Meet Willem Voragen, a Dutch Wound Specialist with more than 28 years of experience in an ICU
Willem Voragen has worked as a nurse for 44 years. In the last 28 years he has worked in the Zuyderland ICU as a wound specialist.
Working in an Intensive Care Unit is a very demanding job. Attention to details and speed in reaction to whatever is that affects the patient’s condition are crucial for their recovery journey. In average, patients can spend between 2 weeks and 4 months in the Intensive Care Unit.
Willem tried throughout his career to find ways to improve the quality of care for his patients by attending national and international congresses for wound specialists either as a keynote speaker or as a participant. In Septemebr 28, at the Decubitus Congress in Kerkrade, Willem presented the results of a study on a new product for incontinece care. His study, stretched over one year, looked at the impact of using Swash® Perineum+ wipes in the management of incontinence-associated dermatitis (IAD). He collected the results of using the new product 35 ICU patients.
I met Willem to discuss more about his job and the way he set-up that study. What makes Willem stand apart as a nurse is his proactive attitude and eagerness to try new ways and better ways to care for his patients. By attending all those events, he aims to stay on top of the latest healthcare developments. He wants to know what are the newest products in the market that could make his life and his patient’s life easier.
“Our profession is still improving all the time. I am always looking for new products that can help us get better results. “, says Willem.
Is there a better way to manage IAD for the patients in intensive care?
In 2021, after an overwhelming corona pandemic year, Willem was committed to finding an easier way to manage incontinence for his patients. That’s when he came across the recording of a Webinar about IAD prevention, organized by Arion. Swash® Perineum+ wipes was presented during that webinar, a product used for cleaning and protecting the skin after an incontinence episode.
What cought Willem’s attention about this product was the fact that Swash® Perineum+ wipes didn’t require any waiting for the product to dry after applying it. The wipes were infused with a lotion made of an innovative combination of ingredients. He thought Swash® Perineum+ wipes could be a good improvement in their incontinence care protocol. After a first discussion with the Swash® team, he decided to start testing the product.
An Incontinence Care product that is easy to apply anywhere and with no drying time? Let’s test it!
Willem decided to initiate a study with the new product shortly after the discussion with the Swash® Product Specialist. He got all the approvals he needed and the consent from the family members of the patient. He explained to his colleagues how to use the new product and how to monitor the progress. Every 3 months Willem had a meeting with the board where he reported on the status.
Patients in Intensive Care Unit have a fragile health condition. Most of them are connected to devices that monitor their vitals. Providing personal care to an ICU patient or cleaning after a bowel movement can be particularly challenging. To make matter worse, the incidence rate of Incontinence-Assciated Dermatitis (IAD) and Decubitus is very high among ICU patients. That’s because they are constantly laying down and their perineal skin is frequently exposed to urine and stool. Using a good barrier cream is crucial for preventing those wounds to develop into pressure-ulcers.
Although the barrier cream Willem and his colleagues were using before testing the new product had good results on the skin, it was very hard to apply it to the inguinal area or to some hairy areas. But the real struggle was the waiting time for the barrier cream to dry. He and his colleagues needed to do a lot of turning and waiting each time after applying the cream.
Willem: “With the previous product we had to wait for 60 to 120 seconds for the cream to dry. 60 seconds might sound like a short time. When you need to hold a patient, with all the tubes connected to his body, for 60 or 120 seconds, each time you apply the barrier cream, it’s not easy. Neither for the patient nor for the nurse. There were situations when we couldn’t hold the patient that long. Then we had to reapply the barrier cream. Other times, the patient would have a diarrhea that washed off the cream. We then had to re-apply the barrier cream. The worst cases were when we had to apply this special cream 8 times in one day! That was expensive.”
Willem collected results for one year, from 35 ICU patients.
“Every 8h we score the IAD. We use the global IAD tool to evaluate the skin. That’s a standard wound protocol. When the skin is damaged, the score of the IAD is 1b or 2b, then we use Perineum+ 4 times a day.”
By applying the product not more than 4 times a day,regardless of the number of incontinence episodes, the wound management cost decreased. Besides that, Willem said he didn’t see the need to use an anti-fungal cream anymore, since just the Perineum+ was already supporting the skin in staying dry. The overall cost of incontinence management decreased by almost 70%.
“The problem is that ICU patients have a higher risk of getting a fungus infection. Because they are so sick, they got a lot of medication and that often causes diarrhea. When the skin is exposed frequently to diarrhea fluid, that makes the IAD get worse. Sometimes there would be also a fungal infection, because fungus love skin moisture. I was looking for a product that could work when the patient has fungal infection. The Perineum+ dries the skin and the fungus dies because it cannot survive if the humidity disappears.”
After seeing the positive results of using Swash® Perineum+ on IAD, Willem and his team implemented a protocol of IAD prevention by applying Swash® Perineum+ two times a day to the newly admitted ICU patients. By using the Perineum+ wipes preventively, they had less cases of IAD development, which was a major achievement for him and his team.
Read a summary of the Zuyderland results
“One of the things we’ve noticed was that we got fewer requests for pain medication. A lot less. In the past, when patients were awake, they were very restless, constantly trying to change position because of the pain. You have to imagine that those wounds on the skin look like chemical burns”.
Saving his patients from going through that unnecessary pain means a lot to Willem. In addition to that, his study brought visible improvements for his deparment. Both in terms on resources efficency and on better patient’s outcomes.
Willem’s story proved that genuine care in healthcare leads to a positive impact not only for the nurses, but also for the patients and on the overall usage of hospital resource.
Do you think your healthcare organization could also benefit from these results?