Verplegingswetenschap - Universiteit Gent
3
1
2
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4. PUCLAS 3 – PROF. D. BEECKMAN, 2014
Definition
 A reactive response of the skin to chronic exposure to urine and
faecal material which could be observed as an inflammation and
erythema with or without erosion or denudation
INTRODUCTION

5. PUCLAS 3 – PROF. D. BEECKMAN, 2014
Size of the problem:
 Survey (1911 caregivers)
o 90.4% observed IAD in daily practice
o Confusion about prevention
• IAD is not a pressure ulcer (73.5%)
• … but should be prevented as a
pressure ulcer (61.5%)
INTRODUCTION

6. PUCLAS 3 – PROF. D. BEECKMAN, 2014
Moisture
Urine Faeces Urine/faeces Washing
Ureum/amonium
pH
Bacterial load
Enzym. activity
pH
Bacterial load
Enzym. activity
Ureum/amonium
pH
Bacterial load
Chemical irritation
Physical irritation
+
Skin permeability
pH
Bacterial growth Cutaneous infections
Friction IAD+Weakened skin
ETIOLOGY
Beeckman et al. 2009

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o Skin barrier
 Stratum corneum: enucleate corneocytes with a basket-
weave appearance
 Patterned lipid lamellae in the extracellular spaces
between the corneocytes
 Effective barrier to water loss , however, there is some
NORMAL movement of water through the stratum corneum
into the surrounding atmosphere (TEWL)
 Normal skin: low levels of TEWL
ETIOLOGY

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o Skin barrier
ETIOLOGY

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CLINICAL CHARACTERISTICS

10. PUCLAS 3 – PROF. D. BEECKMAN, 2014
CLINICAL CHARACTERISTICS

11. PUCLAS 3 – PROF. D. BEECKMAN, 2014
IAD Pressure ulcer
1. Cause Moisture (+ friction) Pressure/Shear
2. Location Peri- anal (anal cleft) Bony prominence
3. Shape Diffuse – Kissing ulcer 1 spot
4. Depth Superficial Superfical - deep
5. Necrosis - Possible
6. Edges Diffuse - irregular Distinct edges
7. Colour Redness is not equal Redness is equal
CLINICAL CHARACTERISTICS

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o How to improve skin
inspection?
 Education to improve visual
inspection skills (PuClas3)
 Develop instruments to guide
nurses/clinicians through
differential diagnosis
 Develop and incorporate
technology to aid with
differentiation
DIAGNOSIS: SKIN INSPECTION

13. PUCLAS 3 – PROF. D. BEECKMAN, 2014
HISTORY
Revised version of PuClas2
• Developed in 2005 by an
international working group
• To improve knowledge and skills
about pressure ulcer
classification
• To improve knowledge and skills
about differentiation between
pressure ulcers and skin lesions
caused by urinary and fecal
incontinence

14. PUCLAS 3 – PROF. D. BEECKMAN, 2014
HISTORY
Reliability of
classification
PUCLAS 1
(Defloor & Schoonhoven
2004, Defloor et al. 2006,
Beeckman et al. 2007)
o The identification of the different affected tissue layers is a
complex skill that requires training and time
o Moisture lesions (IAD) and pressure ulcers are often confused
o More training is needed
o Clinical relevant guidelines should be developed

15. PUCLAS 3 – PROF. D. BEECKMAN, 2014
HISTORY
Reliability of
classification
PUCLAS 1
(Defloor & Schoonhoven
2004, Defloor et al. 2006,
Beeckman et al. 2007)
PUCLAS
classification
guideline
o 15 experts
o Identification of the wound
characteristics used by experts
when classifying wounds using
the thinking aloud method
o Causes, Location, Shape,
Depth, Necrosis, Edges, Colour

16. PUCLAS 3 – PROF. D. BEECKMAN, 2014
HISTORY
Reliability of
classification
PUCLAS 1
(Defloor & Schoonhoven
2004, Defloor et al. 2006,
Beeckman et al. 2007)
PUCLAS
classification
guideline
Effect on
classification
skills
(Beeckman et al. 2008
Beeckman et al. 2010)
PUCLAS 2

17. PUCLAS 3 – PROF. D. BEECKMAN, 2014
Gold standard
Normal Skin
Blanchable
Erythema
Cat 1
Cat 2
Cat 3
Cat 4
IAD
IAD + PU
Normal
Skin
Blanchable
Erythema
Cat 1 Cat 2 Cat 3 Cat 4 IAD IAD + PU
Classificationbyparticipants
Pre-test (Experimental)Post-test (Experimental)
HISTORY

18. PUCLAS 3 – PROF. D. BEECKMAN, 2014
HISTORY
Reliability of
classification
PUCLAS 1
(Defloor & Schoonhoven
2004, Defloor et al. 2006,
Beeckman et al. 2007)
PUCLAS
classification
guideline
Effect on
classification
skills
(Beeckman et al. 2008
Beeckman et al. 2010)
PUCLAS 2
EPUAP/NPUAP 2009
Guidelines
o Changes in classification system
o IAD terminology
o Differentiation between pressure
ulcers and IAD

19. PUCLAS 3 – PROF. D. BEECKMAN, 2014
HISTORY
Reliability of
classification
PUCLAS 1
(Defloor & Schoonhoven
2004, Defloor et al. 2006,
Beeckman et al. 2007)
PUCLAS
classification
guideline
Effect on
classification
skills
(Beeckman et al. 2008
Beeckman et al. 2010)
PUCLAS 2
EPUAP/NPUAP 2009
Guidelines

20. PUCLAS 3 – PROF. D. BEECKMAN, 2014
Before After
WHAT’S NEW IN PUCLAS3?

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WHAT’S NEW IN PUCLAS3?
What is new in PuClas3 ...
• Four modules:
• Introduction to pressure ulcers
• Introduction to incontinence- Associated Dermatitis (IAD)
• Pressure ulcer classification
• Differentiation between pressure ulcers and IAD
• Simple, clean and modern design
• High quality photographs
• Assessment modules and certificate
• Separate assessment module including cases and photographs
• Simpler navigation and content separation

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Before After
WHAT’S NEW IN PUCLAS3?

23. PUCLAS 3 – PROF. D. BEECKMAN, 2014
WHAT’S NEW IN PUCLAS3?

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WHAT’S NEW IN PUCLAS3?
Module 1 – Introduction to pressure ulcers
This eLearning module will provide an overview of
pressure ulcers, the aetiology, prevalence and
incidence, impact on patient quality of life and
carers, and basic principles for prevention.

25. PUCLAS 3 – PROF. D. BEECKMAN, 2014
WHAT’S NEW IN PUCLAS3?
Module 2 – Introduction to incontinence- associated
dermatitis (IAD)
This module will provide an introduction to Incontinence-
Associated Dermatitis (IAD), the size and impact of the
problem, aetiology and basic principles for prevention.

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WHAT’S NEW IN PUCLAS3?
Module 3 – Pressure ulcer classification
This eLearning module will provide an overview of the current
Pressure Ulcer Classification System

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WHAT’S NEW IN PUCLAS3?
Module 4 – Differentiation between Incontinence-Associated
Dermatitis (IAD) and Pressure Ulcers
This eLearning module will provide an overview of the clinical
and patient characteristics of IAD versus pressure ulcers and
the importance of making the correct differential diagnosis.

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Introduction of new useful charts e.g. IAD aetiology
WHAT’S NEW IN PUCLAS3?

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Improvements to data visuals
WHAT’S NEW IN PUCLAS3?

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Short summaries to aid knowledge retention, opportunity to provide feedback
and complete a knowledge check.
WHAT’S NEW IN PUCLAS3?

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Interactive knowledge checks including visual assessments
WHAT’S NEW IN PUCLAS3?

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HOW TO USE AND TO GET INVOLVED?
• EPUAP members will get access to content and will be sent a link.
• Access to content will be through a new link, user name and password.
• PuClas3 will allow you to track progress, provide feedback and
complete short knowledge checks.
• Opportunity to contribute and update with additional cases
• Feedback by users
• Translation

33. PUCLAS 3 – PROF. D. BEECKMAN, 2014
WHO MADE THIS INTERNATIONAL PROJECT
POSSIBILE?
• EPUAP and Board of Trustees
• International working group of experts
• Professionals who provided feedback and
photographs (names will be listed in PuClas3)
• Partners who have provided an unrestricted
educational grant for the technical support
(3M Health Care)
• You as a user and improver of the quality of
pressure ulcer care ...

34. PUCLAS 3 – PROF. D. BEECKMAN, 2014
EPUAP 2015
18th
Annual Meeting of the European Pressure Ulcer Advisory Panel
PUTTING THE PRESSURE IN THE HEART OF EUROPE
16 – 18 September 2015, Ghent, Belgium
www.epuap2015.org
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35. PUCLAS 3 – PROF. D. BEECKMAN, 2014
CONTACT
• URL: http://www.epuap.org
• Email: Dimitri.Beeckman@UGent.be