Acute wound Chronic wound

Indonesia at A Glance
Edward Jamalu
Product Management
BELGIUM FEDERATION OF WOUND CARE
OCTOBER 12TH 2010
MARKET SITUATION ON IPA‐IHPA (NON IDA):
VALUE TREND OF FIRST LINE WOUND CARE
Indonesia at A Glance
y Islands
y Wide Range
y Population
y Density
y GDP Average
: 17.508 islands
: 1.904.569 km sq
: 237.556.363 person (More 50% in Java)
: 124 person/ km sq
: $ 3,979/ yr
€ 4,400 € 4,200 € 4,000 Gr. 10.30%
€ 3,800 € 3,600 Gr. 8.28%
€ 3,400 € 3,200 € 3,000 MAT Q2
1
2008
2
2009
3
2010
IPA –IHPA = Indonesian Pharmaceutical Audit – Indonesian Hospital
Pharmaceutical audit. IDA = Indonesian Drugstore Audit. (/1000)
MARKET SITUATION (VALUE):
BASED ON IPA‐IHPA MAT Q2 2010 (NON IDA)
RANK
Q2 10
PROD DESC
1 SELECTED TOTAL
1 BETADINE
MKB
2 DARYANT-TULLE D.V
3 BIOPLACENTON KLB
4 SOFRA-TULLE
S.A
5 MEBO
COM
6 BURNAZIN
D.V
7 MADECASSOL
CRA
8 ISODINE
MKB
9 SANOSKIN OXY IBT
10 CERPLAST
G2P
11 SANOSKIN M.DERM + IBT
12 DERMAZIN
LEK
13 BETADINE FOR KIDS MKB
14 SOLCOSERYL
SLC
VALUE
Q2 10
MS % GR %
MAT Q2 10
VALUE
MS % GR %
MAT Q2 09
MAT Q2 08
VALUE
MS % GR % VALUE
€ 1,172,755 100.00 11.90 € 4,197,567 100.00 10.30 € 3,805,600 100.00 8.28 € 3,514,590
€ 536,080 45.71 15.85 € 1,795,288 42.77 2.65 € 1,748,866 45.96 20.39 € 1,452,642
€ 125,365 10.69 29.94 € 441,121 10.51 -2.09 € 450,557 11.84 60.62 € 280,516
€ 124,431 10.61 -2.98 € 499,273 11.89 0.10 € 498,767 13.11 32.11 € 377,551
€ 101,141 8.62 56.57 € 318,090
7.58 119.90 € 144,650 3.80 -63.79 € 399,460
€ 89,743 7.65 55.75 € 324,295
7.73 39.05 € 233,219 6.13 134.58 € 99,421
€ 64,742 5.52 -32.47 € 247,232
5.89 15.43 € 214,190 5.63 93.94 € 110,442
€ 54,926 4.68 -1.00 € 228,947
5.45 -9.16 € 252,024 6.62 -6.67 € 270,049
€ 26,180 2.23 -43.36 € 146,005
3.48 1.35 € 144,061 3.79 -45.22 € 262,977
€ 16,448 1.40 160.91 € 54,240
1.29 732.92 €
6,512 0.17 999.00 €
€ 11,852 1.01 5.90 € 61,900
1.47 78.58 € 34,663 0.91 581.67 €
5,085
€
8,375 0.71 34.55 € 29,030
0.69 358.96 €
6,325 0.17 999.00 €
€
6,680 0.57 -41.07 € 29,084
0.69 -36.23 € 45,610 1.20 -69.27 € 148,423
€
3,414 0.29 57.02 € 10,777
0.26 -11.07 € 12,119 0.32 -18.77 € 14,919
€
3,378 0.29 -4.62 € 12,285
0.29 -12.48 € 14,037 0.37 -84.92 € 93,106
MAT = Moving Annual Trend
MS = Market Share, GR = Growth Value vs Value Last Year
Classification
yAcute wound
yChronic wound Chronic Wound
y Chronic wound is defined as a break in the skin of long duration, more than 6 weeks or frequent recurrence
y Trapped in an ongoing inflammatory phase
Fowler E. Chronic wounds: an overview. In: Krasner D, editor.
Chronic wound care: a clinical source book for healthcare
professionals. King of Prussia, PA: Health Management Publications,
Inc; 1990. pp. 12‐8.
Assessment & Wound Care
y Jakarta (Cipto Mangunkusumo National General Hospital is An Ideal Model)
y Vascular Surgeon making assessment of wound and consult to Endocrinologist (Diabetic patient), Orthopedic if need amputation, Plastic Surgeon (Skin Graft and flap), Neurologist or Pediatric (as a Team) and nurses take over wound care of patient supervised by Vascular Surgeon
y Big Cities (Surabaya, Medan, Bandung, Makassar, Manado etc)
y Assessment is done by Specialist/ GP‐ER who is caring patient and sometime consult to Plastic or vascular surgeon (as a team) but nurses take over wound care of patient supervised by the doctor
y Small Cities/ Village
Chronic wound
y Common cause y Venous stasis
y Diabetes mellitus y Pressure necrosis
y Ischemia
y Other cause y Malignancy y Vasculitis
y Pyoderma gangrenosum
Nursing Education
y Start from 18 yo (after High School) and take 3 years (Academy)
y Method: Theory lesson and practical/ hands on start from 1st year
y 90% female nurses and 10% male nurses
y Have Nurse Organization/ Union
y Have A Special Organization for nurses that work at Surgeon Room (HIPKABI), under supervised by Indonesian Surgeon Association (PABI)
y HIPKABI gave them Training & Workshop about Wound care, continuously.
y Wound care is done by GP‐ER and Nurses or only nurses
Management of Ulcers
y Wound Care
y Debridement
y Wound cleansing
Management
y Dressings ( Moist)
y Adjuvant therapies
y Pressure reduction
y Or it will not heal
y Risk factors addressed
y Continence care
y Nutritional
improvement
y Mobility
y Consider operative
repair
Basics
Optimize systemic parameters
y Optimize systemic parameters
y Debride nonviable tissue
y Reduce wound bioburden
y Optimize blood flow
y Age: cannot be reversed, usage of y Reduce edema
y Use dressings appropriately
y Use pharmacologic therapy
y Close wounds with grafts/flaps as indicated
growth factors, aggressive optimization of systemic parameters & supplementation.
y Avoidance of ischemia & malnutrition.
y Correction of diabetes
y Avoidance of steroids, alcohol, smoking.
y Avoidance of reperfusion injury: total contact casting, compression therapy.
Debridement & Reduction of Bioburden
Recent Developments
y Surface irrigation with saline.
y Debridement: surgical, enzymatic (papain with urea, collagenase), mechanical (pressurized water jet), autolytic, maggots.
y Antibiotics: cellulitis, decreased rate of healing, increased pain, straw colored oozing from skin, contaminated wounds, mechanical implants.
y Removal of FB.
y Honey Product in leg ulcers.
y Hydrogel in deep 2nd deg burns.
y LASER therapy enhances tissue repair?
y Nitric oxide containing nanoparticles
y Focus on Diabetic Wound
Diabetes in Indonesia y WHO: y 2007: Indonesia is 4th Rank in the world of Diabetic Patient (After USA, India and China)
y 2000 : 8.4 Million Diabetic patient
y 2007: 11 Million Diabetic patient
y 2030: 22 Million Diabetic patient (11% of population)
Treatment of DU:
What Works
Co‐Morbidity in Diabetes
yPeripheral vascular disease occurs in 11% of diabetic patients
yPeripheral neuropathy occurs in 42% of diabetic patients
yPVD is associated with delayed ulcer healing and increased rates of amputation
Pressure Reduction Off DU
y Must surgically debride ulcer to allow healing: the wound edges are dead
y Weekly debridement down to healthy bleeding tissue gives best results
y Must keep pressure off the ulcers to allow healing
Diabetic Gangren
yOrthopedic shoes: drop recurrence rate from 83% to 17%
ySandals
ySplints
yCrutches/wheelchairs
yTotal contact casting
Honey Base Product For Wound Care y Received US Federal Drug Administration approval in 2007
y Anti‐inflammatory and Anti‐bacterial effects without antibiotic resistance
y Promote moist wound healing
y Low pH
y Facilitate debridement
Therapeutic Effects of Honey Dressings
2
4
Reduces
Malodour
Antimicrobial
Antiinflammatory
1
3
Debridement
Pieper B, J Wound Ostomy Continence Nurs 2009; 36(1): 60‐6
6
Scarless
healing
5
Promotes
healing
Pre op IGD 27.3.2010
Female,56th
Blood pressure: !40/100
ABI Right: 1
Left: 0.6
Albumin: 2.8
Post Debri IGD 30.3.2010 Post Re Debri IBP 2.5.2010
Post Re debri IBP 16.4.2010
Post STGS 6.5.2010
Pre Op,March 10th
Female
Blood pressure: 120/80
ABI Right:1.08
Left:1.08
Albumin: 3.0
Post Debridement,March 13th
Post STSG ,March 21th
Pre Op, March 10th Female
Blood pressure: 150/80
ABI Right:0.91
Left:1.0
Post Op March 18th
Post STSG April 15th
First Come
Male
50 yo
Blood pressure: Normal
After 2 weeks Wound Care
After 4 weeks Wound Care
Summary
y Wound Care Management is good enough but Health service and human resources must be improved
y The risk factors must be evaluated by the doctor especially in diabetes patient
y Modern wound care products are being used more and more in modern
wound care (Sanoskin)
Bunaken Sea Park, Manado, North Sulawesi, Indonesia